Alveolar osteitis is an inflammation of the alveolar bone (ie, the alveolar process of the maxilla or lower jaw). Classically, this occurs as a postoperative complication of tooth extraction.
Alveolar osteitis usually occurs where blood clots fail to form or disappear from the socket (ie, defects left in the gums when teeth are removed). This leaves an empty socket where the bone is exposed to the oral cavity, causing localized alveolar osteitis to be limited to the lamina dura (ie the bone lining the socket). This particular type of alveolar osteitis is also known as dry socket or, more rarely, fibrinolytic alveolitis , and is associated with increased pain and delayed healing time.
Dry sockets occur in about 0.5-5% of routine tooth extraction, and in about 25-30% extraction of the impacted lower third molars (wisdom teeth buried in the bone).
Video Alveolar osteitis
Classification
Since the dry socket occurs exclusively after tooth extraction, it can be considered as an iatrogenic complication and condition, but this does not take into account both the reasons why tooth extraction is necessary (eg, retraction may be unavoidable due to significant pain and infection) as well as the fact that many sockets dryness is the result of poor adherence to postoperative instruction, especially refraining from smoking in the days immediately following the procedure.
Maps Alveolar osteitis
Signs and symptoms
Because alveolar osteitis is not primarily an infection, usually there is no fever (fever) and cervical lymphadenitis (swollen neck gland), and only slight edema (swelling) and erythema (redness) present in the soft tissues around the socket.
Alerts may include:
- An empty socket, partially or completely without a blood clot. Exposed bones may be visible or sockets may be filled with food scraps that reveal open bones after removal. The open bone is very painful and sensitive to touch. The inflamed soft tissues around it can block the sockets and hide the dry sockets from regular checks.
- Wall bare bones.
Symptoms may include:
- Dull, painful, throbbing pain in the socket area, which is moderate to severe and can spread to other parts of the head such as the ears, eyes, temples, and neck. Pain usually begins on the second to fourth day after extraction, and can last 10-40 days. The pain may be so strong that strong analgesics do not ease it.
- Intraoral Halitosis (oral malodor).
- Bad taste in mouth.
Cause
The cause of the dry socket is not fully understood. Usually, after tooth extraction, blood is extracted into the socket, and the form of a blood clot (thrombus). This blood clot is replaced by a granulation tissue consisting of the proliferation of fibroblasts and endothelial cells derived from the remnants of periodontal membranes, alveolar bone and surrounding gingival mucosa. In time this in turn is replaced by abrupt bone, fibrillar bone and finally by a mature bone. The clot may fail to form due to poor blood supply (eg, secondary factors from localized smoking such as, anatomical sites, bone density and conditions that cause sclerotic bone to form). The clot may be lost by excessive mouth wetting, or prematurely destroyed by fibrinolysis. Fibrinolysis is clotting degeneration and may be caused by the conversion of plasminogen to plasmin and the formation of quinine. Factors that promote fibrinolysis include local trauma, estrogen, and pyrogens from bacteria.
The bacteria may be secondary to colonizing the socket, and lead to further dissolution of the clot. The destruction of bacteria and fibrinolysis is widely accepted as a major factor contributing to the loss of blood clots. Bone tissue is exposed to the oral environment, and local inflammatory reactions occur in adjacent marrow spaces. It localizes the inflammation into the socket wall, which becomes necrotic. The necrotic bone in the socket wall is slowly separated by osteoclasts and fragmentary sequues can form. The jawbones appear to have some evolutionary resistance to this process. When bones are exposed on other sites in the human body, this is a much more serious condition.
In a dry socket, healing is delayed because the tissue must grow from the surrounding gingival mucosa, which takes longer than the organization of normal blood clots. Some patients may develop short-term halitosis, which is the result of stagnant food debris in the socket and the subsequent action of halitogenic bacteria. The main factors involved in dry socket development are discussed below.
Site extraction
Dry sockets are more common in the mandible than the upper jaw, due to the relatively poor mandibular blood supply and also because food scraps tend to congregate in the lower sockets more easily than the top ones. This is more common in posterior sockets (molar teeth) than anterior sockets (premolars and incisors), probably because the size of the surgical defect is made relatively larger, and because the blood supply is relatively worse in these places. Dry sockets are mainly associated with low wisdom tooth extraction. Inadequate Irrigation (wash) from the socket has been associated with an increased chance of dry sockets.
Infection
Dry sockets are more likely to occur where there is an infection already present in the mouth, such as necrotizing ulcerative gingivitis or chronic periodontitis. Younger teeth unrelated to pericoronitis tend not to cause dry sockets when extracted. Oral microbiota have been shown to have fibrinolytic action in some individuals, and these individuals may tend to develop dry sockets after tooth extraction. Socket infections after tooth extraction are different from dry sockets, although on dry sockets secondary infections may occur in addition.
Smoking
Smoking and tobacco use in any form is associated with an increased risk of dry sockets. This may be partly due to the action of vasoconstriction of nicotine in small blood vessels. Avoiding smoking in the days immediately after tooth extraction reduces the risk of dry sockets occurring.
Surgical surgery
Dry sockets are more likely to occur after tooth extraction is difficult. It is thought that excessive force is applied to the teeth, or excessive tooth movement polishes the socket bone wall and destroys the blood vessels, disrupting the repair process. It also shows that dry sockets are more likely to occur when an inexperienced surgeon extraction, possibly because of excessive force or excessive tooth movement is used.
Vasoconstrictor
Vasoconstrictors are present in most local anesthetics, and are intended to increase the length of analgesia by reducing the blood supply to areas that reduce the amount of local anesthetic solution absorbed into the circulation and carried from the local tissues. Therefore, the use of local anesthesia with vasoconstrictors is associated with an increased risk of dry sockets occurring. However, frequent use of local anesthesia without vasoconstrictors will not provide sufficient analgesia, especially in the presence of acute pain and infection, which means that the total local anesthetic dose may need to be increased. Adequate pain control during extraction is balanced with an increased risk of dry sockets.
