Alveolar osteitis, also known as dry socket, is inflammation of the alveolar bone (i.e., the alveolar process of the maxilla or mandible). Classically, this occurs as a postoperative complication of tooth extraction.
Alveolar osteitis usually occurs where the blood clot fails to form or is lost from the socket (i.e., the defect left in the gum when a tooth is taken out). This leaves an empty socket where bone is exposed to the oral cavity, causing a localized alveolar osteitis limited to the lamina dura (i.e., the bone which lines the socket). This specific type is known as dry socket and is associated with increased pain and delayed healing.
Dry socket occurs in 0.5% to 5% of routine dental extractions, and in about 25–30% of extractions of mandibular (lower) wisdom teeth that are impacted (buried in the bone of the lower jaw, erupting during adulthood). Surrounding inflamed soft tissues may overlie the socket and hide the dry socket from casual examination. and may last 10–40 days. This blood clot is replaced with granulation tissue which consists of proliferating fibroblasts and endothelial cells derived from remnants of the periodontal membrane, surrounding alveolar bone and gingival mucosa. The necrotic bone in the socket walls is slowly separated by osteoclasts and fragmentary sequestra may form. The main factors involved in the development of dry socket are discussed below.
Extraction site
Dry sockets more commonly occur in the mandible (lower jaw) than the maxilla (upper), due to the relatively poor blood supply of the mandible and also because food debris tends to gather in lower sockets more readily than upper ones. However, on occasion, use of local anesthetic without vasoconstrictors would not provide sufficient analgesia, especially in the presence of acute pain and infection on maxillary teeth, meaning that the total dose of local anesthetic may need to be increased. Adequate pain control during the extraction is balanced against an increased risk of dry socket. However, the use of 3% mepivacaine without epinephrine in inferior alveolar nerve blocks has been found to have a similar anesthetic effect to that of lidocaine with 1:100,000 epinephrine, save for a shorter duration of action, and, as such, this may be considered as an alternative in simple mandibular extractions.
Radiotherapy
Radiotherapy directed at the bones of the jaws causes several changes to the tissue, resulting in decreased blood supply.
Diagnosis
Dry socket typically causes pain on the second to fourth day following a dental extraction. Other causes of post extraction pain usually occur immediately after the anesthesia/analgesia has worn off, (e.g., normal pain from surgical trauma or mandibular fracture) or has a more delayed onset (e.g., osteomyelitis, which typically causes pain several weeks following an extraction). The authors questioned whether treating 19 people with antibiotics to prevent one infection would do more harm overall than good, A 2012 review of treatments for dry socket concluded that there was not enough evidence to determine the effectiveness of any treatments.
<!-- ONLY RELIABLE SOURCES TO BE INCLUDED, PRIMARY SOURCES WILL BE REMOVED: SEE WP:MEDRES FOR MORE INFO -->
Prognosis
If a dry socket occurs, the total healing time is increased. Postoperative pain is also worse than the normal discomfort which accompanies healing following any minor surgical procedure. The pain may last for seven to forty days.