Alveolar Osteitis Following Dental Extraction

Etiology and Pathophysiology

Alveolar osteitis, commonly known as "dry socket," is a postoperative complication following tooth removal, most frequently occurring after mandibular third molar extractions. It is characterized by the premature loss of the blood clot from the extraction site, exposing the underlying alveolar bone. The exact cause is multifactorial, but contributing factors include:

• Disruption or dissolution of the blood clot
• Bacterial contamination of the socket
• Trauma to the socket during extraction
• Smoking
• Poor oral hygiene
• Use of oral contraceptives (in some cases)

Clinical Presentation

The condition is typically marked by:

• Intense, throbbing pain at the extraction site, often radiating to the ear or temple
• A foul odor emanating from the socket
• A partially or completely empty tooth socket, sometimes with exposed bone
• Absence of a normal blood clot

Typical Manifestation

Discomfort generally begins one to three days after the dental procedure. This discomfort is significantly more intense than the usual post-extraction pain. The pain can persist for several days if left untreated and may interfere with daily activities.

Diagnosis and Management

Diagnosis is based on clinical examination and patient history. Management focuses on pain relief and promoting healing. Treatment may include:

• Irrigation of the socket to remove debris
• Placement of a medicated dressing in the socket (e.g., containing eugenol or other pain-relieving agents)
• Analgesics (pain medication)
• Antibiotics (rarely, only if secondary infection is present)

Prognosis and Prevention

Alveolar osteitis is a self-limiting condition that typically resolves within 7-10 days with appropriate treatment. Prevention strategies include:

• Following postoperative instructions carefully
• Maintaining good oral hygiene
• Avoiding smoking
• Gentle rinsing of the mouth
• Avoiding strenuous activity immediately after the extraction