Dry Socket Prevalence and Risk Factors in Third Molar Extractions: A Prospective Observational Study.

Background Third molar extraction is a routine oral surgical procedure that is often complicated by the development of a dry socket (alveolar osteitis). This prospective observational study aimed to investigate the prevalence of dry sockets and identify associated risk factors and causes, contributing to a comprehensive understanding of the postoperative outcomes of oral surgery. Methods This study employed a prospective observational design with a 12-month follow-up period. Participants aged 18-40 years scheduled for third molar extraction were included, whereas those with coagulopathies, pregnant or lactating women, patients with vitamin deficiencies, and individuals on medications affecting healing were excluded. Data collection involved comprehensive assessments at baseline, intraoperative details, and postoperative evaluations at 48 hours, one week, and two weeks. Statistical analyses included descriptive statistics, chi-square tests, t-tests, or Mann-Whitney U tests, and logistic regression for the risk factor analysis. Results A total of 238 participants with diverse demographic characteristics were enrolled in this study. The prevalence of dry sockets increased progressively from 20.6% at 48 hours to 41.2% at two weeks post-extraction. Smoking, poor oral hygiene, and surgical technique emerged as significant risk factors, with corresponding odds ratios of 6.41 (95% CI: 2.86-14.36, p < 0.001), 9.53 (95% CI: 2.12-42.84, p = 0.003), and 3.27 (95% CI: 2.08-5.15, p < 0.001), respectively. Pain intensity, measured using a Visual Analog Scale, gradually decreased from 48 hours to two weeks post-extraction. Conclusion This study provides valuable insights into the prevalence and risk factors associated with dry sockets following third molar extractions. Smoking, poor oral hygiene, and poor surgical techniques were identified as significant contributors, emphasizing the importance of preoperative counseling and targeted interventions.

Prevalence of fibrinolytic alveolitis following extraction of impacted mandibular third molars: A systematic review and meta-analysis.

Our research aims to assess the prevalence of alveolar osteitis (AO) following impacted mandibular third molar extractions and investigate the impact of potential moderating factors on this occurrence. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus, and Google Scholar databases. The pooled prevalence, accompanied by 95 % confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Our meta-analysis included twenty-eight eligible studies, encompassing a total of 41,859 impacted mandibular third molar extractions. The overall prevalence of dry socket (DS) following impacted mandibular third molar extractions was estimated at 6.7 % (95 % CI 4.6-9.1 %), indicating considerable heterogeneity among the studies. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.

Er:YAG Laser Therapy on Alveolar Osteitis After Mandibular Third Molar Surgery: A Randomized Controlled Clinical Study.

Background: Alveolar osteitis (AO) or "dry socket" affects the quality of life of patients, and there is a high clinical demand for its effective treatment. Objective: To evaluate the effect of Er:YAG laser therapy (ErLT) on AO after mandibular third molar surgery. Methods: Eighty-three patients were randomly divided into Er (n = 43) and control groups (n = 40). In the Er group, the Er:YAG laser (2940 nm; AT Fidelis Fotona, Ljubljana, Slovenia) was used to irradiate the AO site directly in micro short-pulsed mode (pulse duration 0.1 ms, pulse energy 100 mJ, frequency 40 Hz, water 4, and air 2) until all debris and necrotic material had been removed, exposing fresh bone and soft tissue surfaces with blood exudation. The control group received mechanical therapy until the treated lesions resembled those in the Er group. Pain assessment was performed at baseline and on days 1-7 post-intervention using the visual analog scale (VAS). Wound healing was assessed using the wound healing index (WHI). The operating times of the two therapies were also recorded. Results: Group Er had lower VAS scores than the control group on days 1-3 (p = 0.00). There was no significant difference between the two groups on days 4-7 (p = 0.15). The WHI scores were better in the Er group than those in the control group (t = 2.65, p = 0.01), especially in terms of redness (t = 2.70, p = 0.01). There was no significant difference in the operating time between the two groups (t = 0.76, p = 0.45). Conclusions: Compared with mechanical therapy, ErLT for AO provides rapid pain relief and improved wound healing.

