Alveolitis sicca occurs as a complication after tooth extractions. Inflammation of the alveolus occurs. The alveolus is the bony compartment of the tooth.
What is alveolitis sicca?
In alveolitis sicca, the bony compartment of the tooth becomes inflamed after a tooth is removed. The condition occurs two to four days after tooth extraction. In alveolitis sicca, the bony compartment of the tooth becomes inflamed after tooth extraction. The condition occurs two to four days after tooth extraction and is accompanied by severe pain. The complication occurs mainly in the mandibular region and predominantly in the jaw angle region. The bone here is very compact and has little blood supply. Thus, inflammations can develop more quickly. Alveolitis sicca is also called dolor post extractionem. This name reflects the main symptom of the disease. Dolor post extractionem translates as pain after extraction. In medical usage, the term postextraction syndrome is also increasingly used. Another titling is ostitis alveolaris.
Causes
Each tooth is attached to the bone in the alveolus by fibers. After the tooth is removed, a bony and empty space is created here. This fills with blood. The resulting blood clot is also called a coagulum. It closes the open wound and protects the tooth socket from bacteria and other pathogens. Basically, the coagulum acts as a kind of natural bandage. After ingrowth of small blood vessels, the coagulum is transformed into connective tissue. The cause of alveolitis sicca is a breakdown of the blood clot. Thus, the blood clot may be removed from the alveolus by excessive mouth rinsing. However, bacteria may have also entered the wound and removed the blood clot. Some patients also tear the coagulum from the wound with the bite swab. After particularly difficult tooth extractions, often only an unstable coagulum forms. A coagulum may also not form if there is very little bleeding from the wound. Another cause is incomplete removal of the tooth or leaving infected tissue behind. As a result, the bone in the alveolus is exposed without protection. The surrounding tissue is additionally inflamed.
Symptoms, complaints, and signs
The exposed bone of the alveolus causes severe pain. The pain radiates to the entire jaw area. Bad breath may also occur due to the inflammation. Normally, however, there is neither abscess formation nor suppuration. Pain is the only recognizable sign of inflammation. However, it can be so severe that patients cannot sleep at night and feel very ill and fatigued because of the pain. Over-the-counter pain medications provide little to no improvement. The pain can last for several weeks if left untreated.
Diagnosis and course
If you experience severe tooth pain after a tooth extraction, you should see a dentist as soon as possible. Upon inspection of the oral cavity, he or she will find a bloodless alveolus. The blood coagulum is no longer visible. The differential diagnosis is difficult. It is possible that the patients are only particularly snivelling and it is not alveolitis sicca at all. However, the pain may also be due to osteomyelitis, an inflammation of the bone marrow. On the one hand, however, this rarely occurs after tooth extractions, and on the other hand, this inflammation usually manifests itself as a multiple abscess. An unintentional opening of the maxillary sinus by the doctor must also be considered. This results in a so-called mouth-antrum connection. To rule out such an opening of the maxillary sinus after extraction, a nose-blowing test is performed. In this test, the patient is asked to snort into the nose with the nose held shut. The mouth remains open. The pressure build-up in the nasal cavity increases the pressure in the pharyngeal smoke under physiological conditions. The ears “crack.” The soft palate seals the oral cavity so that there is no pressure buildup in the oral cavity. When the maxillary sinus is opened, air flows into the maxillary sinus at high pressure and from there into the mouth via the resulting mouth-antrum connection. In the process, a loud hissing or whistling sound is heard from the alveolus. In this case, the nasal blow test is positive and a tight closure must be made to close the created connection. Normally, however, the pain caused by a jaw opening is not so severe.However, in case of doubt, the test can still be made up at this stage.
Complications
Alveolitis sicca is a postoperative complication that develops a few days after a tooth extraction. If the symptom occurs, the affected person should see his or her dentist immediately. Once a tooth has been removed, a blood clot forms in the empty tooth socket. The clot prevents the entry of germs that cause infections and contributes to wound healing. However, once the blood clot is lost or dissolves, the bone is exposed and pathogens penetrate deep into the jaw. The open wound hurts considerably and becomes inflamed. In some cases, an unpleasant foul odor develops. In most sufferers, alveolitis sicca develops in the lower jaw, especially when wisdom teeth are removed. Other complications include: a lockjaw, headache, tissue loss, and fever. If the wound appears relatively stable, caution is still advised. The blood clot can be damaged and lost by brushing too hard. Provided that reduced bleeding already occurs during tooth extraction, no blood clot is formed, and the area becomes rapidly inflamed, a dry socket will develop. This must be accurately treated under local anesthesia and the necrotic tissue removed. The dentist can provide relief through appropriate measures and medication. Nicotine should be avoided until complete healing, as this substance negatively affects wound healing.
When should you go to the doctor?