Radiotherapy
Radiotherapy is directed at the jawbone causing some changes in tissue, so the blood supply decreases.
Menstrual Cycle
The menstrual cycle can be a decisive risk factor in the frequency of Alveolar Osteitis. Studies have shown that due to hormonal changes, women in the middle of menstrual cycles and who use oral contraceptives (birth control pills) have a higher tendency to experience Alveolar Osteitis after tooth extraction surgery. It is recommended that elective surgery be performed during both menstrual periods in both oral and non-user use of contraceptives to eliminate the effects of hormonal changes related to cycles on the development of Alveolar Osteitis.
Diagnosis
Dry sockets usually cause pain on the second to fourth day after tooth extraction. Other causes of post-extraction pain usually occur soon after the anesthesia/analgesia has faded, (eg, normal pain due to surgical trauma or mandibular fracture) or has a slower onset (eg, osteomyelitis, which usually causes pain a few weeks after extraction). The examination usually involves gentle irrigation with warm saline and probing sockets to make the diagnosis. Sometimes part of the tooth root or piece of bone is broken and kept in the socket. This could be another cause of pain in the socket, and lead to delayed healing. Dental radiography (x-rays) may be indicated to indicate suspected fragments.
Prevention
A systematic review reported that there is some evidence that gargling with chlorhexidine (0.12% or 0.2%) or placing a chlorhexidine gel (0.2%) in the extracted tooth socket reduces the frequency of the dry socket. Another systematic review concludes that there is evidence that prophylactic antibiotics reduce the risk of dry sockets (and infections and pain) after third wisdom tooth extraction, but their use is associated with mild and temporary adverse events. The authors question whether treating 12 patients with antibiotics to prevent one infection would be more harmful overall than good, given potential side effects and also antibiotic resistance. Nevertheless, there is evidence that individuals at risk can clearly benefit from antibiotics. There is also evidence that antifibrinolytic agents applied to the socket after extraction may reduce the risk of dry sockets.
Some dentists and oral surgeons routinely cut down bone socket walls to encourage bleeding (bleeding) in the belief that this reduces the incidence of dry sockets, but there is no evidence to support this practice. It has been suggested that tooth extraction in women taking oral contraceptives is scheduled on days without estrogen supplementation (usually days 23-28 of the menstrual cycle). It has also been suggested that the teeth to be extracted should be scaled before the procedure.
Prevention of alveolar osteitis can be confirmed by following post-operative instructions, including:
- Take the recommended drugs
- Avoid hot fluid intake for one to two days. Hot liquids increase local blood flow and thus disrupt clot organization. Therefore, cold and food liquids are recommended, which facilitate clot formation and prevent disintegration.
- Avoid smoking. It reduces the blood supply, leading to tissue ischemia, reducing tissue perfusion and ultimately higher incidence of painful sockets.
- Avoid drinking through straws or spitting by force because this creates a negative pressure in the oral cavity that leads to an increased chance of blood clotting instability.
Treatment
Treatment is usually symptomatic, (ie analgesic) and also removal of debris from sockets by irrigation with saline or local anesthesia. Medical dressings are also commonly placed in sockets; although this will act as a foreign body and extend healing, they are usually required due to severe pain. Therefore, dressing usually stops after the pain is reduced. Examples of medicinal dressings include antibacterial, topical anesthesia and obtundan, or a combination of all three, for example, zinc oxide and eugenol infused with cotton pellet, alvogyl (eugenol, iodoform and butamen), dentalone, bismuth subnitrate and iodoform paste (BIPP) on gauze and ointment ribbons metronidazole and lidocaine. A systematic review of the efficacy of treatment for dry sockets concluded that there was insufficient evidence to distinguish the effectiveness of any treatment. People who develop dry sockets usually seek medical advice/teeth several times after tooth extraction, where the old dressing is removed, the socket is irrigated and placed in new dressing. The socket curette increases the pain and has been prevented by some people.
Prognosis
If a dry socket occurs, the total healing time increases. Postoperative pain is also worse than the normal discomfort that accompanies healing after a small surgical procedure. The pain can last for seven to forty days.
Epidemiology
Overall, the incidence of dry sockets was about 0.5-5% for routine tooth extraction, and about 25-30% for the impact of mandibular third molar teeth (wisdom teeth buried in bone).
Women are more often affected than men, but this appears to be related to oral contraceptive use rather than the underlying gender predilection. The majority of dry sockets occur in individuals between the ages of 20 and 40 when most tooth extractions occur, although for each individual it is likely to occur with age.
Other possible risk factors include periodontal disease, acute necrotizing ulcerative gingivitis, local bone disease, Paget bone disease, osteopetrosis, semeno-osseous dysplasia, previous history of developing dry sockets with past extraction and inadequate oral hygiene. Other factors in the postoperative period that can cause loss of blood clots include strong saliva, sucking through a straw, and coughing or sneezing.
Etymology
Alveolar refers to the alveolus, the alveolar process of the lower jaw or upper jaw; osteitis comes from oste - , from Greek, osteon meaning "bone"; and -itis means a disease characterized by inflammation.
Osteitis generally refers to local bone inflammation without progression through the marrow space (compared with osteomyelitis).
Often, the term alveolar osteitis is considered to be synonymous with "dry socket", but some specify that the dry socket is focal or local alveolar osteitis. An example of another type of osteitis is focal sclerosing/condensing osteitis. The name of the dry socket is used because the socket has a dry look after the blood clot is gone and the dirt is gone.
References
Source of the article : Wikipedia
0 Comments