Alveolitis after tooth extraction - symptoms and treatment

alveolar sockets or alveoli the holes in the bone tissue of the jaw in which the teeth are held. They are also called “the receptacle of the dental root system.” When a diseased tooth is removed, an empty socket is left and if its walls, dry socket or gum are injured, then alveolitis - suppuration of a blood clot . With alveolitis, the socket itself and the surrounding tissues are affected. But there are rare exceptions, when alveolitis is caused by chronic inflammation and infections (more details in the article “Alveolar osteitis: when a tooth was removed carelessly“)

Alveolus (alveolar socket) and its infection (alveolitis)

Description of the disease

Not all dental surgeon patients know that inflammation may develop after removal, so they often ask the question: “Alveolitis - what is it, and why does it occur?” Other names for the disease: “dry socket”, “alveolar local osteitis”. The pathogenesis of the condition is based on a violation of the formation of a physiological clot or its loss from the socket after tooth extraction, which most often occurs due to a violation of the postoperative regimen or low human immunoresistance.

Inflammation of the alveoli is possible only due to removal of the segment. Alveolitis cannot develop after tooth treatment, since the hole is formed only as a result of extraction of the unit.

The main reasons for the appearance of alveolitis after tooth extraction

Tooth extraction is a surgical procedure that is accompanied by the formation of a wound. A blood clot forms in it, protecting it from the penetration of microorganisms. Inflammation of the tooth socket after extraction occurs due to disruption of the process of formation or displacement of a blood clot. The most common causes of pathology:

1. Difficult extraction. The more traumatic the operation, the more the tissue’s ability to regenerate decreases and the likelihood of infection increases.
2. Wisdom tooth removal. The structure of the root system of third molars is complex, so their extraction is always traumatic. In addition, the bone in the figure eight area has increased density and is less vascularized compared to other areas, which also creates conditions for the formation of a dry socket.
3. Concomitant somatic diseases of the patient (diabetes mellitus, immunodeficiency states).
4. History of pericoronitis (inflammation of the soft tissues around the tooth).
5. The presence of foci of infection in the mouth before surgery. Penetrating into the wound with saliva, pathogenic flora causes alveolitis.
6. Inadequate sanitation of the alveoli. After removal, careful curettage of the wound is necessary to remove fragments of bone tissue, roots, pieces of filling, and granulations. Foreign fragments disrupt healing and lead to alveolitis.
7. Exceeding the dose of anesthetic. Leads to a narrowing of the lumen of the capillaries, the development of local ischemia, which disrupts the filling of the hole with blood.
8. Mechanical damage to the clot. Failure to follow the doctor’s recommendations during the postoperative period (rinsing the mouth, carelessly brushing teeth, etc.).
9. Impaired hemostasis. Due to poor blood clotting, a clot does not form.

Alveolitis can be provoked by smoking, taking hormonal contraception, and insufficient oral hygiene. Age plays a certain role in the development of alveolitis after tooth extraction: the older the patient, the greater the likelihood of developing pathology. This is due to a slowdown in metabolic processes and a decrease in the regenerative ability of tissue cells.

Symptoms of alveolitis of the socket

Alveolitis goes through several stages of development, each of which has its own clinical picture:

If left untreated, alveolitis has an unfavorable outcome. The main complications after alveolitis:

• phlegmon (extensive purulent inflammation);
• acute periostitis (inflammatory process of the periosteum);
• osteomyelitis (purulent-necrotic inflammation of the jaw bone);
• sepsis (purulent-septic blood disease).

Alveolitis after wisdom tooth removal

Indications for the removal of eighth segments in a row can be different: deep caries, improper eruption, orthodontic correction of jaw bite, dystopia, etc. Extraction of third molars is always associated with trauma to nearby tissues, which increases the development of inflammation. The pathological process is observed in 45% of cases due to the removal of lower wisdom teeth.

Symptoms of alveolitis after wisdom tooth removal are similar to the general symptoms of the disease. However, with such localization of inflammation, a sore throat and impaired functionality of the temporomandibular joint on the affected side may occur (difficulty and painful opening of the mouth).

Stages of alveolitis

All these symptoms of alveolitis cannot appear at the same time. Signs of the disease accumulate, alternate, or overlap as inflammation progresses. Symptoms help determine the stage of the disease.

• Serous alveolitis

  It develops 72 hours after tooth extraction. The main symptom is aching pain that intensifies while eating. Body temperature is not elevated, regional lymph nodes are not enlarged. Upon examination, pieces of food and saliva are found in the hole, but there may not be a blood clot there, or it may be partially destroyed. Serous alveolitis continues for a week, and if left untreated, it turns into a purulent form.