Antibiotic prophylaxis in the prevention of dry socket and surgical site infection after lower third molar extraction: a network meta-analysis.

Clinicians frequently prescribe systemic antibiotics after lower third molar extractions to prevent complications such as surgical site infections and dry socket. A systematic review of randomised clinical trials was conducted to compare the risk of dry socket and surgical site infection after the removal of lower third molars with different prophylactic antibiotics. The occurrence of any antibiotic-related adverse event was also analysed. A pairwise and network meta-analysis was performed to establish direct and indirect comparisons of each outcome variable. Sixteen articles involving 2158 patients (2428 lower third molars) were included, and the following antibiotics were analysed: amoxicillin (with and without clavulanic acid), metronidazole, azithromycin, and clindamycin. Pooled results favoured the use of antibiotics to reduce dry socket and surgical site infection after the removal of a lower third molar, with a number needed to treat of 25 and 18, respectively. Although antibiotic prophylaxis was found to significantly reduce the risk of dry socket and surgical site infection in patients undergoing lower third molar extraction, the number of patients needed to treat was high. Thus, clinicians should evaluate the need to prescribe antibiotics taking into consideration the patient's systemic status and the individual risk of developing a postoperative infection.

Frequency and etiological denominators of alveolar osteitis at Northern Province of Kingdom of Saudi Arabia-An observational study.

Objective: Alveolar osteitis is a painful complication that often arises after tooth extraction, presenting a significant clinical challenge. It is imperative to gain a comprehensive understanding of both its occurrence and the contributing factors to enhance the quality of dental care. The aim of this study was to assess the frequency and prevalence of alveolar osteitis among patients and compare these variables based on demographic characteristics (age and sex), the number of teeth extractions, operator experience, health status, and smoking habits in the target population. Methods: This cross-sectional observational study was conducted from May 2019 to April 2020. It included all patients above 16 years of age, of both genders, who underwent permanent tooth extraction for various reasons. Patient demographics, smoking habits, health status, operating dental surgeon's clinical experience, extraction technique, and the number of teeth extracted were recorded. Statistical analysis was performed using SPSS version 25. Chi-square test and regression analysis were used to assess differences between age, sex, smoking habit, dentist category, and the number of teeth extractions in relation to alveolar osteitis. Results: A total of 679 permanent tooth extractions were performed in 438 patients. Alveolar osteitis was observed in 107 cases (15.7%) following tooth extractions. Among these, 36 cases (33.6%) occurred in single tooth extraction cases, while 71 cases (66.4%) were present in patients with multiple extractions. Moreover, 67 cases (62.6%) of alveolar osteitis were found in cigarette smokers. In addition, 61 cases (57%) of dry sockets were reported after tooth extractions performed by dental interns, while 46 cases (43.0%) were noted in extractions performed by experienced dental surgeons and specialists. Conclusion: The study found a 15.7% incidence of alveolar osteitis in tooth extraction patients in the Al-Jouf region. Alveolar osteitis was more prevalent in males and the age group of 56-77 years. Multiple tooth extractions were associated with higher alveolar osteitis incidence, while operator inexperience increased post-extraction complication risks. In addition, a promising novel protocol and risk assessment scoring system have been devised which require further validation and future research.

Incidencia de osteítis alveolar por exodoncia de terceros molares mandibulares impactados: una revisión sistemática / Incidence of alveolar osteitis due to extraction of impacted mandibular third molars: a systematic review

