Features of healing of the gum socket after tooth extraction

From this article you will learn:

• why does the socket hurt after tooth extraction,
• what is alveolitis: photos and videos,
• How is alveolitis treated?

The article was written by a dental surgeon with more than 19 years of experience.

Alveolitis is a classic complication that occurs after tooth extraction and consists of the development of inflammation of the socket of the extracted tooth. Often alveolitis is also called “dry socket” (this is due to the fact that the alveolar bone in the depths of the socket is exposed due to the loss of a blood clot).

On average, alveolitis develops after tooth extraction in 3-5% of cases, but this applies to teeth of any location with the exception of wisdom teeth. When the latter are removed, alveolitis occurs in 25-30% of cases, which is associated with the greater complexity and traumatic nature of the removal process.

Dry socket after tooth extraction: photo

You can see what normal healing of a socket should look like (at different times from the moment of extraction) in the photo in the article: → “What a socket should look like after tooth extraction”

Alveolitis after tooth extraction: symptoms

As for the general symptoms, since alveolitis is not an acute inflammatory process, it usually does not cause fever or inflammation of the submandibular lymph nodes. However, when it lasts for a long time, patients often feel weakness, fatigue, and the temperature may rise (but not higher than 37.5 degrees).

• Patient complaints include aching or throbbing pain in the area of ​​the extracted tooth socket (of varying severity - from moderate to severe).
  Sometimes alveolar pain can also spread to other areas of the head and neck. When alveolitis develops, pain usually occurs 2-4 days after removal, and can last from 10 to 40 days - in the absence of qualified treatment. Sometimes the pain is so severe that even very strong analgesics do not help. In addition, almost all patients report bad breath and an unpleasant taste in the mouth.

• When visually examining the socket, you can see an empty socket in which there is no blood clot (in this case, the alveolar bone in the depths of the socket will be exposed).
  Or the socket may be completely or partially filled with food debris or necrotic disintegration of a blood clot. By the way, if the alveolar bone is exposed, it is usually extremely painful when touched, as well as when in contact with cold or hot water. In some cases, the edges of the mucous membrane converge so closely to each other above the hole that it is completely impossible to see what is happening in its depths. But when washing such a hole from a syringe with an antiseptic, the liquid will be cloudy, with a lot of food residue.

Dry socket after wisdom tooth removal –

Alveolitis after wisdom tooth removal may in addition have several more symptoms (in addition to those listed above). We are talking about difficulty opening the mouth or painful swallowing (24stoma.ru). Also, due to the fact that the socket of the 8th tooth is usually located deep in the soft tissues, suppuration from the socket often develops there (see video 2).

Alveolitis: video

In video 1 below you can see that there is no blood clot in the socket, there is exposed bone, and also in the depths of the socket it is filled with food debris. And in video 2 - alveolitis of the lower wisdom teeth, when the patient presses his finger on the gum in the area of ​​7-8 teeth, and copious purulent discharge comes from the holes.

How to remove a tooth

There are two extraction methods used in dentistry: simple and complex. Their choice depends on which teeth are being removed - premolars and molars with tangled branched roots are removed using a complex method. It is very difficult to pull out such elements entirely due to the fact that the tooth socket is penetrated by retaining ligaments and alveolar processes. Errors during the procedure or insufficient experience of the specialist lead to serious complications. Therefore, even despite the acute condition, always find out in advance where you can have a tooth removed from a good doctor with positive recommendations.

Factors complicating the operation:

• complete destruction of the coronal part;
• high fragility;
• acute inflammatory diseases;
• Unerupted or misaligned wisdom teeth.

The technology of the procedure depends on which teeth are removed. In some cases, tissue incision and suturing are performed.

Dry socket after tooth extraction: causes

There are many reasons why alveolitis develops. It can arise due to the fault of the doctor, the fault of the patient, and for reasons beyond anyone’s control. If we talk about the patient’s responsibility, then alveolitis can occur when -

• poor oral hygiene,
• the presence of untreated carious teeth,
• due to smoking after removal,
• when ignoring doctor's recommendations,
• if you rinse your mouth vigorously and simply rinse the blood clot out of the hole.

Alveolitis can also occur in women due to increased levels of estrogen in the blood during the menstrual cycle or as a result of taking oral contraceptives (birth control pills). A high concentration of estrogen leads to fibrinolysis of the blood clot in the socket, i.e. to degradation and destruction of the clot.

It is because of fibrinolysis that a blood clot is destroyed both with poor oral hygiene and with carious teeth. The fact is that pathogenic bacteria, which live in large numbers in dental plaque and in carious defects, secrete toxins, which, like estrogens, lead to fibrinolysis of the blood clot in the socket.