• Purulent alveolitis

  Occurs 10 days after tooth extraction. By this time, the pain from alveolitis has already become so intense and constant that it is impossible to eat. In this case, unpleasant sensations spread along the branches of the trigeminal nerve. The soft tissues of the affected area swell, and mouth opening is limited. The patient feels weak and unwell, his temperature rises (up to 38 degrees) and a putrid taste and smell appears in the mouth. Upon examination, you can see redness, swelling, a dirty gray coating, and the alveolar process is thickened on both sides of the socket.

• Chronic purulent (hypertrophic) alveolitis

  As the disease becomes chronic, the pain begins to gradually subside, body temperature normalizes, and the patient’s general condition noticeably improves. The soft tissue in the area of ​​the inflamed hole grows, and pus is released from it. The gums at the site of inflammation are swollen and have a bluish tint.

Alveolitis can occur not only in adults, but also in children. If a child has had a permanent tooth removed, parents need to carefully monitor compliance with the doctor’s recommendations.

Methods for diagnosing alveolitis

How long the alveolitis will take to heal depends on timely diagnosis and treatment. Therefore, at the first signs of illness, you should consult a dentist. Identification of pathology occurs after listening to complaints, collecting anamnesis (where there is recent tooth extraction) and examining the socket cavity.

Sometimes the doctor prescribes an x-ray examination, which helps to detect tooth fragments and other foreign fragments in the alveolus. In rare cases, when alveolitis of the tooth socket , computed tomography is prescribed for the purpose of differential diagnosis of other diseases (trauma, tumor, etc.).

Tooth structure

The main function of teeth is to chew food. Also, teeth, as part of the chewing-speech apparatus, are involved in creating sounds during communication.

Teeth are part of a complex complex of interconnected and interacting organs. This complex is responsible for chewing, breathing, speech formation and includes the jaws, teeth themselves, masticatory muscles, cheeks, palate, tongue and salivary glands.

The structure of the tooth as part of the dentofacial segment is determined by the function it performs. Thus, teeth with a cutting edge (incisors) perform the function of biting food. Fangs – tearing off pieces. Small and large molars – chopping and grinding food.

The dentofacial segment (a section of the jaw with a tooth located on it) includes the tooth, the dental alveolus and the part of the jaw adjacent to it; ligamentous apparatus, blood vessels and nerves.

Upon closer examination, the dentofacial segment consists of the following elements:

• periodontal fibers;
• alveolar wall;
• dentoalveolar fibers;
• alveolar-gingival branch of the nerve;
• periodontal vessels;
• arteries and veins of the jaw;
• dental branch of the nerve;
• bottom of the alveoli;
• tooth root;
• neck of the tooth;
• crown of the tooth.

The first teeth to appear in a person are baby teeth. Twenty primary teeth erupt in a specific sequence; The first pair, as a rule, appears first. By the age of two, the eruption of baby teeth is completed, and at the age of five to six years, baby teeth begin to gradually fall out and be replaced by permanent (molar) teeth. The change of dentition is completely completed by the age of 12-15 years.

Anatomically, a tooth consists of three parts - crown, neck and root.

The crown of a tooth is its visible part. It is the condition of the crowns that is responsible for the aesthetic beauty of a smile. The crown consists of natural dentin and enamel, which together provide the hardness of the tooth, and is located in the alveolus (the cavity of the jaw). The formed crown does not increase in size over time, but can wear off and darken. As a rule, loss of the whiteness of a smile is a consequence of poor nutrition, lack of care and damage to the crown enamel.

The neck of a tooth is the connecting link between its crown and root. With healthy gums and good condition of teeth, the neck is not visible. Exposing the neck of a tooth indicates the presence of oral diseases and can provoke increased tooth sensitivity (reaction to cold, hot, etc.).

The root provides immobility for the tooth, serving as natural cement, and also serves as protection for the neurovascular bundle located in the canal. The root of the tooth is located in the socket of the jaw. At the root there is a pulp, the inflammation of which is called “pulpitis”. In most cases, pulpitis is a complication of untreated caries.

To maintain the health of your teeth and the beauty of your smile, make it a rule to attend preventive dental examinations from a specialist at the Neo-Dent clinic once every six months.

