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  Dry Socket Disorder  
 

When a tooth is extracted there is an occurrence of a painful postoperative inflammation known as Dry Socket Disorder. This happens when a blood clot in the open tooth socket is removed or is unsettled. The possibility of dry socket disorder occurrence is from 20% to 30% of all extraction of wisdom teeth or after extraction of the third retained molars. As compared to other tooth removals, the probability of this happening is ten times higher.

The tendency to experience dry socket is higher in women that in men, probably because of the hormone estrogen. It would be best for women to schedule the removal of their wisdom teeth towards the end of their menstrual cycle. Doing the surgery at this time tends to pose lesser chances of having dry socket.

Epidemiology of dry socket disorder

The possibility of dry socket disorder occurring in wisdom teeth is much greater as compared to other teeth. This may be because of the factors that differentiate in diagnostic criteria, in evaluation, in information from simple extractions and retained teeth, small or unrepresentative samples and in surgical and post operative surgery procedures. As there is a lot of flaws in the methodology a lot of these studied cannot be depended upon. According to authors, a study that shows an incidence that is lower the 1% or higher than 35% cannot be accurate.

Although the reasons of dry socket disorders are not known, studies show the following risk factors: tooth extraction difficulty, inexperienced surgeons, oral contraception use, patient’s advanced age, female sex, tobacco, immunosuppression and surgical trauma.

The incidence of tooth extraction trauma is most likely because of the surgeon’s lack of experience. This may cause the healing to take longer and bring about complications like reduced resistance to infection in the jawbone.

The risk of dry socket disorder is five times higher in women than in men because of the gender and more because of the use of oral contraceptives. The creation of the dry socket and the early destruction of blood clots are contributed by the use of estrogen and other drugs.

The possibility of experiencing dry socket disorder increases by 500% for people who smoke. Smoking a packet a day increases this further to 20% and by 40% for patients who smoked on the day of the operation or immediately after the operation.

For diabetics or immunosuppressed patients, the change of the healing process tends to make them more inclined to have dry socket disorders.

Clinical forms of dry socket disorder

Dry socket is easily recognizable by the appearance of on empty tooth socket with no blood clot and exposed jawbones as well. The patient will experience sharp pain which increases because of chewing or suctioning. It is not unusual for the pain to spread from the ear and parts of the head. The characteristic appearance develops two or three days after extraction.

With or without treatment, this appearance will last usually from ten to fifteen days. In the beginning, there will be a minor improvement then suddenly worsens with pain; even with analgesics, this is hard to control. Dry sockets rarely appear before the day after the tooth extraction as time is needed for the clot to break up.

Treatment of dry socket disorder

Prevention is the best treatment for dry socket disorder as the causes are not yet known. Reduction of the pain is the goal of the treatment as the infection develops. The usual practice is to continue analgesic symptomatic treatment, anti inflammatory treatment even 10 to 15 days after the condition heals. Some doctors would even recommend antibiotic treatment.

Prevention of dry socket disorder

Antifibrinolytic agents, laundries, antiseptics and antibiotics are the preventive drugs used in the therapy of dry sockets. In all antifibrinolytic agents, antiseptics and antibiotics are proven to be the best.

Using antifibrionolytic agents hinder the early ruin of blood clot. Tranexamic acid, an antifibrinolytic agent, does not help in lessening the occurrence of dry socket. Although PEPH is more successful, but because it has important secondary effects, their use should be prevented. What should be included in the prevention therapy of dry socket is laundries of serum as this have proven to be effective.

A 50% reduction of dry socket incidence can be brought about by the use of antiseptics, after removing the third mandibular molars and this is now considered as a suitable therapy for dry socket prevention. Even if antibiotics is deemed to be the right treatment but their use is limited because of the possibility of developing resistance to them and their toxicity. Using topical antibiotics is recommended instead as they have proven to give good results.

 
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