Introduction
Alveolitis sicca or dry alveolus is a post-operative complication following tooth removal. In English it is called dry socket. It often occurs in the posterior region
Anatomical background
Each tooth is attached to the bone in an alveolus, a tooth socket of the jaw process, with fibers. After extraction, i.e. the removal of the tooth, a free bony space is created which fills with blood. This blood clot is called coagulum.
This has an important task in healing the defect. The coagulum closes the bone wound and thus protects the alveolus from invading bacteria. It therefore represents the best wound dressing. Later, after capillaries have grown in, it is converted into connective tissue. This is the normal course after the surgical procedure without complications
Symptoms
Alveolitis sicca is making itself felt by:
- Severe pain that increases during the night
- An anemic alveolus
- Bad breath
- Abscess formation in the wound area
Therapy
If the above symptoms occur, it is strongly recommended that you consult your doctor. He will examine the wound and initiate the first steps of treatment. In extreme cases, the patient will be given a local anaesthetic to help him/her survive the painful procedure.
Using special instruments, dead tissue is removed and the alveolus scraped out. This creates a new wound surface that can heal again. The next step is to make a tamponade.
This dressing is soaked with disinfectant to kill any bacteria that may have penetrated and painkilling medication. The tamponade must be changed regularly by the dentist. Dentisolon ointment strips are currently common inserts in Germany.
Depot tamponades can remain on the wound for a long time. Another possibility is the direct insertion of an absorbable paste with a cannula into the alveolus. One possible paste is Socketol.
This consists of the components lidocaine, phenoxyethanol, thymol and Peru balsam. When using a paste, a carrier strip that has to be changed can be dispensed with. A supplementary administration of antibiotics is not carried out as this has no effect.
If only a mild case is present, which would be, among other things, if an already declining alveolitis sicca is present, careful cleaning and rinsing of the wound area is often sufficient. Irrigation of the alveoli with 3% hydrogen peroxide and oxygen is also possible. A procedure as just mentioned is not indicated in this case, as renewed scratching would again disturb the already initiated wound healing process and thus rather delay regeneration.
An older method of treatment was to apply medicamentous inserts with zinc oxide cement on a strip of gauze which was left on the wound for one week. The treatment of alveolitis sicca can take several weeks, depending on its severity, so patience and cooperation is required from the patient. In the course of treatment, the mucous membrane grows more and more over the wound until it is finally completely closed again.
The administration of antibiotics in acute alveolitis sicca is controversially discussed in dentistry, as the additional administration of antibiotics in the acute stage of alveolitis sicca does not necessarily contribute to faster wound healing. If a massive infection occurs in the course of an alveolitis sicca, the administration of an antibiotic is definitely sensible to prevent the spread of the infection and the development of sepsis (blood poisoning). In patients with a tendency to blood clotting disorders, or a known tendency to develop alveolitis sicca, the prophylactic administration of antibiotics prior to tooth extraction is considered sensible.
Antibiotics from the penicillin group have proven to be effective. However, it is not advisable to administer antibiotics too frequently or too briefly, as there is a risk of resistance to certain antibiotic groups. The use of chlorhexidine solutions (Chlorhexamed forte®), before and after tooth extraction, is one way to reduce the occurrence of alveolitis sicca.