La extracción de terceros molares mandibulares impactados trae consigo, en muchas oportunidades, complicaciones posoperatorias como la osteítis alveolar o comúnmente llamada alveolitis seca que dificulta la cicatrización del alveolo. En este sentido, el objetivo de la revisión fue determinar la incidencia de la osteítis alveolar por exodoncia de terceros molares mandibulares impactados. Se realizó la búsqueda bibliográfica sin restricción de año ni de idioma en PubMed, Scopus, Science Direct, Lilacs y Scielo, empleando tèrminos estandarizados en Medical Subject Headings (MeSH NLM). La confección de la investigación se realizó siguiendo los lineamientos PRISMA-2020 y para la evaluación de la calidad y sesgo de los artículos se empleó las herramientas de la National Heart Lung and Blood Institute (NHLBI). Se obtuvieron (n=4907) estudios, los cuales se subieron al aplicativo web Rayyan para seleccionarlos siguiendo los criterios de inclusión y exclusión planteados previamente. Tras el análisis crítico se eligieron 2 estudios para su revisión, cuyos datos se extrajeron según los indicadores establecidos por los autores. Se concluye que existe una incidencia baja de osteítis alveolar despuès de la extracción de terceros molares mandibulares impactados, descartándose la relación entre el gènero y el padecimiento de esta complicación. Además se resalta la irrigación con clorhexidina y suero fisiológico como tratamiento para esta afección. (AU)

The extraction of impacted mandibular third molars often brings with it postoperative complications such as alveolar osteitis or commonly called dry socket that makes it difficult for the alveolus to heal. In this sense, the objective of the review was to determine the incidence of alveolar osteitis due to extraction of impacted mandibular third molars. The bibliographic search was carried out without restriction of year or language in PubMed, Scopus, Science Direct, Lilacs and Scielo, using standardized terms in Medical Subject Headings (MeSH NLM). The preparation of the research was carried out following the PRISMA-2020 guidelines and the tools of the National Heart Lung and Blood Institute (NHLBI) were used to evaluate the quality and bias of the articles. Studies (n=4907) were obtained, which were uploaded to the Rayyan web application to select them following the inclusion and exclusion criteria previously stated. After critical analysis, 2 studies were chosen for review, whose data were extracted according to the indicators established by the authors. It is concluded that there is a low incidence of alveolar osteitis after the extraction of impacted mandibular third molars, ruling out the relationship between gender and suffering from this complication. In addition, irrigation with chlorhexidine and physiological serum is highlighted as a treatment for this condition. (AU)

A New Approach for Explaining and Treating Dry Sockets: A Pilot Retrospective Study.

Objective Dry socket, a common complication following a tooth extraction, is characterized by severe and radiating pain that typically begins one to four days after the extraction. Despite several risk factors, the exact cause and underlying mechanisms of dry sockets remain unclear. This study aims to propose a novel pathogenesis and management approach for dry sockets based on an infectious process. Methods The study was conducted by reviewing medical records, at a private dental clinic, of patients who fit the inclusion criteria; these patients appeared to have come between April 2022 and April 2023. The study included all patients with age ≥17 years diagnosed with dry socket that was resistant to conventional topical treatment, and who received treatment with ciprofloxacin 500 mg three times per day during the study period. Results Out of 15 patients who received treatment with ciprofloxacin 500 mg three times per day during the study period, 11 patients (73.3%) were completely relieved of symptoms within 24 hours, with no need for additional painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, two patients (13.3%) had a partial response after 48 hours, where their pain was ameliorated from severe to moderate with the use of conventional painkillers (including paracetamol and NSAIDs) and steroidal anti-inflammatory drugs such as dexamethasone (8 mg IM daily) to have total relief. On the other hand, the other two patients (13.3%) had a negative response to the treatment and were out of reach for follow-up. Conclusion These clinical outcomes, coupled with previous laboratory data, could explain all clinical aspects of dry sockets and provide substantial support for the hypothesis that an infectious mechanism plays the principal role in the pathophysiology of dry sockets.

Efficacy of a New Hemostatic Dental Sponge in Controlling Bleeding, Pain, and Dry Socket Following Mandibular Posterior Teeth Extraction-A Split-Mouth Randomized Double-Blind Clinical Trial.

