Is Chitosan Dental Dressing Better Than Cotton Gauze in Achieving Hemostasis in Patients on Antithrombotics?

PURPOSE: Tooth extraction leads to bleeding which may be longer in patients on antithrombotics. This study was aimed to evaluate the hemostatic and wound healing efficacy of chitosan-based dressing in comparison to the cotton pressure pack after tooth extraction in patients receiving single or dual antithrombotics. MATERIALS AND METHODS: This is a prospective, randomized split mouth study. Patients undergoing tooth extractions taking either single or dual antithrombotics, with an international normalized ratio (INR) value ≤ 3 were enrolled at JSS Dental College & Hospital, Mysuru, India during February 2020 to January 2022. The study compared the efficiency of chitosan dressing in achieving quicker hemostasis in comparison to cotton pressure pack. The primary outcome was time to achieve hemostasis and the secondary outcomes were alveolar clinical healing index and alveolar osteitis. The covariates were gender, age, reason for extraction, INR, type of antithrombotic therapy, and the disease condition. RESULTS: Of the 54 enrolled subjects, 39 were males and 15 were females, aged between 33 and 86 years. Thirty six patients were on single antithrombotics, whereas 18 patients were on dual antithrombotics. The reason for extraction was periodontitis in 37 patients and dental caries in 17 patients. The time to achieve hemostasis was lesser with chitosan dental dressing when compared to cotton pressure packs (96 ± 4 and 797 ± 23 seconds; P < .001). In the chitosan group, the time to hemostasis was similar irrespective of single or dual antithrombotic therapy (90 ± 6 and 109 ± 8 seconds, respectively). On the contrary, in the cotton pressure pack group, patients on dual antithrombotics had longer time to achieve hemostasis compared to those on single antithrombotics (940 ± 20 and 726 ± 26 seconds; P < .001). The time to achieve hemostasis was dependent on INR only in cotton pressure pack group (r2 = 0.7756). The alveolar clinical healing index was better in 88.9% with chitosan and only 3.7% with cotton pressure packs. None of the patients treated with chitosan presented with alveolar osteitis, as opposed to 3.7% of patients with cotton pressure packs. CONCLUSION: When compared to cotton pressure packs, chitosan-based dressing was more effective in controlling postoperative bleeding in patients treated with single and dual antithrombotic therapy.

A Comparative Study on Alvogyl and a Mixture of Black Seed Oil and Powder for Alveolar Osteitis: A Randomized Double-Blind Controlled Clinical Trial.

Introduction: Alveolar osteitis (AO) is the most common complication faced by exodontia patients and is usually seen 24-74 hours after tooth extraction, heralded by severe throbbing pain. Nigella sativa is commonly known as black seed known to have anti-inflammatory and antibacterial properties along with other reparative properties that enhance bone formation. This study aimed to evaluate and compare the effects of Alvogyl and a mixture of Nigella sativa powder and oil in the treatment of dry sockets. Materials and Methods: Sixty patients above the age of 18 and below 70 years, from both genders, who underwent extraction of teeth and were clinically diagnosed with a dry socket at the clinic of the College of Dentistry, Jouf University, Saudi Arabia, were included in this study. Pain scores were assessed after placement of the dressing at the following intervals: 5 minutes, 30 minutes, 60 minutes, 2nd day, 4th day, and 7th day. Patients were randomly allocated to three groups, namely, Group 1 (Alvogyl), Group 2 (mixture of Nigella sativa's powder and oil), and Group 3 (control). Pain relief and healing of the socket were compared between the three groups. The collected data were subjected to statistical analysis through Spearman's correlation test, independent t-test, ANOVA, and post hoc test. Results: A mixture of Nigella sativa powder and oil showed a statistically significant difference in relieving pain compared to the Alvogyl group. A mixture of Nigella sativa's powder and oil required fewer dressings when compared to the Alvogyl group. Conclusion: A mixture of Nigella sativa powder and oil is the more efficacious dressing material for the management of dry sockets compared to Alvogyl. It provides immediate and complete pain relief and fewer numbers of repeated visits.

