The Journal
Patients on antipsychotic or antidepressant
medication : It is possible that components
such as epidermal growth factor, transforming
growth factor and clotting factors are
responsible for promotion of healing thus drug
induced hypo salivation might reduce these
protective factors, increasing probability of
healing failure.
Prevention of dry socket
Prevention of developing dry socket may be
influenced by methods used by dentist/surgeon
performing tooth extraction. Since it is the most
common postoperative complication, many
researchers have attempted to find successful
preventive measures. The most popular
techniques are:
• Larsen in 1991 stated the effectiveness of
CHX (chlorhexidine gluconate) in concentration
of 0.12% with smaller secondary effects.
However, a study also indicated that rinses are
not usually used until 24hrs of extraction since it
may cause clot detachment and thus dry
socket. An alternative in such cases could be
gel formulation(0.2%)
• In earlier days prevention included both
pharmacologic and surgical approaches.
Pharmacologic methods may include use
antibiotic preparations placed in socket after
extraction. Use of tetracycline-impregnated
gelatin sponges or gel foam, clindamycin-
impregnated gelfoam, lincomycin in gel foam,
systemic use of metranidazole, systemic
penicillins, and systemic use of erythromycin
showed reduced incidence of dry socket.
• Experiment by placing sulfathiazole cones in
fresh tooth socket of dog result in prevention of
tooth socket but it causes retarded blood clot
formation and remarkably delay in
epithelialization.
• Trypsin digests necrotic tissue and debris and
restrains bacterial growth.
• Myospherulosis: it is the complication of
healing of extraction wound or soft tissue
wound into which there is placement of
6
antibiotic ointment with petroleum base. It
results in formation of clear spaces within the
area of healing and presence of altered
erythrocytes which assume the appearance of
solitary or clusters of spherules that have been
mistaken for large microorganism. When
curetted from non healing sockets, tissue is
brownish black, tarry in texture and often
associated with membranous mucoid
substance.
• Many authors recommended the use of
systemic antibiotics is not necessary in non-
immunocompromised patients unless there are
symptoms of malaise and lymphadenopathy or
there is patient with history of multiple dry
socket. A case was reported of long lasting
intra-alveolar zinc-oxide eugenol dressing that
caused bone necrosis, foreign body reaction,
delayed alveolar healing and hemi-facial pain
that was confused with trigeminal neuralgia.
Management of dry socket
Although dry socket is self limiting but due to its
severity symptomatic treatment is needed.
Around 7-10 days are required for exposed
bone to become covered with new granulation
tissue therefore during this period treatment is
needed to relieve patient’s pain and discomfort.
Bloomer showed that dry socket can be
prevented by immediately packing sockets with
eugenol containing dressings, however, such
measures may delay wound healing.
Irrigation is known to remove debris, sequetra
and bacteria from denuded bone. It can be done
under local anesthesia before the application of
protective dressing composed of zinc oxide and
eugenol mixed into semisolid consistency
applied to iodoform ribbon gauze. The packing
should be changed every 2-3 days and
removed once pain is reduced. The use of
petroleum based carriers is discouraged to
avoid myospherulosis. Analgesics can be given
from short course of NSAIDs to narcotic based
preparations.
Vol. 14 No. 2
May-August 2018