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[1]
- Occurs 2-4d after tooth extraction
- Initial post-extraction pain subsides followed by sudden/severe pain at extraction site
Clinical Features
- Postoperative pain at site of recent tooth extraction
Differential Diagnosis
Dentoalveolar Injuries
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
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
References
- ↑ Kolokythas A, Olech E, Miloro M. Alveolar Osteitis: A Comprehensive Review of Concepts and Controversies. International Journal of Dentistry. 2010; 2010: 249073. doi:10.1155/2010/249073