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Post-extraction pain, or periosteitis, begins as the local anesthetic agent wears off. The pain begins to diminish, most of the time, within 12 hours. The prescription of nonsteroidal anti-inflammatory drugs will provide analgesia and comfort while the pain subsides over 1 to 2 days. Narcotic analgesics may occasionally be required for the first 24 to 48 hours.

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Pain that develops 2 to 4 days after the tooth extraction most likely indicates a localized alveolar osteitis or a dry socket. A dry socket occurs most commonly with the extraction of the third mandibular molar, but can be associated with any tooth that has been extracted. The pain is quite severe in nature. The signs of an infection are absent.

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The etiology or the pathogenesis of a dry socket is not clear.1–6 It is believed to be caused by an increased level of fibrinolysis of the blood clot in the socket before the clot has had the time to be replaced by granulation tissue. The clot falls out of the socket and exposes the bony surface of the socket to the oral cavity. The exposed bone is extremely sensitive, resulting in severe pain.1–4 The extraction site may emit a foul odor and the patient often complains of a bad taste in their mouth.1,2

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The single and utmost therapeutic goal of alveolar osteitis is to relieve the patient’s pain during the healing process. This procedure should be performed on all patients with a dry socket.

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There are no contraindications to the management of a dry socket.

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  • Dental mirror
  • 2×2 gauze squares
  • Scissors
  • Dry socket paste
  • Gelfoam
  • Irrigating syringe
  • Normal saline solution
  • Frazier suction catheter
  • Suction source and tubing
  • Forceps
  • Iodoform ribbon gauze
  • Eugenol-impregnated ribbon gauze
  • Oil of cloves

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Explain the risks, benefits, potential complications, and aftercare to the patient and/or their representative. A signed consent is not required for this procedure. Place the patient sitting upright or supine. A multipositional dental chair is ideal and allows for a variety of positions to visualize the affected tooth. This procedure may be accomplished with no anesthesia. Consider performing a dental block to temporarily alleviate the patient’s pain and allow the procedure to be accomplished with minimal discomfort, and increase the level of patient satisfaction. Refer to Chapter 154 for the complete details regarding dental anesthesia and analgesia. Consider obtaining radiographs to rule out a retained root tip or other foreign material.

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Identify the defective tooth. Gently and thoroughly irrigate the socket with normal saline to remove any debris. Pack dry socket paste into the socket. Dry socket paste is composed of balsa wood fragments saturated with eucalyptol and looks like chewing tobacco. Completely fill the socket with the dry socket paste. The patient will experience almost instant pain relief if a dental block was not performed. Place a piece of Gelfoam on top of the dry ...

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