AIMS: This study aimed to clinically evaluate of a novel gelatin-based biodegradable sponge after mandibular posterior teeth extraction to assess its abilities in controlling bleeding, pain, and dry socket compared a commercial sponge. TRIAL DESIGN: In this study, 26 patients who needed the extraction of two mandibular molar teeth were selected and, in each patient, after tooth extraction, the prepared gelatin sponge was used in the test group and the commercial sponge was used in the control group in the form of a randomized, double-blind, split-mouth clinical trial. The sterile gauzes were used on top of each sponge to absorb the extra blood (unabsorbed blood of sponges) to assess the blood absorption amount. Also, the amount of bleeding was recorded for 1 and 4 h after extraction for two groups. The amount of pain was measured for 12, 24, and 48 h after tooth extraction by Visual Analogue Scale (VAS). All patients also returned for examination four days after extraction to assess the occurrence of dry socket. RESULTS: The results showed that the average weight of absorbed blood by sterile gauze in the control group (6.32 ± 1.06 g) was higher than in test group (3.97 ± 1.1 g), e.g., the bleeding control was better for the test group (p < 0.05). Bleeding was observed to be significantly reduced in the test group within 1 h (p = 0.003), within 1-4 h (p = 0.002), and after 4 h (p = 0.042) post-operatively in comparison to the control group. The average pain decreased significantly over time in both groups and the reduction of the pain was significantly higher for the test group (p < 0.05). Just one dry socket case occurred in the control group. CONCLUSION: The prepared sponge is recommended for use in dental surgeries because of its abilities in bleeding, pain, and dry socket control.

La alveolitis y sus factores de riesgo en la población adulta joven / Dry socket and its risk factors in a young adult population

Introducción: La alveolitis es la complicación más frecuente de la extracción dental, y constituye la causa más común de las consultas de Urgencias, pues los pacientes presentan dolor en el período postoperatorio. Aunque la etiología de esta afección no es muy conocida, se considera que es un trastorno multifactorial. Objetivos: Determinar el tipo de alveolitis más frecuente en la muestra objeto de estudio, así como establecer la relación entre los factores de riesgo y el tipo de alveolitis. Métodos: Se realizó un estudio descriptivo y trasversal en el Servicio de Urgencias de la Clínica Estomatológica «Celia Sánchez Manduley», de Santa Clara, Villa Clara, desde febrero de 2020 a junio de 2021. El estudio se realizó en un total de 51 pacientes diagnosticados con alveolitis dental. Se estudiaron las siguientes variables: tipo de alveolitis y factores de riesgo (edad, sexo, antecedentes de enfermedades, el uso de tabletas anticonceptivas, hábitos tóxicos, condiciones del medio bucal, características de la maniobra quirúrgica y cuidados postoperatorios); los datos fueron recogidos en un formulario. Resultados: Predominó la alveolitis seca en las pacientes del sexo femenino. El hábito de fumar y la práctica de una maniobra quirúrgica compleja fueron los factores de riesgo preponderantes. Conclusiones: Existe una relación significativa entre la presencia de alveolitis seca y las pacientes del sexo femenino asociadas a los hábitos tóxicos, el uso de tabletas anticonceptivas, y haber sido sometidas a una maniobra quirúrgica compleja.

Introduction: dry socket is the most frequent complication after a dental extraction and constitutes the most common cause of emergency consultations, since patients have pain in the postoperative period. It is considered to be a multifactorial disorder although the etiology of this condition is not well known. Objectives: to determine the most common type of dry socket in the sample under study, as well as to establish the relationship between risk factors and the type of dry socket. Methods: a descriptive and cross-sectional study was carried out in the emergency department at "Celia Sánchez Manduley" Dental Clinic, in Santa Clara, Villa Clara, from February 2020 to June 2021. The study was carried out in a total of 51 patients who were diagnosed with dry socket. Type of dry socket and risk factors such as age, gender, history of diseases, use of contraceptive tablets, toxic habits, conditions of the oral environment, characteristics of the surgical procedure and postoperative care were the variables studied; the data was collected in a form. Results: dry socket predominated in female patients. Smoking and performing a complex surgical maneuver were the predominant risk factors. Conclusions: there is a significant relationship among the presence of dry socket and female patients associated with toxic habits, the use of contraceptive tablets, and having undergone a complex surgical maneuver.

