 Hello everyone, welcome back to another session in dentistry and more today we have a tooth extraction complication that is dry socket So we know the alveolar socket where the tooth Is lying and when we do an extraction the socket becomes empty and once the extraction happened The blood clot forms within the socket and a normal healing process happens But sometimes the socket Becomes dry because the blood clot which was helping the socket to get healed or to get Completely sealed is lost or it is damaged or it is partially broken and The socket is becoming dry. So that means the healing process is delayed and there is history of pain and other problems So that is dry socket. So let's learn about dry socket its science and symptoms etiology and management So dry socket it is one of the most painful but easy to treat dental emergencies and It is the symptoms are experienced after a tooth extraction. Okay so what is basically a dry socket it is a Painful condition that sometimes happens after a permanent to this extractor that is traumatic extraction So as I mentioned There is a blood clot at the site of tooth extraction which fails to form and It sometimes it dislods or sometimes it dissolves before the wound healing happens So normally a blood clot forms at the site of tooth extraction and this blood clot Serves as a protective layer over the underlying bone and nerve endings in the empty tooth socket So this clot also provides the foundation for the growth of new bone and for the development of soft tissues over the Clot so if we have a extraction space, okay, this is a tooth and This is also a tooth And we have an extraction here. There will be a blood clot formation here soon after the extraction and this blood clot serves as a foundation of formation of new bone and Soft tissues so exposure of this underlying bone and nerve so Dry socket means this clot is absent. Okay, the socket is dry. So the underlying bones and other nerve structures Are exposed which results in intense pain Not only in the socket but also along the nerves radiating to side of the face if it is on the lower side It radiates to the complete pre-tragus tragus area and temporal area that is side of the teeth It will be mostly unilateral And the socket becomes inflamed and may fill with food debris adding to the pain So if dry socket is developed the pain usually begins one to Three days after the tooth is removed. Usually one to three days So usually the healing process begins and it reaches at a point during this period but If the pain starts between these time you must expect a formation of dry socket So dry socket is most common complication following tooth extraction such as the wisdom tooth. That means third molars Third molars is also known as wisdom tooth Third molars because third molars always require traumatic extraction. We need to Cut the bone and use mini elevators Because the angulation of the tooth sometimes it will be ankle lost The position and it creates a complicated extraction. So since it becomes complicated There will be a distraction of the bone and other tissues So the chances of normal healing is delayed Still if something happens to that socket which disturbs the blood clot It will result in dry socket So there are many synonyms for dry socket. So you may expect the dry socket question In any of these names, okay, so it is also known as alveolar oesthetis Alveolar algea localized oesthetis oesthetis means infection or inflammation of the bone Oesthetis means inflammation. This is bone Algea means pain Alveolitis, sicka, dolerosa, post-operative alveolitis Necrotic socket and localized osteomyelitis. All these names are the synonyms of dry socket So what exactly causing the dry socket? So dry socket is caused by the partial or total loss of blood clot in the tooth socket after a tooth extraction So normally after tooth is extracted blood clot will form as a first step in healing to cover and protect the underlying bones And as I mentioned it stops the area from bleeding over a time and it stimulates bone healing So if this blood blood clot is not formed this bone will be exposed and pain will be there So there are lots of symptoms Such as intense and continuous pain and there will be regional Lymphatinopathy and occasional Christmas and unpleasant taste All these are the Signs and symptoms So what are the causes of dry socket? So dry socket There are various causes like bacterial causes chemical causes So it could be Bacterial, chemical Bacterial Chemical Mechanical And physiological Okay So bacterial means if there is a pre-existing infection that is present in the mouth Prior to the dental extraction such as if the patient has periodontal disease Or any pericoronitis Which can Prevent proper formation of the blood clot and also certain oral bacteria can cause the breakdown of the clot So that is a bacterial cause whereas a chemical cause So chemical cause is nicotine used by Smokers so