In alveolitis sicca, discomfort occurs in the teeth. In this case, the sufferers suffer from very severe pain that affects the exposed bones. It is not uncommon for this pain to spread to other regions of the body, resulting in severe pain in the head or ears as well. The patient’s quality of life is considerably reduced and there is usually severe fatigue. For this reason, the affected person should always consult a doctor immediately if there is severe pain in the teeth that does not disappear on its own within a short period of time. Furthermore, the pain usually also reduces the intake of food and fluids, so that underweight or deficiency symptoms may occur. Dehydration of the patient may also occur due to alveolitis sicca. Furthermore, those affected suffer from bad breath and severe inflammation. The pain can lead to sleep problems at night. As a rule, they cannot be limited with the help of painkillers. A visit to the doctor is also advisable for these complaints.
Treatment and therapy
Treatment of alveolitis sicca is surgical. Necrosis is removed under local anesthesia to create fresh wound surfaces. The remnants of decayed coagulum are cleared out, and the alveolus is scraped out. This painful procedure is performed with a sharp spoon and is referred to as excochleation. A tamponade is then inserted. This is soaked with analgesic and disinfectant medications and must be changed at regular intervals by the treating dentist until complete healing is achieved. This is the only way to prevent further infection of the socket. Alternatively, the dentist can inject an absorbable paste into the alveolus with a thin cannula. In milder cases, careful cleaning and irrigation of the wound area is sufficient. No local anesthesia is required for this. Even inflammation that has already subsided is not cleared out. Normal wound healing has already begun here. Treatment would delay healing. Wound healing after alveolitis sicca can take several weeks. During this time, the bone overgrows with mucosa and thus becomes significantly less sensitive to irritation. The acute symptoms subside under drug treatment after only a few days.
Outlook and prognosis
As a rule, alveolitis sicca causes severe discomfort and inflammation in the oral cavity. The affected persons suffer thereby primarily from very strong pain. This pain can also spread to other areas of the body. It is not uncommon for patients to experience pain at rest, which can cause them to have trouble sleeping. Furthermore, the intake of fluids and food is also restricted, so that underweight or other deficiency symptoms can occur. The quality of life of the affected person is significantly limited and reduced by alveolitis sicca.The disease is also manifested by a strong and unpleasant bad breath, which can have a negative effect on social contacts and lead to psychological complaints. Furthermore, there is also a general feeling of illness and fatigue. Often the pain of alveolitis sicca cannot be relieved by ordinary painkillers. The treatment of alveolitis sicca is a surgical procedure. This usually has to be repeated a few times until the inflammation is completely healed. Usually, there is no further discomfort or pain afterward.
Prevention
Antibiotic administration and local rinsing with chlorhexidine have been shown to be effective preventive measures. In contrast, prophylactic treatment with diclofenac, ibuprofen, or antifibrinolytics is not effective.
Follow-up
In most cases, direct follow-up is not possible or necessary for alveolitis sicca. Affected individuals rely primarily on medical treatment to stop the inflammation and prevent further complications. If alveolitis sicca is detected and treated early, there will be no further complications and usually a complete cure of this complaint. Treatment of alveolitis sicca is performed directly by a dentist and usually proceeds without complications. Furthermore, after the procedure the patient has to take painkillers and antibiotics to avoid further inflammation. Attention should be paid to regular intake of the medication and possible interactions with other medications. Affected persons should not drink alcohol when taking antibiotics, as this can weaken the effect. There continues to be a positive course of the disease. To avoid recurrence of alveolitis sicca, affected persons should take care of their teeth and observe the usual measures of hygiene. The patient’s life expectancy is not negatively affected by alveolitis sicca.
What you can do yourself
In case of discomfort after the removal of a tooth, it is essential to consult a dentist. Under no circumstances should affected individuals attempt to treat alveolitis sicca on their own. However, patients can help to favorably influence the course of the disease or, ideally, prevent it altogether. The most common reason for tooth loss is caries, which is caused by poor oral hygiene. Anyone suffering from caries should brush their teeth after every meal, if at all possible. It is especially important to clean teeth after eating sticky sweets. This includes foods that are healthy in themselves, such as bananas. Disposable toothbrushes from the pharmacy or medical supply store make it easier to clean teeth outside the home. Highly acidic foods and stimulants such as sour fruit, fruit juices or acidic soft drinks should be avoided, as should desserts. After a tooth extraction, care should be taken during daily dental hygiene to ensure that the blood coagulum (the blood plug that closes the wound) is not injured or destroyed by the toothbrush. Consumption of alcoholic beverages can also impair wound healing. Those affected should strictly follow the instructions of the dentist treating them in this regard. If inflammation nevertheless occurs, regular mouth rinses with antiseptics, which are available over the counter at pharmacies, can help. Many patients also respond positively to rinses with sage tea.