When alveolitis occurs due to the fault of the doctor –

• If the doctor left a tooth fragment, bone fragments, or inactive fragments of bone tissue in the socket, which lead to injury to the blood clot and its destruction.

• A large dose of a vasoconstrictor in an anesthetic - alveolitis can occur if, during anesthesia, the doctor injected a large volume of an anesthetic with a high content of a vasoconstrictor (for example, adrenaline). Too much of the latter will result in the hole simply not filling with blood after the tooth is extracted. If this happens, the surgeon must scrape the bone walls with an instrument and cause socket bleeding.

• 
  If the doctor left a cyst/granulation in the socket, when removing a tooth with a diagnosis of periodontitis, the doctor must necessarily scrape out the cyst or granulations (Fig. 10), which might not come out with the tooth, but remain in the depths of the socket. If the doctor did not inspect the socket after extracting the tooth root and left a cyst in the socket, the blood clot will fester.

• Due to the large trauma to the bone during removal, this usually happens in two cases: firstly, when the doctor cuts out the bone with a drill without using water cooling of the bone at all (or when it is not cooled sufficiently).
  Overheating of the bone leads to its necrosis and the start of the process of destruction of the clot. Secondly, many doctors try to remove a tooth for 1-2 hours (using only forceps and elevators), which causes such trauma to the bone with these instruments that alveolitis is simply bound to develop. An experienced doctor, seeing a complex tooth, will sometimes immediately cut the crown into several parts and remove the tooth fragment by fragment (spending only 15-25 minutes), and thereby reduce the trauma caused to the bone.

• If, after a complex removal or removal against the background of purulent inflammation, the doctor did not prescribe antibiotics, which in these cases are considered mandatory.

Conclusions: thus, the main causes of destruction (fibrinolysis) of a blood clot are pathogenic bacteria, excessive mechanical trauma to the bone, and estrogens. Reasons of a different nature: smoking, loss of a clot while rinsing the mouth, and the fact that the hole did not fill with blood after the tooth was extracted. There are also reasons that do not depend on either the patient or the doctor, for example, if a tooth is removed due to acute purulent inflammation - in this case it is stupid to blame the doctor for the development of alveolitis.

Causes

Causes of dry socket may include:

• blood clotting disorder;
• incorrectly selected anesthesia;
• severe tissue injury during extraction;
• active rinsing of the mouth in the first days;
• smoking immediately after the procedure;
• a tooth fragment remaining in the socket;
• poor tissue washing, which leads to infection.

Important! If at the time of tooth extraction there are foci of infection in the oral cavity, this will become a factor of alveolitis. Before extraction, professional hygiene must be carried out and inflammatory processes are eliminated.

Treatment of alveolitis -

If alveolitis develops in the socket after tooth extraction, treatment at the first stage should be carried out only by a dental surgeon.
This is due to the fact that the hole may be filled with necrotic decay of a blood clot; there may be inactive fragments and fragments of bone or tooth. Therefore, the doctor’s main task at this stage is to scrape it all out of the hole. It is clear that no patient will be able to do this on their own. Antiseptic rinses and antibiotics (without cleaning the socket) can only temporarily reduce the symptoms of inflammation, but do not lead to healing of the socket. But at a later stage, when the inflammation in the socket subsides, patients will be able to independently treat the socket with special epithelializing agents to speed up its healing.

Thus, the main method of treatment will be curettage of the hole, but there is also a second method - by creating a secondary blood clot in the hole of the extracted tooth. Read more about these methods...

Curettage of the tooth socket for alveolitis -

1. Under anesthesia, a festering blood clot, food debris, and necrotic plaque from the walls of the socket are removed. Without removing the necrotic plaque and the disintegration of the blood clot (containing a huge amount of infection), any treatment will be useless.
2. The hole is washed with antiseptics, dried, after which it is filled with an antiseptic (iodoform turunda). Usually, the turunda needs to be changed every 4-5 days, i.e. you will have to go to the doctor at least 3 times.
3. The doctor will prescribe you antibiotics, antiseptic baths, and painkillers, if necessary.

Doctor's prescriptions after tooth socket curettage –

• NSAID-based analgesics (for pain),
• 0.12-0.2% Chlorhexidine solution for antiseptic rinses (2-3 times a day for 1 minute),
• Antibiotics: usually either Amoxiclav 625 mg tablets (2 times a day for 5-7 days) or Unidox-solutab 100 mg (2 times a day for 5-7 days) are prescribed. These antibiotics are better, but not cheap. Inexpensive ones are Lincomycin capsules 0.25 (2 capsules 3 times a day), but keep in mind that after this antibiotic, problems with the stomach and intestines develop more often.

