II. Epidemiology

  1. Complicates 5-20% of Tooth Extractions

III. Pathophysiology

  1. Blood clot is lost prematurely at the extraction site
  2. Painful, localized Bone Infection at the extraction site

IV. Risk Factors

  1. Posterior mandibular teeth
  2. Advanced age
  3. Tobacco Smoking
  4. Poor Oral Hygiene

V. Symptoms

  1. Precautions
    1. Trismus is not typically present
      1. Consider alternative diagnosis (e.g. dental abscess)
  2. Severe Dental Pain
    1. Onset 3-4 days after Tooth Extraction (delayed beyond typical post-extraction pain)
    2. Not relieved with Acetaminophen and NSAIDS
  3. Halitosis

VI. Management

  1. Anesthetize the area
    1. See Inferior Alveolar Block
    2. See Periapical Block (Supraperiosteal Dental Anesthesia)
  2. Protect the socket
    1. Flush the socket with saline
    2. Apply Dry Socket paste
  3. Course
    1. Expect pain improvement within 20 minutes of applying paste
    2. Paste typically lasts for 5 days, but reapplication may be needed sooner
  4. Additional Measures
    1. Analgesics
    2. Antibiotics may be indicated

VII. References

  1. Broderick and Deak (2015) Crit Dec Emerg Med 29(1): 2-8

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