The Journal
Etiology
Two main etiological factors may include
• Difficult or traumatic extraction, usually
removal of impacted 3rd molars
• Dislodgement and disintegration of clot and
subsequent bone infection.
Although exact pathogenesis is not known but
there are many etiopathogenic theories that
have intended to explain the dry socket which
are Birn’s fibrinolytic theory and the Bacterial
theory.
Birn in 1973 showed increased fibrinolytic
activity and activation of plasminogen to
plasmin in the presence of tissue activators in
dry socket. This activity was thought to effect
the integrity of blood cloy after extraction.
4
Plasmin is the enzyme which hydrolyzes fibrin
into soluble fragments and regulates the degree
of fibrinolysis and is therefore main factor on
fibrinolytic activity.
Birn hypothesized that increase in fibrinolytic
activity is mainly responsible for dry socket
pathology. It was found higher in case of dry
socket than that in case of normally healing
extraction wounds. According to Birn, direct
tissue activators are released after trauma to
the alveolar bone cells converting plasminogen
to plasmin which digests the fibrin clot, hence
resulting in disintegration of clot leading to dry
socket. He further investigated the fibrinolytic
activity of alveolar bone, however, led to the
realization that indirect activators could have a
greater role in dry socket than was originally
thought.
Vol. 14 No. 2
May-August 2018