PDF: Painful Dry Socket: An alternative perspective

Painful dry socket is an unwelcome complication following tooth extraction, presenting after approximately 3% of routine extractions and may occur in up to 30% of patients following surgical removal of impacted mandibular third molars.

The most common symptom of painful dry socket is a continuous throbbing pain that radiates to the ear and temple. 

Classically, this starts one to three days postextraction and may be accompanied by other signs and symptoms such as foul taste and halitosis.

The symptoms can persist for up to 10 days after extraction and may include pain so severe that it is not relieved by even the strongest of analgesic medications. The main focus of treatment is the relief of pain, and current therapies are based on the removal of debris from the socket by irrigation, and the use of analgesic medication. 

Intra-socket medicaments may be placed such as antibacterials, topical anaesthetics and obtundents or combinations of all three.

These medications include zinc oxide and eugenol impregnated cotton pellets, lidocaine ointment, alvogyl (eugenol, iodoform and butamen), dentalone, bismuth subnitrate, iodoform paste (BIPP) on ribbon gauze and metronidazole. 

Some studies have also reported the use of lasers for the treatment of dry socket. Forty-five percent of patients with painful dry socket require multiple postoperative visits, which are timeconsuming for the practitioner, and which could have significant consequences for the individual patient as well as societal costs including time off work. 

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