A Comparison of Pre-Emptive Co-Amoxiclav, Postoperative Amoxicillin, and Metronidazole for Prevention of Postoperative Complications in Dentoalveolar Surgery: A Randomized Controlled Trial.

OBJECTIVE: To compare the effectiveness of different oral antibiotics for prevention of dry socket and infection in adults following the surgical extraction of teeth under LA. METHODS: This randomized controlled study was conducted from 10 September 2020 until 10 May 2021. Forty-six patients were randomly allocated to three groups. Sixteen patients were in the postoperative co-amoxiclav (625 mg) group, fifteen in the preoperative co-amoxiclav (625 mg) plus postoperative metronidazole (500 mg) group and fifteen in the preoperative co-amoxiclav (625 mg) plus postoperative amoxicillin (500 mg) group. Evaluation of the postoperative signs of alveolar osteitis and infection was made by a dental surgeon five days postoperatively. Evaluation of the post-surgical extraction pain was made by patients immediately and five days postoperatively on standard 100 mm visual analogue scales (VAS). Furthermore, difficulty of surgery was recorded for all patients immediately postoperatively using (VAS). RESULTS: all antibiotics used in this study were effective. Only 15% of patients had painful alveolar osteitis and 2% had oral infections. There was no significant decrease in the number of patients with severe alveolar osteitis or infection for co-amoxiclav plus metronidazole and co-amoxiclav plus amoxicillin groups compared to co-amoxiclav group at 5 days post-operation (p-values: 0.715, 0.819 & 0.309). Clinically, metronidazole was more effective in protecting the extracted tooth socket from alveolar osteitis compared to co-amoxiclav and amoxicillin. Moreover, there were significant decreases in mean pain scores at 5 days post-operation compared with the levels of pain immediately after surgery (p-value: 0.001). CONCLUSIONS: Administration of a single preoperative dose of co-amoxiclav with a full postoperative dose of amoxicillin or metronidazole was more effective than conventional treatment with postoperative co-amoxilcalv in reducing the incidence of both alveolar osteitis and infection after surgical extractions. However, these differences were not statistically significant. Interestingly, patients in metronidazole group had the lowest incidence of dry socket.

Initial Observation of Factors Interfering with the Treatment of Alveolar Osteitis Using Hyaluronic Acid with Octenidine-A Series of Case Reports.

Alveolar osteitis (AO) is a common complication following the extraction of the teeth, particularly the lower third molars. It starts within a few days after the extraction and manifests mainly as pain in the extraction site. Several strategies of treatment are available in order to relieve pain and heal the extraction wound. Recently, a novel medical device combining hyaluronic acid (HA) and octenidine (OCT) was introduced for the treatment of AO. This series of case reports aims to summarize the initial clinical experiences with this new device and to highlight factors possibly interfering with this treatment. The medical documentation of five patients with similar initial situations treated for AO with HA + OCT device was analyzed in detail. Smoking and previous treatment with Alveogyl (Septodont, Saint-Maur-des-Fossés, France) were identified as factors interfering with the AO treatment with the HA + OCT device. In three patients without these risk factors, the treatment led to recovery within two or three days. The patient pretreated with Alveogyl and the smoker required six and seven applications of the HA + OCT device, respectively. According to these initial observations, it seems smoking and previous treatment with Alveogyl prolong the treatment of AO using the HA + OCT device that, in turn, shows a rapid effect if these risk factors are not present.

Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: An observational study.

OBJECTIVES: Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. METHODS: This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). RESULTS: The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. CONCLUSIONS AND CLINICAL RELEVANCE: Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.

Antibiotics in Dentoalveolar Surgery, a Closer Look at Infection, Alveolar Osteitis and Adverse Drug Reaction.

