Tips For Managing Dry Socket (Alveolar Osteitis) | OnlineExodontia.comJun 01, 2021
socketis severe pain that occurs in patients after tooth extraction. Now it will happen to you eventually. If you are eating a tooth, you should know how to deal with it and in this video I am going to show you my protocol to manage a dry
socketin my office we are also going to look at the causes of dry socket the diagnosis of a dry socket and the course of the treatment so basically how long does this last and basically when is it going to resolve first how do we diagnose a dry socket?
Well, a dry socket is usually diagnosed when a patient presents and tells you that they are in severe pain. He just pulled a tooth. Maybe three or four days ago. Symptoms and they might even tell you, you know what doctor, you pulled that tooth out and everything was great, it went well and I went home, things felt good and I woke up this morning and, man, it hurts and now it's like I said three or four days later so they are taking advil they are taking tylenol nothing is touching the pain they have a throbbing shooting pain that often radiates to the ear or eye depending on where that socket is and can have a bad taste or a bad smell emanating from that socket when you look down and you'll see where that tooth was you'll see an empty injured socket and it'll be yellowish gray tissue just necrotic tissue and food debris that's in there it doesn't look healthy and around the edges of there you'll see some angry, swollen red tissue; it is not unusual for the lymph nodes to be a little swollen under the jaw or in the neck on the affected side, but the patient will not have a fever or any signs of infection Finally, when you irrigate these things, they can usually be a little tender, so be sure of letting the patient know that it's a possibility beforehand and if you irrigate it and it becomes a little tender, then that's a plus. confirmation that what you are treating was in fact a dry socket, so how do I treat this in my office?
Well the first thing I do is talk to this patient about whether or not it's an infection because usually that's their main problem so the first thing I do is express their fears that this is not an infection but something very common called concern about the dry socket that appears three or four days later is the throbbing pain we go through all the symptoms and I tell them what we are going to do to treat them and when it will improve, then the treatment we do for them is to irrigate the site, so basically let's say we pulled a mandibular second molar and this is where the pain now comes from so we're going to take our mono jack syringe and in it we've made up a 3% peroxide solution in about 20 to 25% of the mix and 0.12% chlorhexidine in the remaining 75% we are going to irrigate and rinse in that baseboard with this solution and what will happen is that the peroxide will come into contact with the tissues and bubble, oxygenate the area and remove any residue to of that alveolus.
Now before I go any further I should say that it is a 3% peroxide and peroxide itself is not good for osteoblasts so please understand that osteoblast proliferation is inhibited by peroxide so you don't want to use pure peroxide there and actually it's not even ideal to use a lot of it so we want to dilute it with our chlorhexidine which we're doing but I still want to get that bubbly property and oxygenation out of there to try to remove that and clean up the lines a bit. stuff, that's why we still use it now if you're not comfortable with that and prefer to use sterile saline that's fine, it may not get rid of all that debris as easily, but it's a suitable alternative if you're more comfortable using it now, the next thing we're going to do is just suck a little bit on there to dry it out for a while and then I'm off to use this Alvia Jill now on the via Jill it's a good bandage material that may not be available to everyone but it's something that will last a long time.
It may take a day or two, giving the patient almost complete pain relief, and works literally in minutes. Let's talk. about that in another video when we take it out and put it in there what we're going to do is use this instrument here called the gauze packer so this is a nice tool you can use it has these little prongs on the end and if are you using Alvia Jill or are you using, say, gel foam with a paste or some other bandage it's a good way to basically pack that slightly down into the socket now it's going to be a little soft down there for the patient and you don't want to stick it tightly you just want to make sure it's in there enough that it doesn't come off once I have the Elvia gel in there for the patient I'll usually take a gauze pad and what I'll do is just to take it and place it over that area and it's they will close softly on this just to soak up some of the flavor coming out of there that may be seeping into the liquid from that Elvia Jill how long is this going to last for the pain the patient may last for approx. roughly four to eight days, so the total time for the cavity to granulate, which basically means that instead of forming from that blood clot, it has to grow over the edges and into the cavity that it will take around 7 to 10 days, so your patient may have pain for 8 days, will it be as severe as it was on day 3 or 4?
Absolutely not it will get better each time so if you choose to put something in that socket understand that and explain this to your patient it is a foreign body so when you put something in that socket maybe it makes you feel better but you are causing a long healing period, so when you tell your patient i find out he will have it. it comes back less fr accordingly, repack it because usually down the road, once you've done it once or twice, they can deal with a little bit of pain that's left behind and manage it with ibuprofen instead of coming to see me, this is always a self limiting condition so even if we left it alone and did absolutely nothing you could explain to your patient that as a treatment option it will get better on its own in that amount of time we mention now why does it happen dry socket?
Oh a dry socket is basically caused by a loss of the blood clot so the blood clot comes out or dissolves or breaks down in those early days now some causes of this could be estrogen causing fibrinolytic activity so if do you have someone taking an oral contraceptive such as young teens or you know middle aged adult girls are going to take this medication that may be causing these clots to not form properly or break down. furthermore, half a packet a day increases the risk of dry socket by almost four times, according to what the literature says. around the area causing it to scar badly and causing the clot to break up could also have someone come home and this happens frequently they go home and rinse and rinse and rinse and get in there and even though you told them not to Don't that, they present you a few days later with pain and tell you that I did everything I had to.
I went home and rinsed right off with salt water and brushed real good back there and you know they tell you everything you do I told them not to but maybe they didn't really hold it back when you told them that straws are something they know been implicated in the cause of dry socket due to straw sucking. Now this is kind of a myth because when you swallow, you're actually generating as much or more force than you would through a straw, so it's probably not a valid thing. Still, you could tell your patients to avoid them just to be safe. but if you are, it may not be necessary.
There is also a theory that too much force is applied to a tooth to extract it, which then traumatizes the bone around the tooth socket and that leads to clot destruction and release. of guys that caused pain now i could see anecdotally this seems to be the case for me when i have had extractions where i pull the tooth out nothing breaks nothing is difficult other than i have to apply more force than i normally would on the forceps or the elevator to remove that tooth, those patients may come back with more pain than normal and many times have developed a dry socket
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