Acute alveolar osteitis

Background

• Osteomyelitis of exposed bone. Also known as "Dry socket"
• Caused by premature loss of healing clot in the alveolar socket after tooth extraction
• Occurs 2-4d after tooth extraction
• Initial post-extraction pain subsides followed by sudden/severe pain at extraction site

Clinical Features

Acute alveolar osteitis of a socket after tooth extraction of all maxillary teeth; note lack of blood clot in socket and exposed alveolar bone.

The most common location of acute alveolar osteitis: in the socket of an extracted mandibular third molar (wisdom tooth).

Dry socket

• Postoperative pain at site of recent tooth extraction

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Evaluation

• Clinical diagnosis
• Exposed bone with no clot in extraction site

Management

• Analgesia (often requires dental block)
• Irrigate but socket should not be curetted and any residual clot should not be removed
• Pack with iodoform ribbon gauze soaked with eugenol (oil of cloves) or local anesthetic
• If available, may use commercially available "dry socket paste"
• Penicillin VK 500mg PO QID OR clindamycin 300mg PO QID

Disposition

• Discharge with dental follow-up within 24 hours

See Also

• Dental problems
• Dental numbers