How to treat alveolitis after tooth extraction

The main task of correction is aimed at eliminating the cause that caused the pathology and stopping the inflammatory process. The doctor decides how to treat alveolitis after tooth extraction. Treatment tactics depend on the stage of the pathological process. It may include revision (if necessary, curettage) of the hole, drug treatment, physical therapy (laser, magnet, fluctuarization, ultraviolet radiation). All manipulations are performed under local anesthesia.

Treatment program:

1. Local anesthesia.
2. Antiseptic treatment of the wound (removal of saliva, food debris, pus).
3. Freeing the cavity from a disintegrated blood clot, foreign inclusions (tooth fragments, root remains, etc.), granular tissue.
4. Repeated treatment with an antiseptic, application of a turunda soaked in an anesthetic drug.
5. Applying a medicated antiseptic bandage.

When treating alveolitis, the doctor can use proteolytic enzymes (trypsin, chymotrypsin), which break down necrotic tissue, thereby helping to cleanse the socket. To reduce pain, a blockade is made with local anesthetics, which are injected into the soft tissue near the inflamed alveoli. To suppress the infectious process, a course of antibiotic therapy is prescribed.

Treatment of alveolitis -

If alveolitis develops in the socket after tooth extraction, treatment at the first stage should be carried out only by a dental surgeon.
This is due to the fact that the hole may be filled with necrotic decay of a blood clot; there may be inactive fragments and fragments of bone or tooth. Therefore, the doctor’s main task at this stage is to scrape it all out of the hole. It is clear that no patient will be able to do this on their own. Antiseptic rinses and antibiotics (without cleaning the socket) can only temporarily reduce the symptoms of inflammation, but do not lead to healing of the socket. But at a later stage, when the inflammation in the socket subsides, patients will be able to independently treat the socket with special epithelializing agents to speed up its healing.

Thus, the main method of treatment will be curettage of the hole, but there is also a second method - by creating a secondary blood clot in the hole of the extracted tooth. Read more about these methods...

Curettage of the tooth socket for alveolitis -

1. Under anesthesia, a festering blood clot, food debris, and necrotic plaque from the walls of the socket are removed. Without removing the necrotic plaque and the disintegration of the blood clot (containing a huge amount of infection), any treatment will be useless.
2. The hole is washed with antiseptics, dried, after which it is filled with an antiseptic (iodoform turunda). Usually, the turunda needs to be changed every 4-5 days, i.e. you will have to go to the doctor at least 3 times.
3. The doctor will prescribe you antibiotics, antiseptic baths, and painkillers, if necessary.

Doctor's prescriptions after tooth socket curettage –

• NSAID-based analgesics (for pain),
• 0.12-0.2% Chlorhexidine solution for antiseptic rinses (2-3 times a day for 1 minute),
• Antibiotics: usually either Amoxiclav 625 mg tablets (2 times a day for 5-7 days) or Unidox-solutab 100 mg (2 times a day for 5-7 days) are prescribed. These antibiotics are better, but not cheap. Inexpensive ones are Lincomycin capsules 0.25 (2 capsules 3 times a day), but keep in mind that after this antibiotic, problems with the stomach and intestines develop more often.

Method for creating a secondary blood clot -

However, there are 2 situations in which a different treatment method can be used.
This method involves the creation of a secondary blood clot in the socket and, accordingly, if successful, the socket will heal much faster than after constantly placing iodoform turundas into it for 2-3 weeks. It is preferable to use this method only in the following two situations... Firstly, when you consulted a doctor immediately after, for example, you rinsed a clot out of the hole or it fell out on its own (i.e. when the hole is not yet filled with infection and food debris , and there is no necrotic clot disintegration or suppuration). Secondly, when the patient has a sluggish alveolitis for a long period of time, and the socket is filled with inflammatory granulations.

How this technique is carried out - if the hole is empty, then under anesthesia the bone walls of the hole are scraped out with a curettage spoon to create bleeding and the hole fills with blood (video 3). If the hole is filled with granulations, then they are carefully scraped out, i.e. do the same curettage (video 4). Then, in both cases, after the hole is filled with blood, an anti-inflammatory medicine (Alvogel) is placed deep into the hole, and several sutures are placed on the mucous membrane to bring the edges of the wound closer together. Antibiotics are immediately prescribed.

Curettage to create a secondary blood clot: video 3-4

Summary: i.e. In both the first and second methods, curettage of the hole is carried out in the same way, but in the first case, the hole heals slowly under iodoform turundas, and in the second case, a blood clot forms in the hole for the second time, and the hole heals, as it should do under normal conditions .