Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: An observational study.

Hiroki Otake,Atsushi Abe,Yoko Sato,Hideaki Asai,Shingo Takei,Moriyasu Adachi,Kohta Fukuta,Eiji Nakatani,Philip Hawke,Akihiko Ogino

doi:10.1371/journal.pone.0254221

Abstract

ObjectivesDry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion.MethodsThis retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7).ResultsThe occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7.Conclusions and clinical relevanceInserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.

Highlights

Dry socket occurs when a clot becomes partially or completely detached from the extraction site before the wound has healed [1, 2]
The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p
The results showed that both VASdefined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on postoperative day 3 (POD3) and postoperative day 7 (POD7)

Summary

Introduction

Dry socket occurs when a clot becomes partially or completely detached from the extraction site before the wound has healed [1, 2]. It is one of the most studied complications in the field of oral and maxillofacial surgery [3]. The incidence of dry socket has been reported to be about 3% for all teeth and more than 30% for lower third molars [4]. Several studies have reported that a variety of local and systemic factors are involved in dry socket, but its exact etiology has not been clarified. Risk factors include male sex, smoking, and a history of inflammation [5, 6]

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