Hi everyone, I'm Prateek, a dentist and specialty doctor and in this video we're going to be looking
at a very common post-extraction complication - dry sockets. If you want to see more educational
videos similar to this, then please make sure you subscribe to the channel. So a dry socket,
or alveolar osteitis, occurs when a blood clot fails to form in a socket post-extraction
or is dislodged or lost from the socket before healing has occurred.
The blood clot forms two purposes following an extraction. Firstly, it forms the basis for new
bone and new soft tissue to form in the area so that things can return to normal. And secondly,
it helps protect the underlying bone and nerves and therefore, if it is lost, these are exposed
and the patient usually experiences pain. So if the clot is lost, patients will have impaired healing
and they'll also experience symptoms i.e pain. If we look at the aetiology or the causes of a
dry socket this is an area that is up for intense debate, however there are some obvious risk factors
that increase your risk of developing a dry socket. The first one of these is smoking and
tobacco use. For example, we know nicotine causes vasoconstriction and with vasoconstriction you
will have a reduced blood supply to the area in order to help healing. This is why we advise
patients not to smoke for as long as possible following an extraction. Similar to this, patients
who have had radiotherapy have hypovascular bones so they have reduced blood supply to these areas.
Therefore along with their risk of developing osteoradionecrosis following an extraction,
they also have a potentially higher risk of developing a dry socket. If we look at
the extraction itself, the area the tooth is being taken out from also has an impact. So anatomically
the maxilla has a lower incidence compared to the mandible and the more posterior the tooth
the higher the risk of a dry socket compared to an anterior tooth. The reason behind this
again comes down to vascularity. So the maxilla is more vascular compared to the mandible and the
more posterior the tooth the lower the vascularity compared to an anterior tooth. Additionally
posterior teeth tend to have larger sockets and therefore the demand in terms of healing
is greater - there's a bigger socket to heal, more blood is needed and therefore the capacity for
a dry socket increases. So the mandible has a higher risk than the maxilla and posterior teeth have
a higher risk than anterior teeth. Additionally, if the extraction is particularly traumatic then the
patient is usually at a higher risk of dry socket so this is why dry sockets are extremely common
following extraction of lower third molars because they're in the mandible, they're posterior teeth
and they're typically a difficult extraction so there's a lot going against them. Additionally, if
patients fail to follow the post-operative advice, their risk may be higher so we advise patients to
not rinse and not spit out following an extraction and the reason behind this is to avoid that
blood clot either failing to form or dislodging completely once it has formed. However, if patients
fail to follow this advice, that blood clot is going to struggle to stay in place and their
risk of a dry socket will increase. Other factors that may increase the risk of a dry socket include
if the patient's got a pre-existing infection and also hormonal changes, so patients who are on the
oral contraceptive pill for example, we tend to see a higher rate of dry sockets and this may be
due to the fact that hormone changes can impair your ability to heal. Next let's look at the signs
and symptoms of a dry socket. It's important to note that a true dry socket is not an infection,
so a patient will typically not have a fever or pyrexia, they will not usually have enlarged lymph
nodes or lymphadenopathy, and typically there won't be any pus in the socket. However, patients who are
typically at a higher risk of a dry socket, are also at a higher risk of infection and therefore
we often see them occurring together. If we look at the true symptoms of a dry socket the most
important one is that patients will experience pain. Now this is typically moderate-severe, dull,
throbbing pain from the area of extraction. It usually develops a few days after the extraction
and a lot of patients will describe it as being worse than the pain they experienced
before in terms of toothache. Typically you can't control it with regular analgesia.
Additionally, patients may be experiencing bad breath or halitosis and they may have a bad
taste in their mouth, usually metallic taste. If we then clinically looked at the socket
in terms of the signs that we'd see there would either be a loss of the clot completely
or a partial loss of the clot in the socket. There may also be some debris in the socket and
usually there is localised inflammation of the soft tissues surrounding the socket. In order to
diagnose a dry socket, we don't necessarily need any imaging of sorts - this is usually a diagnosis
that is done through clinical factors and also looking at the patient's history. It becomes very
very obvious when the patient mentions the symptoms that we've discussed and we see the
signs that we've discussed, a dry socket is usually the obvious diagnosis. Now in terms of management -
managing a dry socket is usually symptomatically done. So we first gently irrigate the socket with
saline or with a local anesthetic and this helps get rid of any debris that's in the socket that
may be impairing healing. This may also encourage some bleeding from the socket and the fresh blood
may form a new clot. We then usually put a sedative dressing into the socket, such as Alveogyl, this helps
relieve the patient's pain but it also again can form the basis for a new clot to form. Next we want
to ensure that the patient follows the correct post-operative advice. So we need to remind them
not to rinse, not to spit out, no exertions so that when the new clot is forming, it can stay there
and it won't get dislodged again. Additionally, patients may need some advice regarding analgesia
so either we need to work through the WHO pain ladder and just recommend what they should use or
we need to prescribe them something to help manage their pain if necessary. Now finally, if the patient
does have an infection along with the dry socket then we may have to prescribe antibiotics if
they've got systemic signs. So there we go, we've looked at what a dry socket is, the risk factors
for developing a dry socket, the signs and symptoms and how we diagnose a dry socket
as well as the management of a dry socket. These are really important things to know because
it's such a common post-extraction complication it's something that can easily be handled in
practice. My recommendation in this video is another YouTuber called The Dentist Raj. Now Raj
is currently studying dentistry and his YouTube channel is excellent for anyone who's currently
on a dental course as he discusses a lot of the issues relating to going through a dental course
as well as giving you some helpful tips - so i'll put the link in the description make sure to check
the channel out. If you find this video useful please make sure to like, comment and subscribe
and let me know of any of the videos that you'd like me to do - until the next video take care!