Etiology of dry socket: additional factors.

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Adeyemo, W.L.
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I read with interest the article on dry socket (alveolar osteitis) in a recent issue of the Journal by Oginni et al (J Oral Maxillofac Surg 61:871-876, 2003).1 Despite the fact that dry socket is a consistent problem in our practice in Africa, few reports can be found in the international literature on the incidence of this common complication of dental extractions in the African population. According to the authors, most of the extractions (72%) that resulted in dry socket were carried out by less-experienced surgeons (house officers and undergraduate students). Less-experienced surgeons have been reported to cause more trauma during extractions than experienced surgeons.2 This is probably due to excessive trauma and intraoperative complications that are inflicted by the less experienced surgeons. Excessive trauma has been known to delay wound healing.3 Birn3 proposed that trauma during extraction damages the alveolar bone cells, causing inflammation of the alveolar bone marrow and the subsequent release of direct tissue activators into the alveolus, where they may precipitate fibrinolytic activity, thus playing a major role in the pathogenesis of alveolar osteitis. One important factor that was not evaluated in the report by Oginni et al,1 probably due to the nature of their study (retrospective), was the intraoperative complications (tooth fracture, alveolar bone fracture) during the extractions. Birn3 suggested that roots or bone fragments (remnants) remaining in the extraction wound could possibly cause alveolar osteitis.
Dry socket , Aetiology
Adeyemo WL. Etiology of dry socket: additional factors. J Oral Maxillofac Surg. 2004 Apr;62(4):519-20