Tips for dry socket (AO)?

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Angry Birds

Angry Birds

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I've never had a major problem with these, but I just had a patient with which I really struck out. I mean, it was an overall negative patient encounter. I suspect he was an IV drug user and was just an A hole as well, but nonetheless, I did not succeed in relieving his symptoms. I don't know if it's him or if I messed up.

Any tips?
What's the easiest method of dealing with these? I spent way too much time in that room.
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viscous lidocaine soaked gauze has worked well for me before. Then I tell them they need to make sure to put soaked gauze on it all the time.

But with a IVDA YMMV
 
rcheech7 said:
viscous lidocaine soaked gauze has worked well for me before. Then I tell them they need to make sure to put soaked gauze on it all the time.
Click to expand...

Wow, that's incredibly simple.
So, you put a soaked viscous lidocaine gauze and then leave it there, with instructions to put another soaked gauze in its place should that fall out?
 
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Did you try or offer a dental block? I can’t think of anything else appropriate other than Toradol.
 
Angry Birds said:
Wow, that's incredibly simple.
So, you put a soaked viscous lidocaine gauze and then leave it there, with instructions to put another soaked gauze in its place should that fall out?
Click to expand...

Yea that's more or less what dentists do. They take lidocaine putty and stuff it in the hole.
 
RustedFox said:
What does AO stand for in the title?
Click to expand...
Alveolar Osteitis

For treatment, I have done a block if I have time and am being nice. Otherwise, viscous lido soaked gauze, irrigate and make sure there isn't something in the socket, basic dry socket instructions, and refer back to the dentist for f/u and pain management since it is their complication.
 
OK, thank you for all your replies. Here is what I did and why it went badly:

1) I tried to use Cavit Temporary Filling Material to fill the hole. I think this was my mistake, right? Is this only for dental fractures and not for tooth extractions?
I guess the dentists use clove paste... I didn't have any of this. (WTF is a clove?)

2) Anyways, he was rolling all over the place, in pain and rude... I normally don't tolerate such behavior but the realization that I might have used the wrong stuff (not sure?) made me play Mr. Nice Guy. So, I moved to doing an inferior alveolar nerve block, first with Lidocaine and then with Bupivacaine. He was moving around like an idiot while I was doing it but I think I nailed it. He initially said it brought the pain down from a 10 to 5, and he looked completely pain-free to me. But, then he started amping up again and then switched to saying it didn't work at all.

3) Now, I tried to find something to pack the stupid thing with. All I could find in my stupid ER was iodoform packing which did not seem the right width. I irrigated his socket first. By this time, he was demanding to go. I gave him a shot of Toradol on the way out.

Anyway, the whole thing sucked and took up a lot of my time. Mostly, I'm upset I made a mistake.

Putting in a gauze soaked in Viscous Lidocaine seems a helluva lot easier. After this experience, I might even consider giving a slug of Morphine 10 mg IM about twenty minutes before I enter the room... although maybe not for IVDA guy.
 
gamerEMdoc said:
Dental block followed by filling the socket with dry socket paste is usually what I've done in the past.
Click to expand...

cavit-1-28g-jar-44030.jpg




Is this an acceptable dry socket paste? Or is this something else?
 
Antibiotics, something you can accomplish quickly, for pain, "Call ____ dentist at 8:00 am," and bye-bye. You don't need to make it any more complicated than that. Anything more is a waste of everyone's time.
 
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Hmm, I don't know that I've ever wasted time on these. I give them a syringe and tell them to flush out the socket after every meal, Rx some pain meds, abx, +/- chlorhexidine rinse with instructions to f/u with their dentist. Occasionally, I'll do a block. It's just not an emergency. They need a dentist and not only am I not a dentist but there are zero dentists in most emergency rooms. I don't think I've ever bothered to mess with the socket.

It sounds like this guy was being a little bit melodramatic. Did you do a controlled Rx search on him?
 
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Groove said:
Hmm, I don't know that I've ever wasted time on these. I give them a syringe and tell them to flush out the socket after every meal, Rx some pain meds, abx, +/- chlorhexidine rinse with instructions to f/u with their dentist. Occasionally, I'll do a block. It's just not an emergency. They need a dentist and not only am I not a dentist but there are zero dentists in most emergency rooms. I don't think I've ever bothered to mess with the socket.

It sounds like this guy was being a little bit melodramatic. Did you do a CSMD on him?
Click to expand...
This thread has more acronyms I've never seen than most others.

AO, I now understand to mean Alveolar Osteitis (never heard this one before). Now groove is throwing around CSMD. From context I'm guessing this is some sort of controlled substance database? We have one in my neck of the woods but it's called something different.
 
