dry socket
TRANSCRIPT
![Page 1: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/1.jpg)
Unchalee Kitiviriyakul
![Page 2: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/2.jpg)
Dry socket
lAlveolar osteitislAlveolitis sicca dolorosalAlveolitislLocalized acute alveolar osteomyelitislPostextraction osteomyelitis syndrome lFibrinolytic alveolitis
![Page 3: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/3.jpg)
lDry socket is the most common painful complication following dental extraction
![Page 4: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/4.jpg)
Definition
l A condition which blood clot disintegrates with the production of a foul odor and severe pain but no supparation
![Page 5: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/5.jpg)
Incidence
lOverall incidence 0.5 – 68.4 %lAll extraction 1 - 3 %l Impacted mandibular molar 25 – 30 %lMandibular molar > mandibular premolar >
maxillary premolar > maxillary molar > canine > incisorlThe highest between 20 and 40 years of
age
![Page 6: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/6.jpg)
S & S
l Intolerable pain ,radiation to the earlNot relieved by medicatorlHistory of extraction within 5 dayslExposed alveolar bone lFoul taste , breath , and smell lSign and symptom may last from 10 – 40
days
![Page 7: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/7.jpg)
Timing
3-5 days after surgery
Location
mandibular third molar region
![Page 8: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/8.jpg)
Confirm diagnosisl probing or passing a small curette into the
socket lextremely painful upon light palpation
![Page 9: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/9.jpg)
Etiology
l Precise etiology is unknownl Increase in bacterial
count results in increased fibrinolyticactivity with clot dissolution
![Page 10: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/10.jpg)
Healing of wound extraction
บาดแผล บาดแผลที่หายแลว บาดแผลที่เย็บแลว
first intention healing
![Page 11: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/11.jpg)
Healing of wound extraction
บาดแผลที่มีชองวาง ล่ิมเลือดที่เกิดขึ้นระหวาง สะเก็ดแผลปรากฏขนาดใหญ ชองวางของบาดแผล อยูที่บาดแผลที่หาย
Second intention healing
![Page 12: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/12.jpg)
Healing of wound extraction
Third intention healing
![Page 13: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/13.jpg)
Healing of wound extraction
-Coagulative phase -Proliferative phase -Osteogenic-remodeling phase-Epithelium formation
![Page 14: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/14.jpg)
Coagulative phase
lCoagulation reaction l Inflammatory reaction lThe clot composed fibrin strand , red blood
cells and plateletslNeutrophilic infiltrationlCentral portion : hypoxia lPeripheral : more oxygen tension
![Page 15: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/15.jpg)
Coagulative phase
lBleeding controllElimination of contaminant bacterialCreation of an environment conducive to
healing
![Page 16: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/16.jpg)
Proliferative phase
lDissolution of the blood clotlFormation of a connective tissue matrixlDevelopment of a blood supply to the
woundlTransformation of osteoprogenitor cells
into osteoblasts
![Page 17: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/17.jpg)
Proliferative phase
lSocket is filled with a dense connective tissuelMatrix containing large numbers of
fibroblastslNumerous osteoblasts appear near the
walls of socket
![Page 18: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/18.jpg)
Osteogenic-remodeling phase
lThe secretion of osteoidlThe mineralization of the matrixlThe remodeling of the bone
Epithelium formation
![Page 19: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/19.jpg)
Healing extraction socket
![Page 20: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/20.jpg)
Risk factors
l Coagulopathiesl Traumal Smokingl Agel Effect of anesthesial Gender predilectionl Blood supplyl Presence of pericoronitisl Role of bacterial fibrinolysisl etc
![Page 21: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/21.jpg)
Coagulopathies
lThere are six groups of drugs that can prolong bleeding time
ü Aspirin and NSAIDsü Anti-inflammatoryü Alcoholü Anticoagulantsü Anticancerü antibiotics
![Page 22: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/22.jpg)
Trauma
lextraction difficulty
¡Traumatic extraction interfere healing of PDL
¡Highly incidence of infection
![Page 23: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/23.jpg)
Smoking
lmajor risk factor : smokers have impaired healing responselNicotine ¡vasoconstriction of capillary¡impair collagen synthesis and protein secretion¡interfere healing mechanism
lTar and other component l:contaminate the site
![Page 24: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/24.jpg)
Carbon monoxide (co)
l Interfere with the uptake of oxygen by the bloodlBinding with hemoglobin 200-300 times
greater than oxygen
![Page 25: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/25.jpg)
Age
lOlder have a cellular response to injury less than younger
1995 study by De Boer et al :complications increase with age
>25 years : 18.9%<25 years : 11.4%
![Page 26: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/26.jpg)
Effects of anesthetic
lExcessive infiltration of anesthetics containing vasoconstrictors ,especially injecting to PDL : decrease blood supplylLocal anesthesia¡2% lidocaine 1:80,000 more incidence than 3%
prilocaine with felypressin¡Intraligamental injection
![Page 27: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/27.jpg)
Gender predilection
lFemale > male¡Related with menstrual cycle and taking oral
contraceptives
lEarly menstrual cycle
l Injectable contraceptives not same oral contraceptives
![Page 28: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/28.jpg)
Estrogen
lOral contraceptive related the dose of estrogenl First half of the menstrual cycle¡ high serum estradiol- to- progesterone ratio ¡ Lower incidence of dry socket
l Days 18-26(latter half of the menstrual cycle)¡ High levels range of serum progesterone¡Lower incidence of dry socket¡Low serum estradiol- to- progesterone ratio
![Page 29: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/29.jpg)
Menstrual cycle
![Page 30: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/30.jpg)
Blood supply
lRelative greater density of the bone
![Page 31: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/31.jpg)
Presence of pericoronitis
In a study by De Boer et al : a higher incidence of dry socket was
seen when pericoronal inflammation was present
Meyer’s study showed a significant difference between with and without the use of antibiotics
![Page 32: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/32.jpg)
Role of bacteria
lBacteria are the primary etiology of dry socketlHigher microbial count ( Staphylococcus
lactis,Streptococcusviridans,Corynbacterium xerosis )can increase the incidencelBacterial contamination cause of clot
break down
![Page 33: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/33.jpg)
Fibrinolysis
lcause of clot dissolutionlbacteria produce enzymes that invasion to
the extraction wound
![Page 34: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/34.jpg)
Fibrinolysis
![Page 35: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/35.jpg)
Etc.
