The prevention of 'dry socket' with topical metronidazole in general dental practice.

OBJECTIVE: The purpose of the study was to determine if the intra-alveolar application of topical metronidazole gel could reduce the incidence of alveolar osteitis (dry socket) following routine tooth extraction in molar and premolar extraction sites. DESIGN: This was a multicentre, double blind, randomised, placebo-controlled clinical trial. A total of 302 patients took part, of which 23 returned with alveolar osteitis. Of these, eight had received the metronidazole gel and 15 the placebo. SETTING: The study was carried out in three general dental practices by general dental practitioners working in England over the period 2000-2003. MAIN OUTCOME MEASURES: Following extraction of either a molar or premolar tooth, either a 25% metronidazole gel or KY Jelly was syringed gently into the socket. A painful post operative complication was recorded if either a dry socket was present or the patient returned with pain. RESULTS AND CONCLUSIONS: The difference in the incidence of alveolar osteitis between the placebo and the active gel groups was not significant and it was concluded that 25% topical metronidazole gel was not effective in reducing the incidence of alveolar osteitis. It was found that the incidence of alveolar osteitis reduced with increasing age and was more likely to occur in a patient with a previous history of the condition.

Variability in measurement of radiomorphometric indices by general dental practitioners.

OBJECTIVES: To assess the variability of general dental practitioners (GDPs) in measurement of radiomorphometric indices on panoramic radiographs following basic instruction and to examine whether the variability could be reduced by more individualised instruction. METHODS: Nine GDPs measured Gonion Index (GI), Antegonion Index (AI), Mental Index (MI) and Mandibular Cortical Index (MCI) on copies of 10 panoramic radiographs following a lecture on osteoporosis and the use of radiomorphometric indices. Their measurements were related to expert-derived measurements of the same copy radiographs. Mean differences and limits of agreement (2x standard deviation of differences) were calculated for quantitative indices (GI, AI, MI) and agreement of GDPs with expert-derived MCI assessments was determined using weighted kappa. Following individualised feedback to GDPs, all measurements were repeated after 2 weeks and the statistical analysis repeated. RESULTS: There was extensive variation amongst GDPs in measurement of GI, AI and MI and in assessment of MCI. There was a general tendency of GDPs to record thicker mandibular cortices than did the experts. Limits of agreement were wide relative to the mean values of each quantitative index at both readings. Agreement of the GDPs with experts in assessment of MCI was moderate at both readings, but with a wide range in assessment. CONCLUSIONS: Variability in measuring radiomorphometric indices amongst the GDPs was high and was not predictably improved by individualised instruction. This study casts considerable doubt on the potential value of radiomorphometric indices given their lack of precision.