BoardingDoc said:
This thread has more acronyms I've never seen than most others.

AO, I now understand to mean Alveolar Osteitis (never heard this one before). Now groove is throwing around CSMD. From context I'm guessing this is some sort of controlled substance database? We have one in my neck of the woods but it's called something different.
Click to expand...

Google tells me it stands for the "College of Southern Maryland" so perhaps it's how the cool kids ask "did you school him?" :naughty:
 
BoardingDoc said:
This thread has more acronyms I've never seen than most others.

AO, I now understand to mean Alveolar Osteitis (never heard this one before). Now groove is throwing around CSMD. From context I'm guessing this is some sort of controlled substance database? We have one in my neck of the woods but it's called something different.
Click to expand...

LOL, I changed it...yeah it's a controlled drug search database in my state. I forget what it even stand for and that it's different for everybody else. I give a copy to all the drug seekers after I've given them ample time to lie to me about recent Rx.
 
#1 Send the guy back to the dentist that removed the tooth!
#2 Send the guy back to the dentist that removed the tooth!
#3 Eugenol soaked iodafrom gauze placed into the open socket. (No need for a block if you are slick.)
#4 Send the guy back to the dentist that removed the tooth!
 
Angry Birds said:
(WTF is a clove?)
Click to expand...
Clove is a spice (not to be confused with "a clove of garlic or shallots"). Eugenol is what gives clove its spice. Your can get clove Lifesavers (and, fun note - like wintergreen Lifesavers, clove LS will "sparkle" when crunched).
 
As someone who has had dry socket - clove worked wonders. Better than any opiates or anything
 
Saddleshoes said:
Check with your pharmacy.
Oil of clove is an ancient medicament that is used for all kinds of palliative treatments.
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you just rub it on the affected part?

Like if you have sinus pain, you rub it on your cheeks?

Dysuria...rub it on your urethra?

gas pain...drink it or put it up your arse?

I'm gonna look into this
 
Angry Birds said:
2) Anyways, he was rolling all over the place, in pain and rude... I normally don't tolerate such behavior but the realization that I might have used the wrong stuff (not sure?) made me play Mr. Nice Guy.
Click to expand...

On another note, this made me feel much better about life. Glad to know you much more experienced guys still feel unsure about things at times.
 
Mushdoc said:
As someone who has had dry socket - clove worked wonders. Better than any opiates or anything
Click to expand...
Saddleshoes said:
Check with your pharmacy.
Oil of clove is an ancient medicament that is used for all kinds of palliative treatments.
Click to expand...

I can attest to this. Combination of antibiotics and clove oil has done wonders for prior tooth infections with associated severe pain, until I've been able to seek emergency dental care. Haven't used it for dry socket (touch wood I've never experienced dry socket) but if it works half as well as it does for other types of dental pain you're laughing.
 
So, you guys got me so curious about clove oil that I ordered some off amazon to see what all the fuss was about.

It's liquid and came with a dropper. It's some powerful stuff. I grimaced after squirting a bit in my mouth and had to hold on to the sink and wall with my face contorted and trying to spit continuously. It made my tongue and lips go numb for a good 10 minutes. I suppose it's very similar to lidocaine. It gave that same sort of analgesic, numbing effect that you would expect from a local anesthetic. I can definitely see how useful this would be for toothaches or putting a few drops on some gauze and packing the mouth. Powerful stuff! I have no idea what I'm going to do with the rest of the bottle.... Damn you guys.
 
Groove said:
So, you guys got me so curious about clove oil that I ordered some off amazon to see what all the fuss was about.

It's liquid and came with a dropper. It's some powerful stuff. I grimaced after squirting a bit in my mouth and had to hold on to the sink and wall with my face contorted and trying to spit continuously. It made my tongue and lips go numb for a good 10 minutes. I suppose it's very similar to lidocaine. It gave that same sort of analgesic, numbing effect that you would expect from a local anesthetic. I can definitely see how useful this would be for toothaches or putting a few drops on some gauze and packing the mouth. Powerful stuff! I have no idea what I'm going to do with the rest of the bottle.... Damn you guys.
Click to expand...

My dad is a newly retired (Congrats, Old-manFox) dentist.
He knows about this trick, and chuckled when I asked him about it.
"Oil of Clove is back?!"
 
RustedFox said:
My dad is a newly retired (Congrats, Old-manFox) dentist.
He knows about this trick, and chuckled when I asked him about it.
"Oil of Clove is back?!"
Click to expand...