PURPOSE: To execute an evidence-based review answering the following questions: "What antibiotic type and mode of delivery are most effective at reducing inflammatory complications in third molar and dental implant surgery? What are the types and rates of antibiotic-related adverse reactions in the context of third molar surgery, infective endocarditis, medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN)?" MATERIAL AND METHODS: We performed a comprehensive literature review of peer-reviewed studies using MEDLINE/PubMed, Cochrane, Scopus/Elsevier, Google Scholar, and Wiley online library databases. RESULTS: Twenty-five studies were reviewed for third molar surgery. Although there is some evidence that systemic antibiotics reduce inflammatory complications (infection and alveolar osteitis), routine use is not recommended for third molar surgery. For at-risk cases, a single preoperative dose of amoxicillin is preferred. Clindamycin, amoxicillin-clavulanic acid and erythromycin have a high adverse risk profile. Eight studies were reviewed for dental implant surgery. Antibiotics with dental implant placement showed little reduction in post surgery infection and minimal improvement in long-term success. A comprehensive search found limited data on antibiotic-related adverse effects in the context of infective endocarditis, MRONJ and ORN. CONCLUSIONS: A set of clinical recommendations are presented to better guide evidence-based and standardized antibiotic usage on the basis of the literature discussed in this review. This review highlights the need for further research focusing on antibiotic type and timing of delivery with adverse drug reaction as a primary outcome measure when assessing treatment outcomes and complications in dentoalveolar surgery. This will better elucidate the risks vs benefits of antibiotic in dentoalveolar surgery.

Evaluation of the effects of intra-alveolar irrigation with clindamycin, rifampicin and sterile saline in alveolar osteitis treatment.

BACKGROUND: To evaluate the efficacy of intra-alveolar irrigation made with clindamycin, rifampicin and sterile saline on pain and alveolar mucosa healing in the treatment of alveolar osteitis (dry socket). METHODS: Fifty-four patients diagnosed with alveolar osteitis were divided into three groups for the treatment protocol. Sterile saline was used in Group A, rifampicin was used in Group B and clindamycin was used in Group C for intra-alveolar irrigation. In the groups, the patients were evaluated for their pain levels and alveolar mucosa healing. RESULTS: The incidence of alveolar osteitis was significantly higher in females and mandibles at a statistically significant. In the group that used clindamycin for intra-alveolar irrigation, the pain level was found lower than the two other groups. Clindamycin and rifampicin groups were superior to the sterile saline group in clinical alveolar mucosa healing. CONCLUSION: Irrigation with clindamycin appears to reduce the pain associated with alveolar osteitis when compared to rifampicin and sterile saline. In the treatment of alveolar osteitis, irrigation with antibiotics following curettage was found effective for pain relief and alveolar mucosa healing.

Guaiacol/ß-cyclodextrin for rapid healing of dry socket: antibacterial activity, cytotoxicity, and bone repair-an animal study.

PURPOSE: Dry socket (DS) is one the most common and symptomatic post-extraction complications; however, no consensus on its treatment has been reached. This study aimed to develop a novel dressing material for DS containing the phenolic agent guaiacol and evaluate its biological properties. METHODS: An inclusion complex of guaiacol and ß-cyclodextrin (Gu/ßcd) was prepared by freeze-drying. Its antibacterial activity over six oral bacteria was analyzed using the microdilution method, and its cytotoxicity in osteoblasts was assessed with the MTT assay. The alveolar healing process induced by Gu/ßcd was evaluated histologically after the treatment of DS in rats. RESULTS: ßcd complexation potentiated Gu's antibacterial effect and reduced its cytotoxicity in osteoblasts. Bone trabeculae were formed in the alveolar apices of rats treated with Gu/ßcd by day 7. On day 14, woven bone occupied the apical and middle thirds of the sockets; on day 21, the entire alveolus was filled by newly formed bone, which was in a more advanced stage of repair than the positive control (Alvogyl™). CONCLUSION: The improvement in Gu's biological properties in vitro and the rapid alveolar repair in comparison with Alvogyl™ in vivo demonstrated the benefits of the Gu/ßcd complex as a future alternative for the treatment of DS.

The Efficacy of Plasma Rich in Growth Factors for the Treatment of Alveolar Osteitis: A Randomized Controlled Trial.

