The Journal
The bacterial theory stated that the existence of
a high count of pre and postoperative bacteria’s
around the extraction place in patients may lead
to dry socket. The anaerobic bacteria’s are
mainly found. The alveolar pain would be due to
the effect of bacterial toxins in the nervous
terminations of the alveolus. It was found in an
animal model that Actinomyces viscous and
Streptococcus mutants retard the alveolar post
extraction healing. Also, a fibrinolytic activity
has been observed with increased count of
Treponema Denticola which was postulated by
Nitzan as an etiologic factor in dry socket.
However, it has not been universally accepted
hypothesis due to lack of conclusive data.
What are the risk factors? :-u
Surgically extracted teeth : This could be due
to more liberation of direct tissue activators
secondary to bone marrow inflammation
following more difficult extraction. Surgical
extractions in comparison to non surgical
extractions result in more increased incidence
of dry socket. Dry socket occurrence according
to Younis et al is 7.3% in case of single
extractions and 3.4% in multiple extractions as
multiple extractions are generally simple as
they are performed on mobile and
periodontically compromised teeth.
Age : The incidence of dry socket increases
with increased patient age due to compromised
periodontal health. However exact age group
may vary according to different authors.
MacGregor reported the peak incidence in the
age group of 30-34 years and Younis et al
reported that dry socket is highest in third and
fourth decades of life with peak incidence in 18-
33 years of age group.
Gender : It is reported that prevalence of dry
socket is more in female patients than in male
patients. Use of oral contraceptives is a main
factor that raises the prevalence of dry socket.
Estrogen is responsible for increased plasma
5
fibrinolytic activity (increasing factors II, VII, VIII,
X and plasminogen) and therefore increasing
blood clot lysis.
According to Sweet and Butler occurrence of
dry socket is 4.1% while that of men is 0.5%.
Mohammed et al, describes the prevalence as
2.5% in males and 4.3% in females.
Bad habits : Smoking effects the socket
healing. It reduces neutrophil chemotaxis and
phagocytosis and impede the production of
immunoglobulin. Nicotine is found to be
absorbed through oral mucosa and it act as a
vasoconstrictor. Gardner also observed that
there is removal of clot through suction and
negative pressure during smoke inhalation.
Pericoronitis : it has been observed that teeth
with perocoronitis gives rise to increase in
cases of dry socket.
Operative procedures : It has been observed
that extractions under general anesthesia are
more prone to dry socket than that done under
local anesthesia. Also a study indicated that dry
socket is more prevalent where prilocaine with
1:200,00 epinephrine was used versus
lidocaine with 1:100,00 epinephrine. According
to them epinephrine could reduce bleeding and
might interfere with oxygen tension thus
reducing healing and also increases
fibrinolysis. Although, Younis et al (2011) stated
in a study that there is no significant role of local
anesthesia. Another factor was found by
Birn(1973) stated that excessive irrigation of
alveolus might interfere with formation of clot
and violent curettage may injure the alveolar
bone. Whereas Butler conducted a study where
one side was irrigated with 175ml of saline and
other side was irrigated with 25ml and he found
that instances of dry socket was more in low
volume of irrigation than that in high volume
irrigation. However no evidence confirmed
these allegations.
Vol. 14 No. 2
May-August 2018