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
Dry socket

Clinical Features
  • Postoperative pain at site of recent tooth extraction

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

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
  1. 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
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