PURPOSE: To investigate the efficacy of plasma rich in growth factors (PRGF; BTI Biotechnology Institute, San Antonio, Spain) for the treatment of alveolar osteitis compared with a positive control (Alvogyl; Septodont, Maidstone, Kent, UK). MATERIALS AND METHODS: This single-center, single-blinded, randomized, 2-treatment, parallel study was conducted in a UK dental hospital. All healthy adults who presented with alveolar osteitis after tooth extraction over a 3-month period were invited to participate. Each socket was randomized and treated with 1 of 2 treatment modalities, a test treatment (PRGF) or a positive control (Alvogyl). After treatment, patients were reviewed at 3 and 7 days by a second clinician blinded to the treatment given. Outcome measures included pain, exposed bone, inflammation, halitosis, dysgeusia, and quality-of-life assessment. RESULTS: Thirty-eight patients with data from 44 sockets (22 in the PRGF group and 22 in the Alvogyl group) were analyzed. The PRGF group showed significantly faster bone coverage and significantly decreased inflammation and halitosis (P < .05) compared with the control group receiving Alvogyl. There was no significant difference for pain, quality-of-life measures, or dysgeusia between groups. CONCLUSION: PRGF predictably treated alveolar osteitis after tooth extraction compared with the conventional standard treatment of Alvogyl, which has been used for many years. PRGF could be considered an alternative treatment for alveolar osteitis and indeed appears to have considerable advantages over Alvogyl.

Role Of 0.2% Bio-Adhesive Chlorhexidine Gel In Reducing Incidence Of Alveolar Osteitis.

BACKGROUND: Alveolar osteitis is a frequent postoperative complication of third molar surgery. A number of preventive methods have been tried. Chlorhexidine is most widely used antiseptic which is thought to be helpful to prevent alveolar osteitis. The objective of this study was to evaluate role of 0.2% bio-adhesive chlorhexidine gel in reducing incidence of alveolar osteitis after surgical removal of mandibular third molars which causes extra monetary burden on the patients in the form of several follow up visits.. METHODS: A randomized clinical trial was performed in the Dental Section, Ayub Medical College, Abbottabad. Approval from ethical committee was obtained. Total 180 patients were randomly divided into Group A in which patients received 0.2% bio-adhesive chlorhexidine gel and Group B where patients received placebo gel in the extraction socket after removal of mandibular third molar. RESULTS: 0.2% bio-adhesive chlorhexidine gel used after mandibular third molar removal reduced incidence of alveolar osteitis by 10% in comparison to control group with statistically significant difference, i.e., p=0.044.. CONCLUSIONS: 2.3 times reduction in the incidence of alveolar osteitis was observed after use of 0.2% bio-adhesive chlorhexidine gel.

Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial.

To evaluate the effect of postoperative irrigation with chlorhexidine on inflammatory complications after the extraction of lower third molars under local anaesthesia, we recruited 100 patients to participate in a controlled, single-blind, randomised clinical trial. They were assigned to one of two groups: the intervention group (postoperative irrigation of the surgical site with chlorhexidine for seven days) or the control group (postoperative chlorhexidine mouth rinse for seven days). The primary outcome variables were pain, swelling, trismus, infection, and alveolar osteitis. The secondary outcome variables were wound dehiscence and food impaction. A total of 95 participants completed the study (47 in the irrigation group and 48 in the rinse group). In the irrigation group, alveolar osteitis and facial swelling had reduced significantly at seven days postoperatively (both p<0.01). Pain scores had also reduced significantly at seven days (p<0.01), but not at 48hours, and patients had lower levels of food impaction (p<0.01) and less severe symptoms (p=0.02). Routine irrigation with chlorhexidine after the extraction of third molars helps to reduce pain and lowers the incidence of alveolar osteitis.

Effectiveness of 0.2% chlorhexidine gel and a eugenol-based paste on postoperative alveolar osteitis in patients having third molars extracted: a randomised controlled clinical trial.

