Development Of Alveolar Osteitis Research Articles

Possible roles of short-chain fatty acids produced by oral bacteria in the development of alveolar osteitis.

Alveolar osteitis (dry sockets) is a painful condition characterized by a limited immune response. It is typically caused by the removal of blood clots from extracted tooth sockets, which leads to the fermentation of trapped food remnants by oral bacteria in the cavities, producing high concentrations of short-chain fatty acids (SCFAs). This study examined the effects of SCFAs on immunity and bone metabolism. Mouse macrophage Raw264.7 cells were treated with oral bacteria supernatants or SCFA mixtures, and inducible nitric oxide synthase (iNOS) levels were determined by western blot. The same cells were treated with SCFA mixtures in the presence of receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoclast-like cells were counted. MC3T3-E1 cells were treated with SCFA mixtures and stained with alizarin red S. Raw264.7 cells treated with oral bacterial culture supernatants of Porphyromonas gingivalis and Fusobacterium nucleatum inhibited lipopolysaccharide (LPS)-induced iNOS production, likely due to SCFA content. SCFA mixtures mimicking these supernatants inhibited the number of RANKL-induced tartrate-resistant acid phosphatase (TRAP)-positive cells and MC3T3-E1 cell mineralization. These data suggest that SCFAs produced by P. gingivalis and F. nucleatum may reduce the inflammatory response and mildly induce mineralization of the alveolar walls. These results may contribute to the understanding of alveolar osteitis.

Comparative Study on Immediate and Delayed Extraction of Mandibular Molars in the Management of Acute Dentoalveolar Abscess

Objective: This study compared treatment outcome between two acute dentoalveolar abscesses in the same patients diagnosed simultaneously in both quadrants of the mandible, treated by either immediate or delayed extractions of the affected first and/or second molars. Methods: This is a prospective, cohort, clinical-based study. The timing of infected tooth is the predictor variable, whereas the healing parameters are the outcome variables. The outcome variables include timing of extraction, patients’ preference of immediate or delayed extraction, healing time of soft tissues surrounding extraction sockets, and development of complication(s). Other variables were grouped into demographic and clinical parameters. Descriptive and bivariate statistics were computed. Results: The sample composed of 77 patients with 154 molars grouped as follows: control (n= 77, 50%) extracted on first visit and experimental (n= 77, 50%) removed subsequently on the 5 th day. There was no significant association between acute dentoalveolar abscess and development of alveolar osteitis (P= 0.831) as complication rates were 5.2% in control group and 6.5% in experimental. Most patients preferred immediate extraction, and healing period of soft tissues was 0.5 weeks shorter in the control than experimental group (P= 0.57). Conclusion: The results of this study suggest that in patients with acute dentoalveolar abscess and accessible oral cavity, immediate extraction should be practiced.

COMPARATIVE STUDY ON IMMEDIATE AND DELAYED EXTRACTION OF MANDIBULAR MOLARS IN THE MANAGEMENT OF ACUTE DENTOALVEOLAR ABSCESS

Objective: This study compared treatment outcome between two acute dentoalveolar abscesses in the same patients diagnosed simultaneously in both quadrants of the mandible, treated by either immediate or delayed extractions of the affected first and/or second molars. Methods: This is a prospective, cohort, clinical-based study. The timing of infected tooth is the predictor variable, whereas the healing parameters are the outcome variables. The outcome variables include timing of extraction, patients’ preference of immediate or delayed extraction, healing time of soft tissues surrounding extraction sockets, and development of complication(s). Other variables were grouped into demographic and clinical parameters. Descriptive and bivariate statistics were computed. Results: The sample composed of 77 patients with 154 molars grouped as follows: control (n= 77, 50%) extracted on first visit and experimental (n= 77, 50%) removed subsequently on the 5 th day. There was no significant association between acute dentoalveolar abscess and development of alveolar osteitis (P= 0.831) as complication rates were 5.2% in control group and 6.5% in experimental. Most patients preferred immediate extraction, and healing period of soft tissues was 0.5 weeks shorter in the control than experimental group (P= 0.57). Conclusion: The results of this study suggest that in patients with acute dentoalveolar abscess and accessible oral cavity, immediate extraction should be practiced.

Alveolar osteitis in a patient with common variable immunodeficiency

Patients with primary immunodeficiency disorders are prone to dental problems, and a lack of proper communication with surgeon may create complications following invasive dental procedure. We present the case of a patient with common variable immunodeficiency disorder (CVID) who underwent a dental extraction and later on, developed alveolar osteitis. A 26-year-old male reported to the outpatient department, with a complaint of severe pain in his left lower jaw following the extraction of mandibular molar 1 week ago. The clinical picture was suggestive of suppurative alveolitis. The fact that he was a diagnosed case of CVID was not revealed to the operating surgeon. He was undergoing treatment for the past 6 years at another center that included intravenous immunoglobulin G (IgG) administration. Serum IgG level performed about 10 months back was 6.1 g/L. The patient recovered fully after a week of treatment with zinc oxide pack and oral metronidazole. CVID is a known risk factor for the development of alveolar osteitis. Proper communication is vital for avoiding complications in such cases.

