Dry socket, or alveolar osteitis, is a delayed healing of the extraction socket without infection. It occurs when the blood clot fails to form or is dislodged from the socket, exposing bare bone. Common causes include poor blood flow, infection, trauma, or improper rinsing after extraction. A 45-year-old diabetic man presented with severe pain in his lower left jaw 3 days after a tooth extraction. Examination revealed an empty socket with exposed bone and food debris. Radiographs did not show any abnormalities. He was diagnosed with dry socket based on the clinical presentation. The socket was irrigated and dressed with a medicated dressing to manage pain until it subsided in a few days with

1. Associate prof Dr Muhammmad Ishfaq
BDS,FCPS.
Consultant Maxillofacial Surgeon
Dry socket (alveolar osteitis)

2.  Dry socket or alveolar osteitis is delayed healing but is not
associated with an infection
 The term dry socket describes the appearance of the tooth
extraction socket when the pain begins.
 The occurrence of a dry socket after a routine tooth
extraction is rare (2% of extractions).
 it is frequent after the removal of impacted mandibular third
molars (20% of extractions in some series).

4. Causes of dry socket
 Exact cause not known.
 Either the clot fails to form (decrease blood flow)
 Lysis of the clot (infection or trauma)
 Dislodgment of the clot(moth rinsing ,spiting frequent
change of cotton)

5. Duration of routine tooth extraction
pain

6.  A 45 yrs old diabetic patient presented to your surgery ward
complaining of severe pain in the left lower jaw. Hisotry of
present illness shows that he had an extraction of lower
posterior tooth 3 days ago.the pain radiates to the ear ,his
sleep is disturb the pain does not respond to medications.he
also complains of foul smell and bad tast.

7. examination
 On examination the lower 2nd molar has been extracted.
 The socket has no clot and is full of food debris
 On removal of the food debris the walls of the extraction
socket appear bare.and the exposed bone is very sensitve to
touch.
 All the other teeth on that side appears noraml.

8. investigation
 Radiographic findings not significant

9.  Radiographs were advised to see any fractured root, bone
piece or any other foreign material.
 And to exclude other causes of post op pain

10. diagnoses
 Dry socket

11. management
 Irrigation of the socket with noraml saline
 Remove all the debris from the socket
 No curretage
 Isolate the socket
 Put medicated dressing to control pain
 No antibiotic
 Change the dressing every other day till pain subsides
 Usually it needs two or three dressings

12. alvogel
 Eugenol
 Benzocain
 Balsum of peru

13. prevention
 Infection control
 Asceptic technique
 Preoperative rinsing with chlorohexidine
 Atraumatic surgery
 Irrigation
 Tetracycline placed in the extraction socket
 Proper post op instructions