The aim of this study was to compare the effect of application of 0.2% chlorhexidine gel, a eugenol-based paste, together with a control group on the postoperative incidence of alveolar osteitis in patients having third molars extracted. A total of 270 patients who had this procedure at the Dept of Oral and Maxillofacial Surgery, Saveetha Dental College and who met the inclusion criteria were enrolled in the study and divided into 3 groups: the first had a 0.2% chlorhexidine-based gel applied to the alveolar socket once after extraction; the second had a eugenol-based paste applied to the alveolar socket once after extraction; and the third group acted as controls, with no treatment. The incidence of alveolar osteitis was recorded for 7 days. We also recorded postoperative pain, inflammation, infection, and wound healing. Nine of the control group (10%) and 2 (2%) of the chlorhexidine group developed alveolar osteitis on the seventh postoperative day. The overall incidence (11/270) was 4%, which is less than reported elsewhere. The distribution of alveolar osteitis among the 3 groups was significant (p=0.002), with the eugenol group having no cases. The chlorhexidine group showed less incidence of alveolar osteitis than other reported studies and also less pain, inflammation, infection, and better wound healing than the control group. We conclude that eugenol was the better of the 2 interventions.

Comparison of the effect of low level laser therapy with alvogyl on the management of alveolar osteitis.

BACKGROUND: This study investigated the efficacy of low level laser therapy (LLLT) for managing alveolar osteitis (AO). MATERIAL AND METHODS: Sixty patients with alveolar osteitis of mandibular third molars were randomly divided into three groups. In group 1, socket irrigation was followed by alvogyl placement, and the treatment was repeated 48 hours later. In group 2, socket was irradiated with a low power red laser for 3 consecutive days (200 mW, 30 seconds on each of the buccal and lingual surfaces and 30 seconds at the middle of the socket, 6 J per area). The subjects in group 3 underwent treatment with a low power infrared laser with the same parameters as group 2. A visual analogue scale (VAS) was used to record the degree of pain at the morning (T0, before intervention) and at 6 (T1) and 12 (T2) hours later for 3 days. RESULTS: Pain was significantly lower in the alvogyl group than the other groups at T1 and T2 points on day 1 and at T0 and T1 points on day 2 (p<0.05). At T2 point on day 2 and on day 3, VAS became significantly lower in the red laser group compared to the other groups (p<0.05). The infrared laser was not more efficacious than the other groups at any of the treatment intervals, but it reduced VAS to an acceptable level. CONCLUSIONS: LLLT displayed good results in this study for treatment of alveolar osteitis and should be further investigated as an alternative to alvogyl for AO management.

Experimental dry socket: microscopic and molecular evaluation of two treatment modalities / Alveolite experimental: análise microscópica e molecular de duas modalidades de tratamento

PURPOSE: To evaluate two treatment modalities of dry socket in rats and to discuss the first findings of the molecular analysis in this experimental model. METHODS: 84 rats underwent a tooth extraction were divided in 4 groups: I-uninfected socket (control), II-infected socket without any treatment, III-infected socket treated with irrigation of 2 percent sodium iodide and 3 percent hydrogen peroxide solution, IV-infected socket submitted to curettage, irrigation with physiological saline solution and fulfilled with metronidazole paste as base. The groups were subdivided in postoperative sacrifice periods: 6/15/28 days. A quantitative and a qualitative microscopic analysis was performed. Also, a quantitative analysis was performed using a RealTimePCR to evaluate the genes expression in the wound healing: Collagen Type I/COL-I, vascular endothelial growth factor/VEGF, osteocalcin/OCN, alkaline phosphatase/ALP, runt-related transcription factor 2/RUNX2 and tumor necrosis factor alpha/TNF-α. RESULTS: The group I showed higher bone formation, followed by groups IV, III, II respectively. The group II presented higher inflammatory infiltrate and the wound healing was delayed compared with other groups. It was obtained a significant positive correlation between bone neoformation and the expression of OCN and RUNX2, inflammatory infiltrate with TNF-α and a negative correlation between bone neoformation and TNF-α. CONCLUSION: No significant difference was found between the treatments.