Autologous Platelet Concentrates to improve post extraction outcomes.

Data sourcesElectronic search of Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL). Manual search of multiple dental journals and review reference lists.Study selectionTwo authors searched studies without any language or follow-up duration restrictions. Randomised and controlled clinical trials with a minimum of five patients per group and a parallel or split-mouth design were included. Outcome variables assessed comparing APC use included: patient satisfaction, self-reported postoperative quality of life, radiographic bone healing, clinical and radiographic marginal bone remodelling, soft tissue healing and complications such as alveolar osteitis.Data extraction and synthesisMethodologic quality of research was assessed using the following parameters: random sequence generation method and allocation concealment, calibration and binding of outcome assessment, comparability of control and treatment groups at entry, clear definition of inclusion and exclusion criteria, clear definition of outcomes assessment and success criteria, completeness of the outcome data reported and explanation for dropouts/withdrawal, recall rate, sample size and number of surgeons involved. Meta-analysis was carried out with data from studies reporting the same outcome measurements at comparable observations times following tooth extraction. Dichotomous outcomes (ie development of alveolar osteitis) for different treatments were expressed as risk ratios with a 95% confidence interval and continuous outcomes (ie quantifiable bone changes) were expressed as mean differences with a 95% confidence interval. Study design risk of bias was assessed using sensitivity analysis.ResultsThirty three studies met the inclusion criteria. Soft tissue healing at seven days after extraction was better when APCs were used (mean difference of 1.01; 95% CI; 0.77 to 1.24). Three months postoperatively, the second mandibular molar distal probing depth was statistically better in the APC group, mean difference of -1.63; (95% CI; -2.05 to -1.22). There were no statistical differences between the APC and control groups for alveolar osteitis, acute inflammation or alveolar infection. Although the percentage of new bone and indirect measurement of bone metabolism were similar for both groups, bone density was statistically better for the APC group, mean difference of 5.06; (95% CI; 1.45 to 8.66). Qualitative analysis found decreased swelling in four of five studies and decreased trismus in two of three studies. The variations between different types of APCs were not evaluated as part of this review.ConclusionsAPCs including platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and plasma rich in growth factors (PRGF) can be used following tooth extraction to improve soft tissue healing, probing depth and bone density, as well as to reduce swelling and trismus. However, their use in reducing other postoperative complications such as pain, alveolar osteitis, inflammation, infection, or in improving new bone percentage and metabolism cannot be recommended. Study heterogeneity made it impossible to perform meta-analysis for pain reduction; therefore further studies investigating the effect on pain are required.

Progesterone Status Does Not Predict Development of Alveolar Osteitis

The purpose of this study is to assess if progesterone, independent of its role in oral contraceptive pills (OCP), is a risk factor in the development of alveolar osteitis (AO) following third molar (M3) extraction. The secondary aim is to confirm that OCP use increases risk of AO following M3 extraction.

Indications and risk factors for complications of lower third molar surgery in a nigerian teaching hospital.

Background:The surgical extraction of impacted third molars is a common oral surgical procedure, and it is often associated with complications such as sensory nerve damage, dry socket, pain, swelling, trismus, infection and hemorrhage.Aim:The aim of this study was to determine the surgical indications and risk factors for complications of third molar surgery at a Nigerian teaching hospital.Materials and Methods:Medical records of patients referred to the Oral Surgery Clinic of our institution for surgical extraction of their impacted mandibular third molars from January 2008 to December 2010 were retrospectively examined. Information on patients’ demography, types of impaction, operative parameters and complications were obtained and analyzed using Statistical Package for Social Sciences (SPSS Version 13), Chicago, IL, USA. A P < 0.0.5 was considered significant.Results:A total of 330 impacted teeth were extracted from 250 patients. Male comprises (104/250 [41.6%]) and female (146/250 [58.4%]). The mesioangular (176/330 [53.4%]) and distoangular (73/330 [22.1%]) impactions were the commonest types. Recurrent pericoronitis (154/330 [46.7%]) was the most common indication for extraction. The complications were delayed healing (19/330 [5.8%]), alveolar, osteitis (9/330 [2.7%]) and injury to alveolar nerve (2/330 [0.6%]). Cigarette smoking (P < 0.001), Oral contraceptives use (P = 0.01), age of the patient (P = 0.03) and the surgeon's experience (P = 0.04) were found to be significantly associated with the development of alveolar osteitis; nerves injuries were significantly associated with the raising of a lingual flap (P < 0.001) and the technique of surgery (P ≤ 0.001).Conclusion:The age of the patient, cigarette smoking and oral contraceptive use at the time of surgery are some of the factors affecting outcome in third molar surgery.