Method for creating a secondary blood clot -

However, there are 2 situations in which a different treatment method can be used.
This method involves the creation of a secondary blood clot in the socket and, accordingly, if successful, the socket will heal much faster than after constantly placing iodoform turundas into it for 2-3 weeks. It is preferable to use this method only in the following two situations... Firstly, when you consulted a doctor immediately after, for example, you rinsed a clot out of the hole or it fell out on its own (i.e. when the hole is not yet filled with infection and food debris , and there is no necrotic clot disintegration or suppuration). Secondly, when the patient has a sluggish alveolitis for a long period of time, and the socket is filled with inflammatory granulations.

How this technique is carried out - if the hole is empty, then under anesthesia the bone walls of the hole are scraped out with a curettage spoon to create bleeding and the hole fills with blood (video 3). If the hole is filled with granulations, then they are carefully scraped out, i.e. do the same curettage (video 4). Then, in both cases, after the hole is filled with blood, an anti-inflammatory medicine (Alvogel) is placed deep into the hole, and several sutures are placed on the mucous membrane to bring the edges of the wound closer together. Antibiotics are immediately prescribed.

Curettage to create a secondary blood clot: video 3-4

Summary: i.e. In both the first and second methods, curettage of the hole is carried out in the same way, but in the first case, the hole heals slowly under iodoform turundas, and in the second case, a blood clot forms in the hole for the second time, and the hole heals, as it should do under normal conditions .

Possible forms

The table shows the forms of alveolitis:

What can you do at home -

After the acute symptoms of inflammation have subsided, there is no need for antiseptic turundas inside the socket, because they do not help the wound to heal (epithelialize) faster. At this stage, the best treatment method will be to fill the hole with a special Dental adhesive paste (Solcoseryl). This drug has an excellent analgesic effect (after 2-3 hours the pain will practically stop, and after 1-2 days it will go away completely), and also speeds up healing many times over.

Scheme of use - this paste is added to a hole that has been washed with an antiseptic and slightly dried with a dry gauze swab (completely filling the hole). The paste is perfectly fixed in the hole and does not fall out of it. There is no need to remove the paste from the hole, because... it slowly dissolves on its own, giving way to growing gum tissue. The only thing that may be required is to periodically add it to the hole.

How to rinse the hole from food debris -

In some situations (when the turunda has fallen out of the hole, and there is no way to see a doctor right away), it may be necessary to wash the hole. After all, after each meal, the hole will become clogged with food debris, which will cause new inflammation. Rinsing will not help here, but you can easily rinse the hole with a syringe.

Important : from the very beginning you must bite off the sharp edge of the needle from the syringe! Next, bend the needle a little and fill a 5.0 ml syringe with a solution of Chlorhexidine 0.12-0.2% (it is sold ready-made in every pharmacy for 20-30 rubles). Screw the needle tightly so that it does not fly off when pressing the syringe plunger! Place the blunt end of a bent needle into the upper part of the socket (do not insert too deeply to avoid injuring the tissue), and rinse the socket under pressure. If necessary, do this after every meal.

In principle, after this the hole can be dried with a gauze swab and treated with Solcoseryl. We hope that our article on the topic: Alveolitis after tooth extraction, symptoms, treatment - turned out to be useful to you!

Sources:

1. Higher prof. the author’s education in surgical dentistry, 2. Based on personal experience as a dental surgeon, 3. National Library of Medicine (USA), 4. “Outpatient surgical dentistry” (Bezrukov V.), 5. “Propaedeutics of surgical dentistry” (Soloviev M. .).

Types of disease and clinical picture

Dentists distinguish between two main types of periostitis: acute and chronic. After tooth extraction, as a rule, there is acute inflammation of the bone tissue.

The clinical picture of flux includes the following symptoms:

• redness and hyperemia of the gum mucosa in the area of ​​tooth extraction;
• the formation of a significant tumor in the upper or lower jaw;
• severe pain that can only go away after taking a painkiller;
• limited mouth opening;
• signs of intoxication of the body in the form of a sharp rise in body temperature to 39⁰C, headaches, general malaise and a feeling of chronic fatigue.

Associated symptoms

Dry socket may be accompanied by symptoms such as:

1. High temperature accompanies acute and purulent inflammation, a dangerous symptom that requires immediate attention from a dentist.
2. Swelling of the cheek indicates the accumulation of pus, the development of a dangerous purulent form of the disease.
3. Severe pain is an obligatory companion of alveolitis and increases with exposure of the bone and purulent inflammation.