Dry Tooth Tray, Alveolitis Sicca

Alveolitis sicca–colloquially called dry tooth socket–(from Latin alveolus “hollow” and siccus “dry”; synonyms: Dolor post extractionem; dry socket; Alveolar gangrene; Alveolar ostitis; Alveolar periostitis; Alveolodental periostitis; Alveolitis of the jaw; Apical ostitis; Dry socket; Suppuration of the dental periosteum; Inflammation of the dental alveoli; Granuloma apicale; Maxillary alveolitis; Dry dental socket; Dental socket inflammation; Dental socket infection; ICD-10: K10. 3: Alveolitis of the jaws) may develop as a complication after tooth extraction (tooth removal).

The incidence of alveolitis sicca is approximately 1%.

Symptoms – Complaints

Alveolitis sicca causes severe pain (= dolor post extractionem) in the wound area about two to four days after a tooth extraction. The coagulum (blood clot) has disintegrated or been lost, which may be accompanied by unpleasant odors (foetor ex ore). The bone is exposed. The wound is sometimes reddened at the wound edges, and the tooth socket appears empty or contains the disintegrated, malodorous coagulum.

Differential diagnoses

Diseases of the mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

Musculoskeletal system and connective tissue (M00-M99).

Pathogenesis (disease development) – etiology (causes)

After tooth extraction, a blood coagulum forms in the wound cavity, which seals the empty tooth cavity. This prevents the invasion of germs and allows the tooth socket to regenerate undisturbed.

However, if the blood coagulum is lost or not formed properly, this protection is missing and a wound infection occurs, which can be accompanied by severe pain.

Excessive brushing in the wound area can also contribute to the loss of the coagulum. If there is only a small amount of bleeding during the tooth extraction, the formation of the sufficiently large blood coagulum may already be absent.

Other causes of alveolitis sicca include: Behavioral causes:

  • Consumption of stimulants
    • Alcohol (woman: > 20 g/day; man > 30 g/day).

Disease-related causes:

  • Tooth not completely removed at:
    • Apical periodontitis (inflammation at the root tip of a tooth).
    • Odontogenic cyst (cysts in the jaw area).

Consequential diseases

There are no known sequelae.

Diagnostics

The diagnosis is made on the basis of the symptomatology and the clinically typical appearance. Pain symptomatology that does not develop until several days after tooth extraction with an empty extraction socket makes the diagnosis easy.

Therapy

The dry socket must be treated in a minor procedure under local anesthesia (local anesthetic). Necrotic tissue is removed and the wound is freshened. Tamponades (medicated inserts) containing disinfectant and analgesic (painkilling) drugs or irrigation with antiseptics (disinfectants) help to promote wound healing. Overall, the therapy can take several weeks, although the severe discomfort usually subsides after the first few treatments at the dentist. Until complete healing is achieved, the patient must be patient and follow the advice of his or her dentist.