lRadiotherapylOsteosclerotic diseaselExcessive use of mouthwash lCurette after extraction
![Page 36: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/36.jpg)
Prevention
lConstant irrigation of bone during cutting phase of extractionlCareful irrigation and debridement
following procedure and prior to suturing lLimiting trauma and bone removallPre and post operative rinsing with 0.12%
chlorhexidinelSystemic prophylactic antibiotics
![Page 37: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/37.jpg)
Prevention
l Avoid smoking,drinking alcohol,and oral contraceptivel Rinsed twice daily with 15 ml of 0.12 or 0.2%
Chlorhexidine gluconate for 30 seconds for one week before and after extractionl Irrigate after extraction with 175 ml of
NSS,especially with reflection of mucoperiostealflap l Do not dislodge clot with over aggressive
irrigation or high speed suction
![Page 38: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/38.jpg)
Prevention
lPlace 250 mg of clindamycin or tetracyclinantibiotic powder into extraction sitelCaution the patient about the “5Ss”
lNo smoking (24- 48 hours both before and after surgery)lSpittinglSucking through a strawlCarbonated soft drinks lMaintenance of a soft diet for 24- 48 hours
![Page 39: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/39.jpg)
Prevention
l A suspension made from a tetracycline capsule or Terra cortrill a gelfoam sponge is
used in each socket
![Page 40: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/40.jpg)
prevention
l Terra-Cortril being placed on Gelfoam
![Page 41: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/41.jpg)
Prevention
l Alternative to medicated Gelfoam : Dry-Lac that put in socket with syringel Dry-Lac has not been
saturated with the blood
![Page 42: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/42.jpg)
Treatment
l Inspection of the socket and confirmation of diagnosis l Examination with radiographsl Local anesthesia lGentle irrigate with warm normal salinel Do not curette the extraction sitel Pressing pack with medicated dressing
common :use with a 1/4 inch strip of iodoformgauze or surgical pack( eugenol + vaseline )
![Page 43: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/43.jpg)
Treatment
lRecheck in 24 hourslchange the pack every 2 dayslDemonstrate the use of a disposable,
plastic syringe that can be use at home for self-irrigation
![Page 44: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/44.jpg)
Treatment
l The socket was irrigated with warm water and pack the iodoform gauze is carefully
![Page 45: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/45.jpg)
treatment
l Iodoform gauze material
l Sutured at the incision line but not fall into the socket
![Page 46: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/46.jpg)
Reference
l Alling Welfrick Alling.Impacted teeth. W.B.Saunders company 1993.l Cowson. Essentials of dental surgery and pathology.l Jamie P. Houston et al .Alveolar osteitis : A review of its etiology ,
prevention and treatment modalities . Journal of general dentistry 2002 sep-oct;457-463.
l Kurt H. Thoma. Volume one oral surgery.C.V.Mosby company.thirdedition.
l Pederssen and Gordon W.Oral surgery. W.B.Saunders company 1980.
l Paul H Kwon,Daniel M. Laskia .Clinical’s manual of oral and maxillofacial surgery.Quntessence publish co,Inc.1991.
l www.google.com
![Page 47: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/47.jpg)
Special thanks
ผ.ศ.ท.พ. อนันต พงษสุวารีกุล
![Page 48: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/48.jpg)
![Page 49: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/49.jpg)
Thank you for your attention
![Page 50: Dry Socket](https://reader034.vdocuments.us/reader034/viewer/2022042615/55cf9ba6550346d033a6dd9f/html5/thumbnails/50.jpg)
Question?