Chlorhexidine lavage of the oral cavity has been found to significantly reduce the microbial load of saliva within seconds of its use and found an associated reduction of certain infections in critically ill hospitalized patients.1
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| Post-operative pain non-responsive to conventional treatments is one hint of a alveolar osteitis |
With this in mind other studies have also found a reduction of oral infections related to Chlorhexidine lavage. I recall instituting a policy to have all patients rinse with chlorhexidine (Peridex, Periogard) prior to the oral examination and before all surgical procedures and before postop appointments. Subsequent to this addition, there was a notable reduction in the number of patients that developed alveolar osteitis or prolonged postop symptoms. Whether it was statistically significant would need further investigation including statistical analysis of the data. However, an unofficial analysis showed a significant reduction. The fact is the total number of patients that required a visit or treatment for an alveolar osteitis aka “dry socket” was much lower. These results support many other published articles that make the same claim.2 ,3, 4
What is Alveolar Osteitis?
• Patients will complain of pain, that may be throbbing in nature, persistent or unabating after tooth extraction.
• Pain unaffected by oral analgesics.
• The protective blood clot that forms within the socket after an extraction becomes hemolyzed. It’s an important situation to enable and initiate healing of the extraction socket.
• Symptoms begin 2-7 days after a tooth extraction and often times not relieved with oral analgesics.
• More common in lower molar extractions.
• Halitosis.
What are the Risk Factors for Alveolar Osteitis?
• Preexisting local bacterial pericoronitis or infection.
• Females taking birth control pills.
• Smoking- causes a reduction of adequate oxygenated within the blood supply to the region and or topical effect of heat or chemicals.
• Inadequate oral hygiene allowing bacterial growth to flourish.
• Mandibular molars-Attributed to thick cortex of mandibular bone morphology that is less vascular.
• Elderly.
• Systemic diseases i.e. Diabetes mellitus.
Prevention of Alveolar Osteitis?
• Avoid causative habits like smoking immediately before and after surgery.
• Maintain excellent oral hygiene and rinse the oral cavity after food consumption.
• Utilize antibacterial agents preoperatively and postoperatively to reduce bacterial contamination. Ie. Chlorhexidine
• Patient education and utilizing staff and written documentation to support this claim.
Treatment of Alveolar Osteitis
• Rinse the socket with saline to remove food debris and organic content.
• Pack a ¼” plain gauze that’s soaked in Eugenol and blotted of excess medicament and coat with topical anesthetic OR administer a manufactured dressing like Dressol-X that is also very effective.
• Explain to the patient that the medicated dressing takes approximately 20 minutes to start to relieve pain and will require removal once symptoms abate. The dressing will remain in the socket from 1-3 days depending on the relief the patient receives from the dressing.
• Change the dressing and replace it, dictated by the patient’s symptoms. Once there isn’t perceived relief then the dressing is replaced with a new one. Sometimes it is within a day or two after the initial dressing. Typically, the need for additional dressings isn’t more than three.
The Girldoc😉
1 https://www.ncbi.nlm.nih.gov/books/NBK541430/
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114788/
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547445/
4 https://www.tandfonline.com/doi/full/10.1080/20002297.2020.1794363
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