After Teeth Extractions
ALVEOLAR OSTEITIS or Dry socket is a complication where wound healing is altered that may occur following extraction of teeth if the initial blood clot is not formed or lost.
An improper wound healing results in exposed bone in the socket which is devoid of normal healing tissues (Clot), hence the name “dry socket.”It occurs three to five days after an extraction and is characterized by an increase in severe and throbbing pain.
Dry socket is treated by temporarily packing the site with eugenol, antibiotics and oral rinses. As the socket forms a new layer of the healing tissue the pain will gradually subside and the socket slowly fills in over the next 2-3 months.
- In patients the risk for dry socket increases who smoke after extractions, too early vigorous rinses, forceful spitting, or use a straw to drink within the first 24 hour, which can disturb the initial blood clot formation.
- Another major risk factor for dry socket is traumatic surgical procedures such as tearing the gum tissue, excessive manipulation of the extraction socket and aggressive drilling of the bone which ultimately will result in devitalized tissue with poor blood supply.
While the possible incidence of dry socket is between 1-3% data shows that no dry sockets were recorded after performing more than 150,000 extractions over the past 20 years.
THE SECRETS TO AVOID DRY SOCKET AFTER TEETH EXTRACTIONS:
- Non-traumatic surgical techniques and procedures: This means no or minimal gum tissue flap, no or minimal removal of bone, use of irrigation, gentle handling of the tissues and atraumatic removal of teeth with ease.
- Avoid rinsing or brushing: Any forceful rinsing or brushing immediately following a tooth extraction can cause dislodging of the blood clot leading to a dry socket. Do not rinse or brush within 24 hours of extraction then rinse gently for the next 1-2 days and more vigorously in the following days.
- Do not use a straw: The use of a straw in the first 24 hours can also cause suction and dislodge the blood clot. Use a glass following liquid consumption.
- Avoid smoking: Smoking creates suction in the mouth that can dislodge the blood clot. It also directly inhibits the normal healing physiology.
- Do not spit: With blood and saliva accumulating in the mouth following an extraction you may be urging to spit that out. This action can disrupt the formation of blood clot and dislodge it. Instead of spitting let the accumulated blood and saliva drool down and wipe it gently with a gauze or tissue.
- Keep firm pressure on the extraction site: The gauze should remain in place for at least 30-45 minutes after extraction. Constant and firm pressure helps to slow down the bleeding and stabilizes the formed blood clot.
HOW TO PREVENT DRY SOCKET
Dry socket (alveolar osteitis) is a wound healing complication that can occur following teeth extractions if the initial blood clot is lost. This results in exposed bone in the socket devoid of normal healing tissues, hence the name “dry socket.” It usually occurs three to five days after an extraction and is characterized by a sudden increase in severe and throbbing pain. Dry socket is treated by temporarily packing the site with eugenol, antibiotics, and oral rinses. As the socket forms a new layer of healing tissue the pain gradually subsides and finally the socket slowly fills in over the next 2-3 months.
The risk for dry socket increases in patients who smoke after teeth extractions, vigorously rinsing too early, spitting, or using a straw to drink within the first 24 hours—all of which can disturb the initial blood clot.
While the possible incidence of dry socket is between 1.5-2%, here at Dr. Sachdeva’s Dental Implant Institute, Delhi, we have experienced no dry sockets after performing more than 6500 extractions over the past 13 years.
Platelet Rich Fibrin (PRF) as healing aid in extraction socket:
Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane, regulate inflammation and increase the speed of healing process.
It is a simple, natural and inexpensive technique for the production of leukocyte- and PRF (L-PRF) concentrates. It includes collection of whole venous blood (around 5 ml) in each of the two sterile vacutainer tubes (6 ml) without anticoagulant and the vacutainer tubes are then placed in a centrifugal machine at 3,000 rpm for 10 min, after which it settles into the following three layers: Upper straw-colored acellular plasma, red-colored lower fraction containing red blood cells (RBCs), and the middle fraction containing the fibrin clot. The upper straw-colored layer is then removed and middle fraction is collected, 2 mm below to the lower dividing line, which is the PRF. The mechanism involved in this is; the fibrinogen concentrated in upper part of the tube, combines with circulating thrombin due to centrifugation to form fibrin. A fibrin clot is then formed in the middle between the red corpuscles at bottom and acellular plasma at the top. The middle part is platelets trapped massively in fibrin meshes. The success of this technique entirely depends on time gap between the blood collection and its transfer to the centrifuge and it should be done in less time.