Tips For Managing Dry Socket (Alveolar Osteitis) | OnlineExodontia.com

Alveolar

osteitis

or alveolitis is severe pain that occurs in patients after tooth extraction. Now it will happen to you eventually, if you are eating a tooth you need to know how to deal with it and in this video I will show you. my protocol for

managing

dry

socket

in my office we will also discuss the causes of dry

socket

, the diagnosis of dry socket and the course of treatment basically how long does it last and basically when will it resolve firstly how do we diagnose alveolitis well? A dry socket is usually diagnosed when a patient comes to you and tells you that they are in severe pain.

He just had a tooth pulled maybe three or four days ago. That is the typical onset of symptoms. They might even say to you: you know what doctor? You pulled that tooth out and everything was great, it went well and he went home. Things felt good and I woke up this morning and it hurts and now it's like I said three or four days. then they are taking advil they are taking Tylenol nothing touches the pain they have a throbbing stabbing pain that often radiates to the ear or the eye depending on where the socket is and they may have a bad taste or odor emanating from that socket when you look down and see where that tooth was, you'll see an empty socket, an injured socket and it will be yellowish gray tissue, just necrotic tissue and food debris that's there.

It doesn't look healthy and around the edges you will see angry, swollen red tissue. It is not unusual for the lymph nodes to be slightly swollen under the jaw or in the neck on the affected side, but the patient will not. finally, when you irrigate these things, they can usually be a little touchy, so make sure you let the patient know that's a possibility beforehand and if you irrigate them, it gets a little bit touchy-feely, so that's a confirmation gain that what you are treating was actually 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 this or not. It's an infection because that's usually your main illness, so the first thing I do is expose your fears that this is not an infection, but something very common called dry socket that occurs three or four days later, it's the stabbing pain that we all experience. the symptoms and I tell them what we are going to do to treat them and when it will get better, then the treatment we do is irrigate the site, so basically let's say we take out a lower second molar and this is where the pain is coming from now so we are going to take our mono jack syringe and in it we have prepared a 3% peroxide solution in approximately 20 to 25% of the mixture and 0.12% chlorhexidine in the remaining 75% that we are going to irrigate and rinse that cavity with this solution and What will happen is that the peroxide will come into contact with the tissues and bubble, oxygenating the area and removing any debris from that cavity.

Now before we continue I have to say that it is a 3% peroxide and peroxide itself is not good for osteoblasts so understand that peroxide inhibits osteoblast proliferation so you don't want to use pure peroxide there and In fact, it's not even ideal to use a lot, so we want to dilute it with our chlorhexidine, which we're doing, but we still want to get that bubbling property and the oxygenation out of there to try to lighten it up and clean things up a little bit, so We still use it now if you're not comfortable with that and would rather just use sterile saline, which is fine, you might not get all that waste out as easily, but it's a suitable alternative if you feel more comfortable using it now.

What I'm going to do is vacuum a little bit in there to dry it out a little bit and then I'm going to use this Alvia Jill now. Al via Jill is a good bandage material, it may not be available to everyone, but it is something that lasts perhaps a day or two, giving the patient almost complete pain relief and works literally in a matter of minutes. We'll talk about it in another video, when we take it out and put it in that place, which we're going to do later. What we do is we're going to use this instrument here called a gauze packer, so it's a nice tool that you can use, it has these little teeth on the end and whether you're using Alvia Jill or you're using, let's say, foam gel with a paste or some other dressing, is a good way to get it lightly into the socket, now it will be a little sensitive there for the patient and you don't want to force it in.

I want to make sure it's in enough that it doesn't come out once I put the Elvia gel on the patient. I usually take a piece of cheesecloth and what I'll do is I'll just fold it and place it on top of it. area and they will gently close over this just to absorb some of the flavor that is coming out of there that may be dripping into the liquid of that Elvia Jill, how long is this going to last so that the pain that the patient has can last them anywhere ? about four to eight days, so the total time for that socket to granulate, which basically means that instead of forming from that blood clot, it has to grow over the edges and into the socket, It will take about 7 to 10 days, so it is possible that your patient may have pain for 8 days.

Will it be the intensity it was on day 3 or 4? Not at all, it will get better each time, so if you choose to put something in that socket, understand it and explain to your patient that that is what it is. a foreign body, so when you put something in that socket, it may make him feel better, but you are causing a prolonged healing period, so when you tell your patient that, I find that they will come back less frequently to have it re-examined. package. because usually in the future, once you've done it once or twice, they can deal with some remaining pain and control it with ibuprofen instead of coming to see me, this is always a self-limiting condition, so even if we leave alone. and we did absolutely nothing, you could explain to your patient that as a treatment option it will improve on its own in that period of time that we mentioned now, why do dry sockets occur?

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 first few days. Some causes of this could be estrogen causing fibrinolytic activity, so if you have someone who takes an oral contraceptive, i.e. teenage girls or you know middle-aged adult girls. If you are taking this medication, this may be causing these clots to not form properly or break down. Smoking is something that has been involved, but generally if you are taking half a pack a day or more, half a pack a day increases.

Your risk of dry socket is almost four times higher according to what the literature says. Some of the theories behind smoking in general causing dry socket may be weak, but they believe that nicotine could be vasoconstricting in some of the vessels around the area, causing it to heal poorly and causing that clot to break down, too. There could be someone who goes home and this happens a lot, they go home and rinse and rinse and rinse and get in there and even though you told them not to do it, they show up a few days later in pain and tell you that I did everything I should have done.

I went home and immediately rinsed with salt water and brushed really well there and you know they tell you everything you told them not to do, but maybe they didn't really save it when you told them that straws are something that's been involved. in causing dry socket due to the suction of the straw, they sought to remove the clot from the socket. Now this is kind of a myth because when you swallow. You're actually generating as much or more force than you would with a straw, so this is probably not valid. You could still tell your patients to avoid them just to be safe, but if you're doing that, it may not be necessary.

There is also a theory about applying too much force to a tooth to extract it, which then traumatizes the bone around the tooth socket and that leads to the destruction of the clot and the release of types that were causing pain. Now I could see this anecdotally. That seems to be the case for me when I've had extractions where I've had the tooth removed, nothing breaks, there's nothing difficult other than I have to apply more force than I normally would on the forceps or elevator to get that tooth out. Patients may return with more pain than normal and have often developed a dry socket.