Dry socket – Reason and treatment

After removal of tooth, blood clot formation is an essential element for the healing to take place. When the blood clot is dislodged from the socket, healing becomes extremely slow or nil and the condition is called as dry socket.

Reasons for dry socket :

  • Dislodgement of blood clot from the socket
  • Difficulty in tooth removal due to its anatomical hinderance
  • Person underwent radiotherapy recently
  • Use of oral contraceptives

signs and symptoms of dry socket :

  • It usually occur couple of days after tooth removal, sometimes may appear after five to ten days as well.
  • The tooth removed region becomes very painful with necrotic bone, foul smelling and without pus formation.
  • The pain may get radiate to neck and ear region
  • Some patients may encounter mild fever and lymph node enlargement

Treatment and instructions :

  • Do warm saline gargle and immediately report to the dental surgeon
  • Complete debridement with ample of irrigation and ZOE + iodoform dressing will be given
  • The dressing should be changed every day
  • Usually the pain will be subsided in a day or two after debridement and dressing process.

 

Reference:

Textbook of oral pathology by shafers

 

Dry mouth – cause and effect

Less amount of saliva secretion cause dry mouth. It is a clinical manifestation of salivary gland dysfunction. There are various factors that causes dry mouth.

Various causes for dry mouth : 

Radiation induced 

Radiation therapy to head and neck region for cancer treatment affects the salivary gland cells (dose dependent) causing dry mouth.

Medicine/ drug induced

Certain drugs that are taken for vomiting, allergy, blood pressure, muscle spasm and convulsions can cause decreased salivary flow because of reduced activity of para-sympathetic action.

Local factors

Like smoking, mouth breathing and decreased chewing can lead to dry mouth

Developmental abnormality

When abnormality of salivary gland occurred during the formation of fetus, or tumor or autoimmune states can cause dry mouth

Systemic alternations

Nutritional deficiency like anemia, vitamin A deficiency and hormonal imbalance can cause dry mouth.

Fluid loss associated with hemorrage, sweating, diarrhea, vomiting and dehydration, Diseases like diabetes, certain syndromes and graft versus host resistances can  cause dry mouth.

Signs and symptoms of dry mouth:

Increased thirst, increased uptake of fluids, frequent use of means like chewing gums and sour candy, difficulties in swallowing, speech and eating dry foods.

Burning and tingling sensation in the mouth, frequent oral infection, intolerance to dental appliance, abnormal taste in mouth, tongue may adhere to soft palate, painful salivary gland enlargement, increased incidence of dental caries. Saliva consistency becomes thick, foamy and ropey.

Suggestions to the people have dry mouth :

Try sweet and tart food and beverages like lemonade, they may help to produce more saliva

chewing of sugar free candy and ice cubes

Use soft and liquid foods, which may be easier to swallow

Hydrate well and drink frequently

Avoid chewing vitamin c and acidic lozenges, dry, sticky and salty foods.

Report to your physician for taking proper medical management.

 

References

Textbook of oral medicine by Anil Govindrao Ghom, 2nd edition

 

 

 

 

 

 

Instructions to be followed after tooth removal

There are certain instructions that should be followed after removal of tooth for better healing process. All these precautions are taken inorder to provide a healthy environment for the blood clot formation and enhance the healing of the tooth removed socket.

On the day of extraction ,

  • Bite the cotton firmly for about one hour
  • Avoid hot and spicy food for three days
  • Do not spit the saliva instead keep swallowing for a day.
  • Do not rinse the mouth heavily for a day
  • Do not use straw kind of stuffs for drinking liquid, just do sipping.
  • Avoid forceful sneeze and cough for three days
  • Keep ice pack on the cheek over the tooth removed region ( particularly during the extraction of wisdom tooth and on the other tooth region when the extraction of the tooth was in difficulty level )
  • Hydrate well
  • Take the medications properly as prescribed by your surgeon.
  • Avoid smoking and alcohol consumption for a week.
  • Do not bite and check the cheeks or lips for three hours after extraction because of numbness feel.
  • If any abnormal bleeding encountered or if mild bleed does not stop for 6 hours after extraction, immediately report to the hospital.

