Prevalence, Clinical Picture, and Risk Factors of Dry Socket in a Jordanian Dental Teaching Center

Nuseir, Y.
Abu Younis, Mohammad H.
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Aims: The aims of this study were to determine the prevalence, clinical picture, and risk factors of dry socket at the Dental Teaching Center of Jordan University of Science and Technology (DTC/JUST). Methods and Materials: Two specially designed questionnaires were completed over a four-month period. One questionnaire was completed for every patient who had one or more permanent teeth extracted in the Oral Surgery Clinic. The other questionnaire was completed for every patient who returned for a post-operative visit and was diagnosed with dry socket during the study period. Results: There were 838 dental extractions carried out in 469 patients. The overall prevalence of dry socket was 4.8%. There was no statistically significant association between the development of dry socket and age, sex, medical history, medications taken by the patient, indications for the extraction, extraction site, operator experience, or the amount of local anesthesia and administration technique used. The prevalence of dry socket following non-surgical extractions was 3.2%, while the prevalence following surgical extractions was 20.1% (P< 0.002). The prevalence of dry socket following surgical and non-surgical extractions was significantly higher in smokers (9.1%) than in non-smokers (3%) (P = 0.001), and a direct linear trend was observed between the amount of smoking and the prevalence of dry socket (P = 0.034). The prevalence of dry socket was significantly higher in the single extraction cases (7.3%) than in the multiple extraction cases (3.4%) (P = 0.018). The clinical picture and management of dry socket at DTC/JUST were similar to previous reports in the literature. The prevalence of dry socket, its clinical picture, and management at DTC/JUST are similar to those reported in the literature. Abstract 2 The Journal of Contemporary Dental Practice, Volume 8, No. 3, March 1, 2007 Introduction Dry socket is one of the most common complications of tooth extraction and is characterized by severe pain starting usually on the second or third day postoperatively. Its prevalence has been reported to vary from 0%1 to more than 35%2 and is more common following mandibular third molar extraction. 3-9 Patients experience pain and may experience loss of productivity. This makes the condition costly to both patient and society, as 45% of patients require multiple postoperative visits in the process of managing this painful condition. 10 The exact pathogenesis of dry socket is not well understood. However, disintegration of the blood clot by fibrinolysis remains the most widely accepted theory.11 Several contributing factors have been reported to be associated with an increased risk of dry socket. They include traumatic extraction, 3-4,11 preoperative infection, 11-12 smoking,13 sex, 11,14 site of extraction, 8,14 use of oral contraceptives, 15 use of local anesthetics with vasoconstrictors, 16 inadequate postoperative irrigation, 17 and low level of operator experience. 4,8 Several methods have been advocated to reduce the incidence of dry socket including the use of antiseptic mouthwashes18-20 antifibrinolytic agents, 21 antibiotics, 22-23 steroids, 24 clot supporting agents, 25 and other intra-alveolar dressings and medicaments. 9,27-28 While this condition cannot be completely treated as long as the exact etiology is not firmly established, its management appears to be simple and effective. It usually involves reassurance of the patient, cleaning and irrigation of the affected socket, and insertion of a medicated pack. 2,25,29-30 This is the first study of dry socket at the Dental Teaching Center of Jordan University of Science and Technology (DTC/JUST) and in Jordan . Its aims were to identify the prevalence and risk factors as well as to describe the clinical picture of this painful condition at this Jordanian dental teaching center. Methods and Materials The DTC/JUST was the setting for the study. This center is located in Irbid, in North Jordan, and is involved in the training of undergraduate and postgraduate dental students. It serves the community of the city of Irbid and its neighboring towns and villages, which have a total population of approximately 750,000. This prospective study was totally observational without any interference with any of the clinical procedures normally followed at DTC/JUST. Description of the Sample During the study period, 838 permanent tooth extractions were carried out in 469 patients. There were 225 (48.0%) male patients and 244 (52.0%) female patients. The age of patients Conclusion: Smoking and surgical trauma are associated with an increased incidence of dry socket. Moreover, patients who had single extractions were more likely to develop dry socket than those who had multiple extractions in the same visit
Dry socket, incidence, signs, symptoms, risk factors, Jordan