I'm honestly surprised there are people that didn't know about it. I consider it a first aid cupboard staple, always had some on hand since I was kid. I'm 48 now and I've seriously only needed narcotic pain relief* for dental issues 3 times in my entire life, the vast majority of times the antibiotics/oil of cloves combo has done the trick (*and by 'narcotic pain relief' I mean 5-10 mgs of Endone oral, not shoot me up with the entire hospital pharamaceutical supply).
 
Groove said:
So, you guys got me so curious about clove oil that I ordered some off amazon to see what all the fuss was about.

It's liquid and came with a dropper. It's some powerful stuff. I grimaced after squirting a bit in my mouth and had to hold on to the sink and wall with my face contorted and trying to spit continuously. It made my tongue and lips go numb for a good 10 minutes. I suppose it's very similar to lidocaine. It gave that same sort of analgesic, numbing effect that you would expect from a local anesthetic. I can definitely see how useful this would be for toothaches or putting a few drops on some gauze and packing the mouth. Powerful stuff! I have no idea what I'm going to do with the rest of the bottle.... Damn you guys.
Click to expand...

Hmmm... I wonder if I should just buy some and keep it on me for the next dry socket patient.
 
Angry Birds said:
Hmmm... I wonder if I should just buy some and keep it on me for the next dry socket patient.
Click to expand...
Don't let anyone (i.e. nurses) see you with it (ever), but, keep it in your pocket, and let it do its magic.

You may recall Marathon Man, from 1976, when Dr. Szell ("der weisse Engel") is drilling into Babe's tooth, and that is what he uses for relief. (True story: Sir Laurence Olivier, who played Szell, had to do The Boys From Brazil, where he hunted Nazis, to make up, in public image, for playing a Nazi in MM.)
 
RustedFox said:
My dad is a newly retired (Congrats, Old-manFox) dentist.
He knows about this trick, and chuckled when I asked him about it.
"Oil of Clove is back?!"
Click to expand...

Well, I usually forbid myself from amazon shopping after I've taken an ambien for bed but this is what happens when my occasional late night and unauthorized shopping sprees are unfettered. That being said, I was honestly shocked by how well it worked. It just goes to show that Mother Nature has a few remaining remedies that are just as good as most prescriptions.
 
Yes Clove Oil is a little miracle for tooth pain, but you do still need to be careful with it. Excessive and/or long term use can cause burning and inflammation of tissues, and accidental ingestion can cause nausea, diarrhea breathing difficulties & lead to a full blown medical emergency depending on the amount ingested (hashtag 'keep out of reach of children').

My Personal Family Instructions for Use*:

(* I did double check this with some Dental sites & it does match up with instructions given on those, like I said before the use of Clove Oil for toothache is something that's been used in my family for decades)

Perform a saltwater mouth rinse prior to application or reapplication of Clove oil. Not sure why this is necessary, apart from regular salt water rinses also being helpful in terms of dental issues until you can get in for an emergency appointment.

Dip a cotton bud into the oil and gently wipe over affected area, or place a few drops on a cotton wool ball and place onto affected area. Repeat every 2-3 hours as needed. If you need to reapply the oil more often than that it's usually best to chat with a Pharmacist or Dentist to get safe instruction on more frequent use, you should have already spoken to your Dentist anyway.

If using in children, or adult patients who find the undiluted oil to be causing issues such as burning, dilute a few drops of Clove Oil with approximately 1 teaspoon of a carrier oil such as Olive Oil.
 
This and several other "essential oils" make for great tox presentations for mystery case-type things. Enough that you can almost rely upon a sleepy, acidotic kid has swallowed some anachronistic remedy.

Guaranteed to get a few "oooohhhhhh yeah"s.
 
xaelia said:
This and several other "essential oils" make for great tox presentations for mystery case-type things. Enough that you can almost rely upon a sleepy, acidotic kid has swallowed some anachronistic remedy.

Guaranteed to get a few "oooohhhhhh yeah"s.
Click to expand...
It's not "anachronistic" if it is in current use.
 
I had dry socket in the two lower molars when I got my wisdom teeth out at 21. It was horribly painful, and not even hydrocodone touched the pain. I went to the dentist the next day, and he packed it with Cloves and it was immediately better.....to the point that I could eat dinner that night at a restaurant. Definitely it works.
 
Apollyon said:
It's not "anachronistic" if it is in current use.
Click to expand...

Also most bottles of clove oil, at least in Australia, sold through pharmacies contain pretty clear instructions on safe use - like 'keep out of reach of children' 'not to be taken, 'if swallowed seek immediate medical care'. I mean sure there are cases of near fatal outcomes in cases of accidental ingestion by children, but I don't know of a single dentist or pharmacist whose instructions for use of clove oil would include the words, 'swig straight from bottle'.
 
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