The Journal
*Dr. Ujjwal Arora
Dry Socket – A Mystery Unfolded
Dry socket which is clinically diagnosed by presence of denuded socket and is basically due to
premature loss of blood clot manifesting slight discomfort to the patient. It is generally encountered by
general dentists and specialists and is postoperative complication of dental extractions and
disimpactions. Till date the exact etiology, pathophysiology and best methods of prevention and
treatment is unknown and is still the controversy matter.
Introduction Clinical findings
Dry socket is the most common
complication arising after extraction or
surgically removing tooth. It is basically focal
osteomyelitis in which blood clot is
disintegrated or is lost. This condition remain as
common postoperative problem that results in
severe pain. It is known as dry socket because
after clot is lost, the socket appears dry because
of exposed bone. However, exact pathogenesis
of dry socket is not known. Many researches
are going on but still it is the matter of
controversy. Crawford in 1896 used the term
“dry socket”. Other terms include:
• Alveolar osteitis
• Fibrinolytic alveolitis
• Alveolitis sicca dolorosa
• Localized osteomyelitis
• Delayed extraction wound healing
• Septic socket
• Alveolagia
• Osteomyelitic postextraction syndrome Pain and empty socket has been found
characterized by denuded sensitive bone
surface covered by grayish -yellow layer of
dentritus and necrotic tissue. Other features
may include severe throbbing pain that starts
after a day or 72 hours after extraction radiating
towards ear and temporal region, low grade
fever, inflamed gingival margin, bare bine,
ipsilateral region lymphadenopathy and grayish
discharge.
Dry socket is a generic name and is most
commonly used term. There are 17 different
definitions of dry socket. The most acceptable
one defines as “ postoperative pain inside and
around dental alveolus which is increased in
severity an some moment between the first and
the third day after dental extraction
accompanied by partial or total disintegration of
intra-alveolar clot sanguine, accompanied or
not of halitosis.” (by I.R. Blum)
Radiological findings
There are no important alterations but in
advanced cases rarefaction areas can be
detected from cortical alveolar region reaching
adjacent bone.
Histological features
There are remnants of blood clot and massive
inflammatory response characterized by
neutrophils and lymphocytes which may extend
into surrounding alveolus.
Most commonly involved area in dry socket is
about 0.5% to 5%(acc to H.W.Krough) and 1%
to 3.75%(acc to I.R.Blum) for impacted third
molars. It is higher in mandibular approximately
10 times more than that of maxillary.
* Private Practitioner
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Vol. 14 No. 2
May-August 2018