Investigation of the clinical efficacy of CGF and ozone in the management of alveolar osteitis: a randomized controlled trial.

OBJECTIVES: To investigate the efficacy of concentrated growth factors (CGF) and ozone in the treatment of alveolar osteitis (AO). MATERIALS AND METHODS: Patients admitted for the treatment of AO and eligible for the study were included and divided into control, ozone, and CGF + ozone groups. For the treatment of AO alveogyl, ozone, and CGF + ozone were applied to control, ozone, and CGF + ozone groups, respectively, and repeated on 3rd day. Demographic data and oral hygiene were recorded at the initial visit. Pain with visual analog scale (VAS) and analgesic consumption were evaluated at the 6th and 24th h, and on 2nd-7th days. Granulation tissue health and inflammation severity were evaluated on the 1st, 3rd, and 7th days. Quality of life was evaluated with the postoperative symptom severity scale (Posse) on the 7th day. RESULTS: A total of 60 patients (43 females/17 males; mean age 42.7 ± 13.76 years), 20 patients per group were included. Among the groups, pain scores on the 7th day (p = 0.042), granulation tissue health on the 3rd (p = 0.003) and 7th (p = 0.015) days showed a significant difference while analgesic consumption, Posse scores, and inflammation severity showed no significant differences (p > 0.05). Between genders analgesic consumption at 6 h (p = 0.027), 24 h (p = 0.033), and on the 2nd day (p = 0.034) and inflammation severity on the 7th day (p = 0.012) showed significant differences while Posse scores and granulation tissue health showed no significant differences (p > 0.05). CONCLUSIONS: This study demonstrates that regenerative treatment which modulates angiogenesis, and tissue regeneration by stimulating stem cells, growth factors, and cytokines with CGF + ozone are more effective than conventional treatment regarding AO. CLINICAL RELEVANCE: Usage of CGF and ozone together provides faster and more satisfactory management of AO.

Effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis: a scoping review.

OBJECTIVES: The aim of this scoping review was to determine the effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis. MATERIALS AND METHODS: Reporting was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A literature search was conducted in the PubMed and Scopus databases to identify all clinical studies on the application of platelet-rich fibrin in the control of pain caused by alveolar osteitis. Data were extracted independently by two reviewers and qualitatively described. RESULTS: The initial search returned 81 articles, with 49 identified after duplicates removal; of these, 8 were selected according to the inclusion criteria. Three of the eight studies were randomized controlled clinical trials, and four were non-randomized clinical studies, two of which were controlled. One study was case series. In all of these studies, pain control was evaluated using the visual analog scale. Overall, the use of platelet-rich fibrin resulted effective in the control of pain determined by alveolar osteitis. CONCLUSIONS: Within the limits of this scoping review, the application of platelet-rich fibrin in the post-extra-extraction alveolus reduced the pain associated with alveolar osteitis in almost all the included studies. Nevertheless, high-quality randomized trials with adequate sample size are warranted to draw firm conclusions. CLINICAL RELEVANCE: Pain associated with alveolar osteitis causes discomfort to the patient and is challenging to be treated. Use of platelet-rich fibrin could be a promising clinical strategy for pain control in alveolar osteitis if its effectiveness will be confirmed by further high-quality studies.

The financial and quality of life impact of urgent dental presentations: A cross-sectional study.

