Oral surgery > Dry socket > Flashcards

Dry socket Flashcards

(66 cards)

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1
Q

What is dry socket (alveolar osteitis)?

A
  • A post-extraction inflammatory condition caused by loss or breakdown of the blood clot=>
  • to exposed alveolar bone and severe pain.
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2
Q

Is dry socket an infection?

A
  • No.
  • It is primarily inflammatory not infectious though secondary infection may occur.
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3
Q

What is the key pathological failure in dry socket?

A
  • Failure of stable clot formation or maintenance=>
  • preventing normal granulation tissue formation.
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4
Q

When does dry socket typically present after extraction?

A
  • 2–5 days post-extraction most commonly around day 3.
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5
Q

How does pain progression differ from normal post-extraction pain?

A

Pain worsens after initial improvement instead of steadily improving.

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6
Q

Is dry socket self-limiting?

A
  • Yes
  • but it causes significant morbidity and delayed healing if untreated.
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7
Q

Which extractions have the highest risk of dry socket?

A

Mandibular molars especially lower third molars

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8
Q

What procedural factors increase dry socket incidence?

A
  • Surgical difficulty
  • trauma
  • excessive manipulation
  • inadequate irrigation.
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9
Q

What are the main mechanisms causing dry socket?

A
  • Clot dislodgement
  • increased fibrinolysis
  • exposed bone causing nerve irritation.
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10
Q

What contributes to increased fibrinolysis in dry socket?

A
  • Surgical trauma
  • inflammation
  • bacterial enzymes
  • local tissue injury.
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11
Q

Why is pain severe in dry socket?

A

Exposed alveolar bone and nerve endings cause intense nociceptive stimulation.

Layers of bone=>
Cortical plate → cancellous bone (neurovascular) → alveolar bone proper (perforated) → PDL

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12
Q

What is the single most important modifiable risk factor for dry socket?

A

Smoking.

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13
Q

Why does smoking increase dry socket risk?

A
  • Vasoconstriction
  • suction
  • heat
  • impaired healing and clot disruption.
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14
Q

What hormonal factor increases dry socket risk?

A

Estrogen exposure such as oral contraceptive pill.

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15
Q

Name systemic conditions associated with increased dry socket risk.

A
  • Immunosuppression
  • poorly controlled diabetes via impaired healing.
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16
Q

How does surgical trauma contribute to dry socket?

A
  • It increases inflammation and fibrinolysis=>
  • destabilising the clot.
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17
Q

What post-operative behaviours increase dry socket risk?

A
  • Smoking
  • vigorous rinsing
  • spitting
  • using straws
  • poor compliance.
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18
Q

Describe the pain of dry socket.

A
  • Severe throbbing pain
  • often radiating to ear temple or neck.
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19
Q

What other symptoms commonly accompany dry socket?

A
  • Bad taste
  • halitosis
  • sleep disturbance.
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20
Q

What is the classic clinical appearance of a dry socket?

A
  • Empty socket w/ exposed bone
  • possibly grey necrotic appearance.
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21
Q

What signs are typically absent in dry socket?

A
  • Significant swelling
  • fever and pus.
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22
Q

How is dry socket diagnosed?

A
  • Clinically based on timing
  • pain pattern
  • socket appearance.
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23
Q

When should imaging be considered?

A
  • If retained root
  • bone fragment
  • fracture or osteomyelitis is suspected.
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24
Q

List key differentials for post-extraction pain.

