Alveolar Osteitis (Dry Socket)
Brief description of condition
Osteitis (inflammation) of a socket after a tooth is extracted, most common after molar extraction. Patients who smoke are more at risk of this condition.
Key signs and symptoms
- Pain (onset 24-48 hours after extraction; in vicinity of extraction site; tenderness of alveolar socket wall)
- Unpleasant taste or odour from the affected area
- Swelling (occasionally)
Recommend optimal analgesia.
Advise the patient to avoid smoking and maintain good oral hygiene.
Advise the patient to seek urgent dental care.
- irrigating with saline.
- applying a suitable material to dress the socket, e.g. Alvogyl.
Do not prescribe antibiotics unless there are signs of spreading infection, systemic complications, or for an immunocompromised patient.
- Kolokythas A, Olech E, Miloro M. Alveolar osteitis: a comprehensive review of concepts and controversies. International Journal of Dentistry 2010; doi:10.1155/2010/249073.
- Noroozi AR, Philbert RF. Modern concepts in understanding and management of the "dry socket" syndrome: comprehensive review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 30-35.
- Medicines and Healthcare products Regulatory Agency. Drug safety update: Chlorhexidine: reminder of potential for hypersensitivity, 2012.
Note that chlorhexidine has been reported as a very rare but potentially serious cause of allergic reaction when used for dry socket irrigation. As there is no evidence in favour of its use for treatment of dry socket, it is not recommended.
The maximum recommended dose of painkillers that takes into account the patient's age and is within the normal safe limits.