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The most common location of dry socket: in the socket of an extracted mandibular third molar (wisdom tooth). Since alveolar osteitis is not primarily an infection, there is not usually any pyrexia (fever) or cervical lymphadenitis (swollen glands in the neck), and only minimal edema (swelling) and erythema (redness) is present in the soft tissues surrounding the socket.
Socket preservation or alveolar ridge preservation is a procedure to reduce bone loss after tooth extraction. [1] [2] After tooth extraction, the jaw bone has a natural tendency to become narrow, and lose its original shape because the bone quickly resorbs, resulting in 30–60% loss in bone volume in the first six months. [3]
In order to obtain permission from patient for extraction of tooth, the dentist should explain that other treatment options are available, what is involved in the dental extraction procedure, the potential risks of the procedure and the benefits of the procedure. [2] The process of gaining consent should be documented in clinical notes. [2]
A study used e-PTFE membranes to cover surgically constructed average size bone defects in the mandibular angles of rats. Consequently, the e-PTFE membrane acted as a barrier to soft tissue and sped up bone healing, which took place between 3–6 weeks while no healing occurred in the non-membrane control group during a 22 week period. [16]
After extraction of a tooth, the clot in the alveolus fills in with immature bone, which later is remodeled into mature secondary bone. Disturbance of the blood clot can cause alveolar osteitis, commonly referred to as "dry socket". With the partial or total loss of teeth, the alveolar process undergoes resorption.
Tooth #5, the upper right second premolar, after extraction. The two single-headed arrows point to the CEJ, which is the line separating the crown (in this case, heavily decayed) and the roots. The double headed arrow (bottom right) shows the extent of the abscess that surrounds the apex of the palatal root.
Infection resulting from impacted wisdom teeth can be initially treated with antibiotics, local debridement or surgical removal of the gum overlying the tooth. Over time, most of these treatments tend to fail and patients develop recurrent symptoms. The most common treatment for recurrent pericoronitis is wisdom tooth removal.
After tooth extraction, the residual crest irregularities, undercuts or bone spicules should be removed, because they may result in an obstruction in placing a prosthetic restorative appliance. Recontouring can be made at the time of extraction or at a later time.