Abstract
Objectives: To evaluate socket healing, incidence of acute alveolar ostieitis (AO) and associated pain following single molar tooth extraction in patients who receive intra-alveolar 0.2% chlorhexidine (CHX) gel, and those who rinsed with 0.12 % CHX rinse. Study Design: A prospective randomized clinical trial was conducted on two parallel groups of patients. Group1 (141 patients): Rinsed with 0.12 % CHX rinse from the second postoperative day, two times daily for a week. Group2 (160 patients): Who had direct intra-alveolar application of 0.2% CHX gel and day 3 post-operatively. The socket was evaluated 3 and 7 day post operatively for the presence of AO by checking probing tenderness in the socket, empty socket, food debris, halitosis and pain assessment by VAS. Results: Forty-eight AO cases were diagnosed out of 301 extractions (15.9%). In Group1, 25 cases were found (17.7%) while 23 cases were found in Group2 (14.4%). The difference was not statistically significant (p=0.428). Presence of empty socket and food debris in Group1 were higher than in Group2 but the difference was not statistically significant (p= 0.390 & p = 0.415). Occurrence of halitosis in Group2 was more than Group1, but the difference was not significant (p= 0.440). Statistical significance was found between AO in extraction done by root separation (29%) and those routinely extracted (12.3 %) (p=0.001). Conclusions: Postoperative evaluation of molar extraction sockets that received direct intra-alveolar application of 0.2% CHX gel showed insignificant less occurrence of AO when compared with 0.12 % CHX rinse. Key words:Chlorhexidine rinse, bio adhesive gel, alveolarosteitis, dry socket, molar teeth extraction, post-extraction socket.
Highlights
Alveolar Osteitis (AO) commonly known as “dry socket” remains a common post-extraction complication, resulting in severe pain and discomfort
The most recent definition of alveolar ostieitis (AO) is “postoperative pain in and around the extraction site, which increases in severity at any time between 1 and 3 days after the extraction accompanied by a partially or totally disintegrated blood clot within the alveolar socket with or without halitosis.” [1] AO is diagnosed between 2nd and 4th postoperative days when patients complain of a painful extraction socket and which on clinical examination usually reveals empty socket or disintegrated clot with exposed bone and fetid odor [2,3,4,5]
Antibiotics could be expensive, may create resistance, and their efficiency in the prevention of AO has been questioned by Ritzau et al [15] who did not find any preventive effect of a single dose of metronidazole in the development of AO
Summary
Alveolar Osteitis (AO) commonly known as “dry socket” remains a common post-extraction complication, resulting in severe pain and discomfort. Risk factors for AO mentioned in the literature include; traumatic surgery, remaining tooth fragment [9,10], smoking, oral contraceptives, advanced age, female gender, immunosuppression [7] and lack of dentist experience which is associated with higher trauma during extraction [11]. Direct activators are released following trauma to the alveolar bone cells while indirect activators are stimulated by bacteria. Delilbasi et al [16] recommended using chlorhexidine solution with a lactamase inhibitor– containing antibiotic to enhance its effectiveness for the prevention of alveolar osteitis. Some measures were suggested in the literature for the prevention of AO including washing with saline solution, eugenol dressings to provide relief, anti-fibrinolytic agents and tranexamic acid [3,7]
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