Influence of immediate post-extraction socket irrigation on development of alveolar osteitis after mandibular third molar removal: a prospective split-mouth study, preliminary report

The aim of this prospective comparative split-mouth study was to evaluate the role of socket irrigation with a normal saline solution routinely used at the end of extraction on the development of alveolar osteitis (AO) after removal of impacted mandibular third molars (MTMs). Thirty-five patients who satisfied the inclusion criteria were involved in the study and underwent extraction of four third-molars. To be included in the study, the mandibular third molars had to be impacted (partial or full bone) and require an osteotomy for extraction with use of a motorised drill. All surgeries were done under local anaesthesia or IV sedation. This was a prospective split-mouth study. The patient's left (assistant) side was a control side; it had a standard extraction technique of an impacted mandibular third molar that required a buccal full-thickness flap, buccal trough (osteotomy) and extraction of the tooth (with or without splitting the tooth into segments), followed by a traditional end-of-surgery debridement protocol consisting of a gentle curettage, bone filing of the socket walls, socket irrigation with approximately 5 ml of sterile normal saline solution and socket suctioning. The patient's right (operator) side was an experimental side; it also had a standard extraction technique of an impacted mandibular third molar at the beginning with a flap and osteotomy, but it was followed by a modified end-of-surgery protocol. It consisted of gentle curettage but the socket was not irrigated and not suctioned. It was simply left to bleed. The gauze was placed on top of the socket for haemostasis on both sides and the patient was asked to bite. On both sides, the buccal flap was positioned back without the suture. All patients were seen for a follow-up appointment four to seven days after the surgery to assess healing and check for symptoms and signs of alveolar osteitis, if present, on both irrigated and non-irrigated sides. This study followed the ethical guidelines of human subjects based on the Helsinki Declaration. Thirty-five patients or 70 sockets were evaluated. Eleven out of 35 patients in the study were subjected to a dry socket syndrome (31.4%). The higher number of AO was likely related to specifics of MTM selection in this study - only impacted (partial and full bone) MTMs were chosen. Among eleven patients with AO, two patients had a bilateral condition. By excluding two patients with bilateral dry sockets from the study, there were nine patients (18 extraction sites) with unilateral AO in the study. Seven out of nine patients (14 extraction sites) developed unilateral dry socket on the control (irrigated) side (77.8%) and only two (four extraction sites) on the experimental (non-irrigated) side (22.2%). Therefore, in this study there were 3.5 times more patients (extraction sites) with dry socket syndrome on the irrigated (control) side than patients (extraction sites) in the non-irrigated (experimental) side. A noticeable difference of dry socket syndromes (77.8% on the irrigated versus 22.2% on non-irrigated side) was demonstrated between the traditional extraction protocol versus modified approach without the end-of-surgery irrigation. The study demonstrated that the post-extraction socket bleeding is very important for the proper uncomplicated socket healing. If it's not washed away with irrigation solution at the end of extraction, the normal blood clot has a higher likelihood to form, and therefore, can potentially lead to an uncomplicated socket healing without development of alveolar osteitis. Socket bleeding at the extraction site creates a favourable environment for the formation of a blood clot - a protective dressing - necessary for a favourable osseous healing of the socket.

Logistic Regression Analysis of Risk Factors for the Development of Alveolar Osteitis

To assess risk factors for alveolar osteitis. A prospective nested case-control study was conducted in an urban community dental clinic in Valdivia, Chile. A cohort of 1,355 patients who underwent dental extractions was included. Eight predictor variables (risk factors), namely patient gender, hygiene, tooth location, previous surgical site infection, traumatic extraction, systemic diseases, alcohol consumption, and tobacco use, were considered in a risk factor model. A binary regression logistic analysis was performed to determine significant associations. In total 1,302 participants completed the follow-up. Eighty incident case patients with alveolar osteitis and 80 matched control patients were included. A statistically significant association was found between traumatic extraction (odds ratio [OR], 13.1; 95% confidence interval [CI], 5.4 to 31.7), tobacco smoking after extraction (OR, 3.5; 95% CI, 1.3 to 9.0), previous surgical site infection (OR, 3.3; 95% CI, 1.4 to 7.7), and the development of alveolar osteitis. Previous surgical site infection, traumatic extraction, and tobacco smoking are associated with an increased risk of alveolar osteitis.

Alveolar osteitis after surgical removal of impacted mandibular third molars: Identification of the patient at risk

One hundred thirty-eight impacted mandibular third molars were surgically removed. A prospective study of risk factors associated with the development of alveolar osteitis (dry socket) postoperatively was undertaken. Two surgeons, one experienced and one inexperienced, removed the teeth. Patients were controlled for age, sex, use of oral contraceptives, radiographic difficulty of the extraction, and tobacco use. Patients treated by the inexperienced surgeon and those using tobacco had a significantly greater incidence of alveolar osteitis. Previously identified risk factors of increased age, female sex, oral contraceptive use, and increased surgical time were not associated with an increased incidence of dry socket. Recommendations are made regarding prevention of alveolar osteitis in those patients identified as being at high risk.

Effect of 0.12% chlorhexidine on the development of alveolar osteitis after surgical removal of impacted mandibular third molars

Effect of 0.12% chlorhexidine on the development of alveolar osteitis after surgical removal of impacted mandibular third molars