AIM: This study aimed to: (i) calculate personal financial costs associated with urgent dental attendance; and (ii) investigate the pain-related disability and quality of life impact of dental conditions which result in urgent dental attendance. METHODOLOGY: Data were collected from those presenting with urgent dental conditions to an out-of-hours dental service, a dental emergency clinic (DEC) and five primary care general dental practices across North-East England. A pre-operative questionnaire explored the impact of urgent dental conditions on oral health-related quality of life (OHRQoL) using Oral Health Impact Profile-14 (OHIP-14) and a modified Graded Chronic Pain Scale (GCPS). OHIP-14 yields a maximum score of 56, with a higher score indicating a lower OHRQoL. Personal financial costs were summed to provide a total. These included travel, appointment fees, childcare costs, medication use and time away from work. Data were analysed using one-way anova and multivariable modelling. RESULTS: In total, 714 participants were recruited. The mean OHIP-14 score was 25.73; 95% CI [24.67, 26.79], GCPS CPI was 71.69; 95% CI [70.09, 73.28] and GCPS interference was 49.56; 95% CI [47.24, 51.87]. Symptomatic irreversible pulpitis was the most frequently managed dental emergency and was associated with the highest mean OHIP-14 score (31.67; 95% CI [30.20, 33.15]). The mean personal financial cost of urgent dental care (UDC) was £85.81; 95% CI [73.29, 98.33]. Differences in travel time (F[2, 691] = 10.24, p < .001), transport costs (F[2, 698] = 4.92, p = .004), and appointment time (F[2, 74] = 9.40, p < .001) were significant between patients attending an out-of-hours dental service, DEC and dental practices for emergency care, with a DEC being associated with the highest costs and dental practices the lowest. CONCLUSIONS: Diseases of the pulp and associated periapical disease were the most common reason for patients to present for UDC and were the most impactful in terms of OHRQoL and pain in the present sample. Personal financial costs are significant from urgent dental conditions, with centralized services increasing the burden to patients of attending appointments.

Comparative Clinical Study of the Effect of Nigella Sativa Oil on Soft Tissue Healing and Inflammation Reduction Compared to Eugenol in the Context of Dry Socket.

Research background Dry socket is one of the most common complications occurring after the extraction of a permanent tooth, but despite its high incidence, there is no established treatment for this condition. Nigella sativa oil has anti-inflammatory properties and enhances wound healing. Thus, we have decided to conduct a study to evaluate the efficacy of Nigella sativa oil in the context of dry sockets.  Aim of the study This study aims to evaluate the effect of a Nigella Sativa oil dressing compared with an Eugenol dressing for the treatment of dry sockets in terms of accelerating soft tissue healing and reducing the intensity of inflammation.  Materials and methods A total of 36 patients (19 males, 17 females), ranging between 20 and 50 years, 40 sockets with Alveolar osteitis randomized into 20 sockets for each group. In the first group, Eugenol with a Gelfoam carrier was used, in the second group, Nigella Sativa oil with a Gelfoam carrier was used and after copious irrigation with normal saline in both groups. Soft tissue healing and the degree of inflammation were monitored on the third (T1) and seventh (T2) days.  Results The results of our study showed clinical and statistical superiority in favor of the Nigella Sativa oil group compared to the Eugenol group at time T2, where the P-value was less than 0.05.  Conclusions Within the limits of our study, we found that Nigella Sativa oil led to better healing of soft tissues and reduced the intensity of inflammation in the context of dry socket, and was superior in effectiveness to Eugenol, and we recommend its use for the treatment of dry socket.

Root-shaped antibacterial alginate sponges with enhanced hemostasis and osteogenesis for the prevention of dry socket.

Tooth extraction commonly causes uncontrolled bleeding, loss of blood clots, and bacterial infection, leading to the dry socket and bone resorption. Thus, it is highly attractive to design a bio-multifunctional scaffold with outstanding antimicrobial, hemostatic, and osteogenic performances for avoiding dry sockets in clinical applications. Herein, alginate (AG)/quaternized chitosan (Qch)/diatomite (Di) sponges were fabricated via electrostatic interaction, Ca2+ cross-linking, as well as lyophilization methods. The composite sponges are facilely made into the shape of the tooth root, which could be well integrated into the alveolar fossa. The sponge shows a highly interconnected and hierarchical porous structure at the macro/micro/nano levels. The prepared sponges also possess enhanced hemostatic and antibacterial abilities. Moreover, in vitro cellular assessment indicates that the developed sponges have favorable cytocompatibility and significantly facilitate osteogenesis by upregulating the formation of alkaline phosphatase and calcium nodules. The designed bio-multifunctional sponges display great potential for trauma treatment after tooth extraction.