A
  • Normal post-op pain
  • local infection
  • retained root or bone
  • osteomyelitis
  • referred orofacial pain.
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25
What differentiates dry socket from infection?
* Dry socket **lacks systemic signs=>** * such as **fever swelling** and **pus.**
26
What are the main goals of dry socket management?
* Pain relief * socket cleaning * protection of exposed bone * support healing.
27
What is the first clinical step in managing dry socket?
* **Reassure** the patient * **assess** for infection or complications.
28
Why is gentle irrigation used in dry socket management?
To **remove debris** and **reduce local irritation**.
29
What is the role of intra-socket dressings?
To provide **analgesia** and **protection** to exposed bone.
30
What caution is needed with socket dressings?
* **Do not pack** tightly or **leave** indefinitely * reassess **regularly.**
31
What is first-line analgesia for dry socket?
**NSAIDs** with or without **paracetamol.**
32
What is the first clinical step in managing dry socket?
Gentle **irrigation** of the socket
33
What solution is used to irrigate a dry socket?
* Warm **saline**; * **Chlorhexidine** (low concentration)
34
Should the socket be curetted in dry socket management?
* **No** **aggressive** curettage=> * **may delay healing** and increase **pain**
35
Why is irrigation used in dry socket treatment?
* **Removes** debris and bacteria; * **Reduces** local irritation; * **Does not** aim to induce bleeding
36
What dressing is commonly placed in a dry socket?
**Medicated obtundant dressing**
37
Example of a medicated dressing used for dry socket
Alvogyl
38
What are the functions of a dry socket dressing?
* Provides **analgesia**; * **Soothes** exposed bone; * Acts as a **temporary protective covering**
39
How long is a dry socket dressing usually left in place?
**24–72 hours** then reassessed
40
What is the role of analgesics in dry socket treatment?
**Pain control** – **NSAIDs** ± **paracetamol** as first line
41
Are systemic antibiotics indicated in uncomplicated dry socket?
**No** – only if signs of **spreading** **infection** are present
42
Why should aggressive curettage be avoided in dry socket?
* Increases **trauma**; * **Delays** healing; * Worsens **pain**
43
What are the components of Alvogyl?
* **Eugenol** (analgesic); * **Butamben** (local anaesthetic); * **Iodoform** (antimicrobial)
44
Why is re-establishing a blood clot not the goal of dry socket treatment?
* Condition is **self**-**limiting**=> * Forcing bleeding **increases** **trauma** without improving outcome
45
How often may a dry socket dressing need to be replaced?
Every **1–2 days** depending on symptoms
46
What clinical sign indicates improvement of dry socket?
* **Reduction** in pain; * Decreased **halitosis**; * Improved **comfort** between visits
47
What is the expected healing time after dry socket treatment begins?
Symptoms usually resolve within **7–10 days**
48
When are antibiotics appropriate in dry socket management?
* If **systemic** involvement present; * Signs of **spreading** **infection** (fever, cellulitis, lymphadenopathy)
49
Why are topical antibiotics not routinely used in dry socket?
* **Limited** **evidence** of benefit; * Risk of **resistance**; * Condition is **not** primarily infective
50
Why is dry socket considered a self-limiting condition?
* Healing occurs once **inflammation** **subsides**; * Socket **re**-**epithelialises** over time
51
When is a curette indicated in dry socket management?
* Only if there is **loose** **necrotic** **debris** or **foreign** **material**; * **Not** for **routine** or aggressive socket curettage
52
When should a curette NOT be used in dry socket treatment?
* When bone is **exposed** but **clean**; * When curettage would cause **additional** **trauma** or **bleeding**
53
How should a curette be used if indicated in dry socket?
* Very **gently**; * **Superficial** **removal** of loose debris only; * **Avoid** **scraping** viable bone
54
Name dressings other than Alvogyl used in dry socket
* **Zinc** **oxide**–**eugenol** dressing; * **Iodoform** gauze; * **Obtundant** **pastes** (e.g. obtundent dressings)
55
What should the socket look like when a dressing is removed?
* **Reduced** inflammation; * Less **exposed** **bone**; * **Early** **granulation** **tissue** formation
56
Which NSAIDs are commonly prescribed for dry socket pain?
* Ibuprofen; * Naproxen
57
What alternative analgesic can be used if NSAIDs are contraindicated?
Paracetamol
58
Are opioids routinely indicated for dry socket pain?
No – reserved only for **severe** **refractory** **cases**
59
Why is inducing fresh bleeding not recommended in dry socket treatment?
* Increases **trauma**; * **Does** **not** improve healing; * Condition **resolves** with **symptom** **control**
60
How does eugenol-containing dressing relieve pain physiologically?
* Eugenol acts as a **local analgesic;** * **Desensitises** exposed nerve endings in bone
61
How does iodoform contribute to dry socket dressing function?
* Mild **antimicrobial** effect; * **Reduces** bacterial load locally
62
How does zinc oxide–eugenol dressing work in dry socket?
* Eugenol provides **analgesia** and **soothing**; * Zinc oxide provides a **protective** **matrix** over exposed bone
63
What is obtundent action in dry socket dressings?
* Temporary **reduction** in nerve sensitivity; * **Mechanical** and **chemical** protection of the socket
64
Typical ibuprofen dose for dry socket pain (adult)?
**400–600 mg every 6–8 hours** within safe limits
65
Typical paracetamol dose for dry socket pain (adult)?
**1 g every 4–6 hours** respecting maximum daily dose
66
Why are NSAIDs particularly effective in dry socket?
* Dry socket is **inflammatory not infective**; * NSAIDs reduce **prostaglandin-mediated pain**
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