OBJETIVO: Avaliar duas modalidades de tratamento da alveolite em ratos e discutir os primeiros achados de uma análise molecular neste modelo experimental. MÉTODOS: 84 ratos foram submetidos a uma extração dentária e foram divididos em quatro grupos: I- alvéolo não infectado (controle), II- alvéolo infectado sem tratamento, III- alvéolo infectado tratado com irrigação de iodeto de sódio a 2 por cento e solução de peróxido de hidrogênio a 3 por cento, IV- alvéolo infectado submetido à curetagem, irrigação com solução salina fisiológica e preenchimento com pasta a base de metronidazol. Os grupos foram subdivididos em períodos de sacrifício pós-operatório: 6/15/28 dias. Uma análise quantitativa e qualitativa microscópica foi realizada. Além disso, uma análise quantitativa foi realizada utilizando RealTimePCR para avaliar a expressão de genes no reparo alveolar: o colágeno tipo I / COL-I, o fator de crescimento endotelial vascular / VEGF, osteocalcina / OCN, fosfatase alcalina / ALP, fator de transcrição runt relacionados 2 / RUNX2 e fator de necrose tumoral alfa / TNF-α. RESULTADOS: O grupo I mostrou maior formação óssea, seguido pelos grupos IV, III, II, respectivamente. O grupo II apresentou maior infiltrado inflamatório e a cicatrização foi atrasada em comparação com outros grupos. Foi obtida uma correlação positiva entre a neoformação óssea e a expressão de OCN e RUNX2, infiltrado inflamatório com TNF-α e uma correlação negativa entre a neoformação óssea e TNF-α. CONCLUSÃO: Nenhuma diferença significativa foi encontrada entre os tratamentos.

Experimental dry socket: microscopic and molecular evaluation of two treatment modalities.

PURPOSE: To evaluate two treatment modalities of dry socket in rats and to discuss the first findings of the molecular analysis in this experimental model. METHODS: 84 rats underwent a tooth extraction were divided in 4 groups: I-uninfected socket (control), II-infected socket without any treatment, III-infected socket treated with irrigation of 2% sodium iodide and 3% hydrogen peroxide solution, IV-infected socket submitted to curettage, irrigation with physiological saline solution and fulfilled with metronidazole paste as base. The groups were subdivided in postoperative sacrifice periods: 6/15/28 days. A quantitative and a qualitative microscopic analysis was performed. Also, a quantitative analysis was performed using a RealTimePCR to evaluate the genes expression in the wound healing: Collagen Type I/COL-I, vascular endothelial growth factor/VEGF, osteocalcin/OCN, alkaline phosphatase/ALP, runt-related transcription factor 2/RUNX2 and tumor necrosis factor alpha/TNF-α. RESULTS: The group I showed higher bone formation, followed by groups IV, III, II respectively. The group II presented higher inflammatory infiltrate and the wound healing was delayed compared with other groups. It was obtained a significant positive correlation between bone neoformation and the expression of OCN and RUNX2, inflammatory infiltrate with TNF-α and a negative correlation between bone neoformation and TNF-α. CONCLUSION: No significant difference was found between the treatments.

The efficacy of a topical anesthetic gel in the relief of pain associated with localized alveolar osteitis.

PURPOSE: This prospective randomized clinical study assessed the efficacy of pain control for postextraction alveolar osteitis comparing the use of eugenol on a gauze strip versus a thermosetting gel containing 2.5% prilocaine and 2.5% lidocaine. PATIENTS AND METHODS: Thirty-five patients who presented with postextraction alveolar osteitis were randomly assigned to either a control group or test group. After irrigation of the extraction site with normal saline solution, the control patients were treated with eugenol on a gauze strip placed in the socket and the test patients were treated with the thermosetting gel placed directly into the socket. All patients were given a series of visual analog scales to record their pretreatment pain and post-treatment pain at 5, 10, and 15 minutes and then at 1-hour increments during waking hours for the next 48 hours. They were also given a prescription for an analgesic to use for breakthrough pain during the 48-hour period, if necessary, and instructed to record the dose and timing of any pain medication taken. All patients were seen for follow-up at 48 hours after treatment. RESULTS: The mean pretreatment pain score was 6.72 on a scale ranging from 1 to 10 for the eugenol group and 6.37 for the prilocaine-lidocaine group (SE, 0.46), and the 2 groups were not different (P = .62). In the immediate post-treatment period (0-15 minutes) the pain levels were significantly reduced in both groups (Ps < .001). However, the thermosetting gel produced a significantly greater reduction in pain (mean, 3.23; SE, 0.62) than the eugenol (mean, 4.83; SE, 0.43) (P = .022). Over the next 48 hours, the pain level was nominally less with the thermosetting gel, but this difference was not statistically significant (Ps = .2). CONCLUSION: Although the efficacy of the 2 treatments was not significantly different, the nominal superiority and ease of using the thermosetting gel warrant further investigation.