smoking is a big factor Which causes decrease in the blood supply in the mouth and as a result The blood clot may fail to form at the site of the tooth extraction. So that is a chemical cause, okay So bacterial cause is periodontitis or pericoronitis Chemical is smoking. Okay, ultimately it disturbs the blood clot that is the concept And mechanical is sucking through a straw aggressive rinsing spitting dragging So all this becomes mechanical Physiologic means hormones And or poor blood supply and other Physiological factors hormones All this becomes physiology. So usually it is seen in people with more than 25 years 25 years then previous history of dry socket people with poor oral hygiene and smoking and most common one is Traumatic extraction okay traumatic extraction and Or the infection of bacterial infection. So it can be categorized as bacterial chemical mechanical and physiological. Okay So symptoms are pain and Empty looking socket with a visible bone and pain radiates to the eye temple and neck region And there will be unpleasant taste So how we diagnose dry socket? The diagnosis of dry socket is based on the history of dental treatment clinical examination and symptoms So usually the timing when symptoms begin may be an indicator for dry socket and During normal healing the discomfort of an extraction should lessen over time. Okay, so if it is a normal healing The problems of tooth extraction or the post extraction problems will be decreased over the period of time, but in dry socket This will increase normal extraction that will decrease So if the pain increases it is an indication that healing is delayed and could possibly due to dry socket So if symptoms for dry socket develop usually two to four days after tooth extraction And what is the treatment? Okay, so we discussed about etiology We discussed the various synonyms and the treatment we can Have two types one is non pharmacological and pharmacological So pharmacological is using various antibacterial antiseptic anti-fibrinolytics And obtinent dressing So all this can be used And the main thing is Analgesic medicated dressing or packing is placed within the socket to cover the exposed bone Or eugenol or clove oil that is known as dry socket paste Dry socket paste Which is eugenol Eugenol paste Eugenol or clove oil paste Which is known as dry socket paste And we can give antibacterials antiseptics anti-fibrinolytics And we can give nsides And prf that is plasma rich fibrin It is a very promising agent for the management of dry socket in a cost effective manner And prf does not have reactions like analgesics As it is derived from the patients on blit Okay So We can use Non-pharmacological methods also that is mainly before the extraction So non-pharmacological methods mainly include use of good quality pre-operative radiographs to make sure that The tooth The root is how the root is placed and plan a proper treatment because sometimes we don't take x-rays and We expect the root to be in a normal position and we go for extraction when we apply pressure There will be fracture of the root and then it will create a very complicated procedures We may need to cut the bone excessive bone cutting and finally it will end up in dry socket So pre-operative radiographs is very much vital and careful planning of surgery Use of good surgical principles It should be performed with minimal amount of trauma and maximal amount of care And we should confirm the presence of blood clothe subsequent to extraction And there should be pre-operative oral hygiene measures Like he should stop or limit smoking in Immediately post-operative for a period Then avoid vigorous mouth thru and sink for at least 24 hours. So post Extraction instruction is very much vital if it is a traumatic extraction For patients who are taking oral contraceptives Extraction should be ideally be performed during Day 23 to 28 of their menstrual cycle And comprehensive pre and post-operative verbal instructions. So proper instruction should be given So pharmacological measures as we discussed we can go for And debacterial like penciline erythromycin and the combination of such as moxclav And socket irrigation with betadine and topical application And use of like chloractine mouthwash also will help And and inflammatory agents and the dressing okay And also sometimes we may need to go for surgical management And block anesthesia like a sharp margins should be trimmed and rounded If any foreign bodies present should be thoroughly removed Then the detached ginger margins should be scraped off So such things we might need to do As a surgical management okay So that is all about dry socket it is a common complication not very common Complication associated with traumatic extraction mostly the third molar extraction And we discussed about the etiology with signs and symptoms various synonyms And its management okay, so I'll come up with a new topic in In history and more thank you