Prevalencia de alveolitis seca asociada a urgencias dolorosas durante el aislamiento social preventivo y obligatorio de la pandemia COVID-19 en un servicio de urgencias del área bonaerense metropolitana en la República ArgentinaPrevalence of dry socket associated with urgent dental extractions due to pain performed at an emergency service in the Buenos Aires Metropolitan Area during the mandatory preventive social isolation for the COVID-19 pandemic in Argentina / Prevalence of dry socket associated with urgent dental extractions due to pain performed at an emergency service in the Buenos Aires Metropolitan Area during the mandatory preventive social isolation for the COVID-19 pandemic in Argentina

Objective: To evaluate the prevalence of dry socket as a postoperative complication in cases where there was intense local pain in the preoperative state, during the preventive mandatory social isolation (PMSI) for the COVID-19 pandemic in Argentina. Methods: This was a descriptive study, which included 1209 walk-in patients at the emergency and orientational service at Buenos Aires University School of Dentistry during the PMSI from March 20 to June 20, 2020, with indication for dental extraction as well as intense acute pain at the surgical site. The presence of dry socket was exploratoryly associated with the variables age, sex, smoking and chronic medication use. Results: 1209 patients were operated, resulting in a total 1372 dental extractions. Average patient age was 41 years. The prevalence found in this study was 1.06%. Conclusion: The prevalence of dry socket was 1%, not being higher than other experiences where pain was not considered a condition prior to extraction.

Objetivo: Evaluar la prevalencia de alveolitis seca como complicación postquirúrgica, cuando existió dolor intenso local en el preoperatorio, durante el Aislamiento Social Preventivo y Obligatorios (ASPO) de la pandemia COVID-19 en la República Argentina. Material y Métodos: Se realizó un estudio descriptivo en el que fueron incluidos 1209 pacientes, que presentaron indicación de exodoncia y concurrieron al servicio de urgencias y orientación de pacientes de la Facultad de Odontología de la universidad de Buenos Aires, durante el ASPO en un periodo comprendido entre el 20 de marzo y el 20 de junio de 2020, con dolor agudo e intenso en el sitio quirúrgico. La presencia de alveolitis seca fue asociada de forma exploratoria con las variables edad, sexo, tabaquiamo y medicación de uso crónico. Resultados: Fueron operados 1209 pacientes a los que se les realizaron un total de 1372 exodoncias, con un promedio de edad 41 años. La prevalencia fue de 1,06%. Conclusión: La prevalencia de alveolitis seca fue del 1%, no siendo superior a otras experiencias donde no se consideró al dolor como una condición previa a la exodoncia.

Comparison between ozone and CHX gel application for reduction of pain and incidence of dry socket after lower third molar removal.

OBJECTIVES: The aim of this study is to evaluate the efficacy between ozone gas and 1% chlorhexidine (CHX) gel in the incidence of dry socket after surgical extraction of impacted lower third molars. MATERIAL AND METHODS: Overall, 30 patients of both genders were included in the study, with indication of surgical extraction of lower third molar, positioned similarly after being clinically and radiographically checked by X-ray and orthopantomography. Each patient was subjected to both groups in separate sessions: treated with ozone gas and with CHX gel 1%. Data on pain intensity, number of taken analgesics-painkillers, and dry socket were recorded for 48 h and at Day 7. RESULTS: Ozone gas and CHX gel effectively reduced pain intensity and prevented dry socket. The number of taken analgesics 48 h and 7 days after surgery showed no statistical significance. The same was observed for the distribution of pain. Only one patient reported the occurrence of dry socket 7 days after the surgical extraction. CONCLUSIONS: Ozone gas and CHX 1% gel are both efficient in decreasing postoperative symptoms and incidence rates of dry socket, but in comparison to each other, the use of ozone gas is showing a bit better prevention capability.

Antimicrobial and bone repair effects of boric acid in a rat model of dry socket (alveolar osteitis) following dental extraction.

