Dry Socket Following Teeth Extraction: Effect of Excessive Socket Saline Irrigation

Introduction: Alveolar osteitis, “dry socket”, is reported among the most common complications following teeth extraction. Many controversies are present in the literature of the pathogenesis of alveolar osteitis, yet the exact mechanisms are not yet confirmed. Many factors in relation to alveolar osteitis were reported since 1963 including difficulty of surgery, lack of operator experience, location of the extracted tooth, patient's age, gender, smoking habits, oral contraceptives, bacterial infection, excessive irrigation with saline, single extraction versus multiple extractions, the presence of systemic disease, and local anesthetic with vasoconstrictor. No clear data are available in the literature to show the incidence of dry socket due to excessive socket Irrigation with saline. Material and Methods: A total of 574 of teeth were extracted from patients attending the clinic of oral and maxillofacial surgery for different reasons between 31 December 2012 and 30 April 2013. Patients who have unilateral tooth extraction, received chemo or radiotherapy, syndromic patients and pregnant women were excluded from the study. Age, gender, Medical history, location of tooth, difficulty of extraction and the presence of smoking habit were reported. The patients were divided into two groups, in the first group (286 extractions) the extracted socket was irrigated with 20 cc saline (done by the operator) and the second group (288 extractions) received no saline irrigation. All patients were followed up after extraction by one week and instructed to visit the clinic when they develop any signs or symptoms of discomfort related to the extraction site. Patients who developed alveolar osteitis were diagnosed according to the conventional sign and symptoms of dry socket and managed in the standard way. Result: The total number of dry socket reported in this current study was 7 (1.2%) cases, 6 of the cases were females. All these cases were related to extractions in the mandible. Of All cases received excessive socket saline irrigation, only 2 cases developed dry socket. Conclusion: Excessive socket saline irrigation with syrinage after teeth extraction is not related to the development of dry socket as mentioned in the literature, other factors could share in that, but no clear reason could be related.