Modern concepts in understanding and management of the "dry socket" syndrome: comprehensive review of the literature.

OBJECTIVES: This paper provides a comprehensive review of the etiology, pathophysiology and current treatment of dry socket. STUDY DESIGN: The Medline database (Ovid version) from 1966 to 2007 was searched for the term "dry socket" published in the English language, and 317 results were obtained. The articles were screened by abstract for relevance to etiology, pathophysiology, or treatment of dry socket. Treatment papers were ranked on the quality of evidence presented as assessed using the evidence-based systematic review worksheet of the University of Alberta. A total of 62 publications were included in the final review. RESULTS: Prevention methods remain the key to avoiding this complication. Prophylactic placement of topical antibiotics can be considered, whereas systemic antibiotics should be reserved for patients who are immunocompromised. CONCLUSION: This paper provided a comprehensive review of the etiology, pathophysiology, and current treatment of dry socket in dental practice.

Effectiveness of chlorhexidine gel versus chlorhexidine rinse in reducing alveolar osteitis in mandibular third molar surgery.

PURPOSE: Chlorhexidine is an antimicrobial agent used in the prevention of postextraction alveolar osteitis, tooth decay, and periodontal diseases. There are various forms of chlorhexidine application. The most extensively studied is one that uses the rinse as the form of application. Recently, a bioadhesive gel form has become available. Its main advantage is that it prolongs the bioavailability of chlorhexidine in the application area. The purpose of this study was to compare the effectiveness of chlorhexidine gel versus a chlorhexidine rinse in reducing postoperative alveolar osteitis after the extraction of mandibular third molars. MATERIALS AND METHODS: The experimental or gel group (n = 41) applied the bioadhesive 0.2% chlorhexidine gel to the wound during the first postoperative week and a control or rinse group (n = 32) used a 0.12% chlorhexidine rinse during the first week postextraction. RESULTS: We observed a 70% decrease in postoperative alveolar osteitis in the gel group (P = .040). The rinse group had 25% incidence postoperative alveolar osteitis, while the gel group had 7.5%. CONCLUSIONS: It was concluded that the topical application of bioadhesive chlorhexidine gel to the surgical wound during the postoperative week may decrease the incidence of alveolar osteitis after extraction of the mandibular third molars.

Effect estimates and methodological quality of randomized controlled trials about prevention of alveolar osteitis following tooth extraction: a systematic review.

OBJECTIVE: To systematically review the scientific evidence derived from randomized controlled trials (RCT) about prevention of alveolar osteitis (AO). STUDY DESIGN: Literature searches were conducted to locate RCTs about prevention of AO. The RCTs were scrutinized for methodological details and categorized according to the preventive intervention studied. Data were analyzed in relation to the frequency of AO. Absolute risk reductions (ARR), and numbers needed to treat were calculated with 95% confidence limits. RESULTS: There was a wide variation in the design and quality of the RCTs (N = 32). The greatest risk reduction for AO was seen for local treatment with tetracycline (ARR, 12%-31%). For a majority of the preventive interventions, the evidence was absent or inconclusive. CONCLUSIONS: Local treatment with tetracycline, and also 0.12% chlorhexidine rinsing preoperatively and 7 days postoperatively, seem to have significant and clinically relevant preventive effect on AO following surgical removal of lower third molars.