Definition: A recently extracted tooth that has been filled initially with a clot, that disintegrated, leaving the socket of bone partially/ completely bare.
Signs and symptoms:
- Moderate to severe pain (localised to the socket),
- foul odour or taste (without suppuration),
- symptoms occuring 3 – 5 days post-exo,
- absence of swelling/ lymphadenopathy/ bacteraemia,
- course of pain can last 10 – 40 days
- Excessive mechanical trauma during exo,
- inadequate blood supply to extraction site,
- pre-existing infection,
- vasoconstriction effects secondary to LA (especially intraligamental) or to diabetes,
- loss of blood clot due to mechanical factors,
- diseased tissue/ foreign bodies remaining in socket,
- patient's age,
- smoking, use of oral contraceptives,
- trauma and inadequate irrigation of extraction site,
- use of steroids,
- poor OH and periodontal conditions,
- pericoronitis
Management:
- Confirm radiographically no retained roots/ foreign bodies.
- Under LA, socket gently irrigated with warm saline to clear out necrotic debris (socket should NOT be curetted to bare bone, because that would expose more bone and increase pain)
- Socket dried of excess saline.
- Dressing placed into socket —iodoform gauze / Gelfoam soaked in eugenol should be inserted loosely to cover the wall of the socket.
- Dressing is changed every 24 hours for the first 2 – 3 days; dressing is changed every 2-3 days thereafter till granulation tissue covers bone.
- Prescribe analgesics, NSAIDs. Antibiotics rarely indicated.
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