After extraction of a tooth a blood clot is formed at the site with eventual organization of the clot by granulation tissue gradual replacement by coarse fibrillar bone and finally replacement by mature bone. Destruction of the initial clot prevents appropriate healing and causes the clinical condition known as alveolar osteitis
Extensive investigations have been shown that the clot is lost secondary to transformation of plasminogen to plasmin, with subsequent lysis of fibrin and formation of kinins (fibrinolytic alveolitis) these are potent pain mediater.
Etiology of dry socket
1.Traumatic extraction and after extraction of impacted lower third molar. 2.Poor oral hygiene. 3.Inexperienced surgeon. 4.Oral contraceptive pills. 5.Presurgical infection. 6.Inadequate irrigation at surgery. 7.Excessive use of vasoconstrictor in the L A. 8.Heavy sucking or spitting by the patients after surgery and excessive mouth wash at the day of extraction . 9.Use of tobacco products.Clinical Features of Dry Socket
The frequency of alveolar osteitis is higher in the mandible and the posterior areas. The prevalence is between 1% and 3% of all extractions but it increases to 25% to 30% for impacted mandibular third molar.The affected extraction site is filled initially with a dirty gray clot that is lost and leaves a bare bony socket (dry socket) the detection of the bare socket may be hindered by partial retention of the clot or by overlying inflamed tissue that covers the site.
The diagnosis is confirmed by probing of the socket, which reveals exposed and extremely sensitive bone. Typically severe pain, foul odor, and (less frequently) swelling and lymphadenopathy develop 3 – 4 days after extraction of the tooth, on occasion, the pain radiates from the socket to the ipsilateral ear, temporal region, or eye. Rarely trismus also may be noted. the signs and symptoms may last from 10 to 40 days.