BACKGROUND: Alveolitis occurs after dental extraction without blood clot formation, leading to an inflammatory process and bacterial contamination. Boric acid (BA) demonstrates anti-inflammatory, antimicrobial, and osteogenic properties. This study aims to evaluate the possible antimicrobial effects and bone repair of BA in a rat model of alveolitis (dry socket). METHODS: 33 male Wistar rats were submitted to the extraction of the upper right incisor and dry socket induction. They were first divided into two groups: dry socket (n = 17) and dry socket + 0.75 % BA (n = 16). Samples for the microbiological analysis were collected immediately after dental extraction, at the detection of clinical alveolitis, 7, and 14 days after BA application. For microCT and histological analysis, samples from euthanized rats were used in 14 and 28 days after alveolitis detection. RESULTS: Higher bacterial counts were found in 4-5 days after alveolitis induction, compared to the baseline in both experimental groups, decreasing significantly after 7 and 14 days of treatment with BA (P < 0.05). The microCT evaluation displayed increased bone volume, bone volume fraction, trabecular thickness, and bone mineral density in a time-dependent manner, regardless of BA treatment. On the other hand, the number of trabeculae and total bone porosity decreased over the 28 days of the experiment in the dry-socket group and both groups, respectively (P < 0.05). Histological analysis did not differ on bone repair in both experimental groups. CONCLUSION: This was the first report investigating the effects of BA in a rat model of alveolitis regarding microbiological and bone repair aspects. The BA local application decreased the total aerobic and facultative bacteria counts and does not seem to benefit the bone repair after alveolitis development. This study paves the way for more studies involving alveolitis and different BA applications.

Effectiveness of Honey in the Treatment and Prevention of Alveolar Osteitis: Systematic Review and Meta-analysis.

Objectives: Honey has been used for millennia as a treatment for covering wounds that are difficult to repair. Hippocrates already reported the benefits of honey with this type of treatment. The objective of this work is to evaluate the literature on the use of honey in cases as preventive as treatment complications after extractions, more specifically alveolar osteitis or alveolitis. Material and Methods: A systematic literature review was carried out on PubMed, LILACS and Dimensions platforms, following PRISMA guidelines, to gain more knowledge on the topic. Due to the scarcity of articles on the topic, there are no restrictions regarding languages, publication dates or impact factor journal. Animal studies and reviews were excluded. Risk of bias was assessed through Review Manager Software 5.4. Results: With simple, low-cost, and affordable medications, many of the complications after tooth extractions can be resolved more quickly and less painfully for patients with more significant difficulties, whether financial or access, to other treatments. Conclusion: Honey is an effective prevention and treatment for alveolar osteitis.

Effectiveness of different socket dressing materials on the postoperative pain following tooth extraction: a randomized control trial.

We aimed to prospectively evaluate and compare the effectiveness of Alvogyl and Cutanplast as intra-alveolar dressings for managing pain associated with extraction and incidence of dry socket. All patients who underwent maxillary and mandibular teeth extraction and fulfilled our inclusion and exclusion criteria from Feb 2021 to Oct 2021 were included in our study. Patients who were diagnosed with postoperative pain after tooth extraction were randomly allocated to three groups: Group A (Alvogyl), Group B (Cutanplast), and Group C (placebo). Pain relief and healing of the socket were compared between these groups. The collected data were analyzed using the Chi-square test and Z test of proportionality. Alvogyl was superior to the other medication for providing initial pain relief, and the incidence of dry socket was significantly lower than in the Cutanplast and placebo groups (p<0.05). However, wound healing was statistically non-significant among groups A, B, and C (p>0.05). Alvogyl is still the material of choice in terms of pain relief, wound healing, and low incidence of dry socket. Furthermore, no statistically significant difference was detected between the groups in the biographic information, location, and condition of the extracted tooth, presence of a radiologic pathology, or type of extraction procedure. Moreover, whether it is the first extraction or not, Alvogyl and Cutanpast are comparable in postoperative pain management as intra-alveolar dressing materials.