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.
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.
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
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.
There are no contraindications to the management of a dry socket.
- Dental mirror
- 2×2 gauze squares
- Dry socket paste
- Irrigating syringe
- Normal saline solution
- Frazier suction catheter
- Suction source and tubing
- Iodoform ribbon gauze
- Eugenol-impregnated ribbon gauze
- Oil of cloves
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.
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 ...