Aveolar Osteitis

Description

Severe dull pain post dental extraction, two-three days later. Tooth socket appears ‘dry’ with exposed bone and no blood clots, gingiva is inflamed.

Treatment

• Paracetamol 500mg-1g orally 8-hourly for 3 days

OR

• Ibuprofen 200-400mg orally 8 hourly for 3 days

Or

• Diclofenac, oral , adult 50-100mg 12 hourly

Dental referral for LA debridement and curettage to initiate socket healing

Description

A post extraction complication due to infection of the clot due to contamination (Infected socket). The condition is painful and if not managed well could lead to osteomyelitis.

Signs and Symptoms

• Severe painful socket 2–4 days after tooth extraction
• Fever
• Necrotic blood clot in the socket
• Swollen gingiva around the socket
• Sometimes there may be lymphadenopathy and trismus (inability to open the mouth)

Treatment

• Amoxicillin 500mg (PO) 8 hourly for 5–7 days

OR

• Azithromycin 500mg (PO) once a day for 3 - 5days OR
• Erythromycin 500mg (PO) 6 hourly for 5- 7 days AND
• Metronidazole 400mg (PO) 8 hourly for 5 days

Description

Commonly due to disturbing the blood clot by the patient through rinsing or inadequate compression on the gauze, though at times may be due to bony/tooth remnants. Bleeding socket can be primary (occurring within first 24 hours post extraction) or secondary occurring beyond 24 hours post extraction

Signs and Symptoms

• Active bleeding from the socket
• The socket may or may not have blood clot
• Patient may be dehydrated and pale if has lost significant amount of blood
• Features of decreased pulse rate and volume, hypotension also if patient has lost significant amount of blood

Treatment

Supportive

• Ensure the patient airway, breathing and circulation are restored if required
• Check blood pressure and pulse rate and take quick history
• Clear any clot available and examine the socket to identify source of bleeding
• If the bleeding was from soft tissue (which is common) remove any foreign body like bone spicule if found, smoothen any sharp edges
• Suturing of the wound only when necessary (like significantly traumatized gingiva)
• Check and repack the socket with
• Give proper instructions to follow (bite on gauze pack for 30 minutes, not to rinse or eat hot foods on that day at least for 12 hours and avoid disturbance to the wound)
• Packing can be done with materials which stimulate blood clotting like oxidized cellulose (e.g. surgicel/ gauze) or thrombin-containing gel foam sponges

Pharmacological

• Analgesics may be needed:
  • Paracetamol (PO) 1gm 8 hourly for 3 days OR
  • Diclofenac (PO) 50mg-100mg 8 hourly for 3 days OR
  • Ibuprofen (PO) 400mg 8 hourly for 3 days

• Give local anesthesia (lignocaine 2% with adrenaline 1 in 80,000 IU)
• Tranexamic acid 500 mg (PO/IV) 8 hourly for first 24
• Administer Intravenous fluid especially Normal Saline 9% or Ringer’s lactate in case of dehydration then followed by blood transfusion in case of haemoglobin below 7 g/dl in a patient who was otherwise healthy before tooth extract.