Complications of tooth extraction• Local complications• Immediate:• Failure of LA• Failure to move the tooth• Fracture of tooth, alveolus, mandible• Oro-antral communication• Displacement in soft tissues• Hemorrhage• TMJ dislocation• Damage to V1,2,3
• Delayed• Exessive pain, swelling, and trismus• Bleeding• Dry socket• A. osteomyelitis• Infection• Oro-antral fistula• Failure of the socket to heal• Nerve damage
Dry Socket• Pathology: – Destruction of the blood clot either by: 1. Proteolytic enzymes produced by bacteria. 2. Excessive local fibrinolytic activity. – Anaerobes are likely to play a major role. – Destruction of the clot leaves an open socket, infected food and other debris accumulate.
Dry Socket– Pathology: • The necrotic bone lodges bacteria which proliferate freely, Leucocytes unable to reach them through the avascular material. • Dead bone is gradually separated by osteoclasts. • Healing is by granulation tissue from the base of the walls of the socket.
Dry Socket• Clinical features: – Pain usually starts few days after extraction. – Sometimes may be delayed for few days or more. – Deep – seated, severe and aching or throbbing in character. – Mucous membrane around the socket is red and tender. – No clot in the socket ( Dry ).
Dry Socket• Clinical features: – When debris is washed away, whitish, dead bone may be seen or may be felt as rough area with a probe. – Sometimes the socket becomes concealed by granulation tissue growing in from the edge. – Pain may continues for week or two and rarely longer.
Dry Socket• Prevention: 1. Minimal trauma. 2. Squeezed the socket edge firmly after extraction. 3. In case of dis-impaction of 3rd molars dry socket is more common: - Minimum stripping of the periosteum. - Minimum damage to the bone. - Use prophylactic antibiotic.
Dry Socket• Prevention: 4. In patient who have had radiotherapy, every possible precaution should be taken. 5. In osteosclerotic disease: • Little damage to bone (surgical extraction). • Prophylactic antibiotic. 6. Stop smoking for two days post extraction.
Dry Socket• Treatment: – Explain to the patient and warn them. – The aim of the treatment is to keep the open socket clean and to protect the exposed bone: 1. Irrigate the socket by antiseptic solution. 2. Fill the socket with an obtudant dressing containing some non irritant antiseptic. 3. Frequent use of mouth wash.
Dry Socket• Treatment: – A great variety of dry socket dressing has been formulated: 1. Iodoform - containing preparation. 2. Alvogyl – which is easy to manipulate. ( The dressing should be: Obtudant, antiseptic, soft to adhere to the socket walls and absorbable ). – In many cases, irrigation of the socket and replacement of the dressing has to be repeated every few days.