J Korean Assoc Oral Maxillofac Surg.  2018 Apr;44(2):52-58. 10.5125/jkaoms.2018.44.2.52.

Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques

• Mamoun J

• KMID: 2410580
• DOI: http://doi.org/10.5125/jkaoms.2018.44.2.52

Abstract

Dry socket, also termed fibrinolytic osteitis or alveolar osteitis, is a complication of tooth exodontia. A dry socket lesion is a post-extraction socket that exhibits exposed bone that is not covered by a blood clot or healing epithelium and exists inside or around the perimeter of the socket or alveolus for days after the extraction procedure. This article describes dry socket lesions; reviews the basic clinical techniques of treating different manifestations of dry socket lesions; and shows how microscope level loupe magnification of 6× to 8× or greater, combined with co-axial illumination or a dental operating microscope, facilitate more precise treatment of dry socket lesions. The author examines the scientific validity of the proposed causes of dry socket lesions (such as bacteria, inflammation, fibrinolysis, or traumatic extractions) and the scientific validity of different terminologies used to describe dry socket lesions. This article also presents an alternative model of what causes dry socket lesions, based on evidence from dental literature. Although the clinical techniques for treating dry socket lesions seem empirically correct, more evidence is required to determine the causes of dry socket lesions.

Keyword

Alveolar; Dry socket; Fibrinolysis; Osteitis

MeSH Terms

Bacteria
Diagnosis*
Dry Socket*
Epithelium
Fibrinolysis
Inflammation
Lighting
Osteitis
Tooth

Figure

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  Fig. 1 A dry socket lesion where the socket perimeter is fully covered with healing epithelium, but a septum of exposed bone is visible inside the socket. The occlusal aspect of the septum bone is inferior to the projected plane of the occlusal aspect of the socket when the socket fully heals.

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  Fig. 2 The dry socket lesion in Figure 1 after packing with an iodoform paste.

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  Fig. 3 A dry socket lesion with separate buccal and occlusal areas of exposed bone.

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  Fig. 4 Example of a previous dry socket lesion that is now fully covered with a layer of epithelium that does not wash away with irrigation.

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  Fig. 5 Example of a maxillary posterior dry socket lesion surrounded by a viral outbreak. Although the outbreak may theoretically increase generalized inflammation around the dry socket, it is unknown if the outbreak increases pain or the duration of the dry socket or is only coincident with the lesion.

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