From the next day of extraction,

  • Rinse the mouth well for 4-5 times with warm saline water ( 2 ml of salt mixed with 250 ml of lukewarm water)
  • Brush and floss every day to remove plaque formation
  • Avoid brushing on the tooth removed region for three days or do gentle brushing
  • Gently start with mouth opening exercise after 48 hours of extraction
  • Do not stop antibiotics (if prescribed) in a day or two just because the symptoms are subsided , complete the full course as recommended by your surgeon.
  • If sutures are placed, report to the hospital and get it removed after a week of extraction
  • Maintain proper oral hygiene for asymptomatic healing
  • If any abnormal pain encountered after three days of extraction, it could be due to dry socket Dry socket – Reason and treatmentand report to the hospital.
  • If not able to open the mouth adequately or encountering pain while opening after 4-5 days of extraction , it could be due to trismus, indicating inadequate mouth opening exercises. Keep hot pack on the cheek on such condition for 4-5 times on regular interval and report to the hospital.

 

Effect of tobacco on the oral cavity

A week after the world anti-tobacco day, it is good to write a blog on smoking and its adverse effects to the oral cavity.

Tobacco as such is a carcinogen (cancer causing agent). From inflammation till cancer, tobacco can cause anything and everything. A few notable effects that tobacco could cause to oral cavity are,

Tooth discoloration, increased plaque formation and bad breath :

Smoking increase tartar and plaque accumulation on the tooth structure which eventually weakens the tooth supporting structures like gums and periodontium.

Tobacco stains are extrinsic stains, yet are hard to remove completely which gives a poor aesthetic appearance. Halitosis (bad breath) is very common for tobacco users.

Weakening of gums and increased bone loss :

Smoking directly triggers the body inflammatory agents, causing swollened gums, prone for infection and increased risk of bone loss. Because smoking cause impaired collagen mechanism, the rate of repair of the lost structure will be extremely slow or nil.

Delayed healing or no healing after tooth removal :

Smoking have negative impact on healing of the tooth removed area called tooth socket. Heat from the smoke and the other tobacco contents directly disrupt the blood clot ( which is essential for the healing process ) on the socket, causing a condition called ‘dry socket’ ( very painful unhealed condition )

Lower sucess rate of implant :

Adequate bone height and bone density is required for a successful implant procedure. Due to chronic bone loss after smoking, success of implant treatment is questionable.

Inflammation of salivary gland opening and reduced salivary flow :

Saliva is an important component in the mouth which play a vital role in defense mechanism, digestion process, lubrication, etc. Reduction in its flow has a tremendous negative effect on the oral environment. Heat from the smoke cause inflammation of the salivary gland opening (condition called smokers palate) and gradually reduces the salivary flow causing dry mouthDry mouth – cause and effect.

Increased risk of leukoplakia and other keratotic lesions:

Leukoplakia is the pre cancerous lesion where the oral mucous membrane undergoes metaplastic changes. Pouching of tobacco is one of the main etiological factor for such conditions and when left untreated it becomes cancer.

Increased risk of oral cancer :

Tobacco as such have a direct influence on the oral mucosa to cause dysplastic changes and thereby causing oral cancer.

 

Nevertheless of its consequences, it is always better to stay away from tobacco for the healthy and happy life.

Thumb sucking

Thumb sucking is one of the issue i often hear from the parents in the pediatric department. Here we see about the reason behind thumb sucking, its consequences on the prolonged practice, and how to manage it.

Why a child do thumb sucking?

Thumb sucking has a strong correlation with the child psychology. Let us see in detail.

Fear is the first emotion elicit by an individual ever after introduced to the world. It is a kind of inherent one. The rest all emotions are acquired slowly when the child grows. Sucking thumb psychologically provide a secured feel to the child as he/she is close to the mother. Thumb sucking is the positive reinforcement in child’s behavior upto the age of 3. By this time the child should have acquired trust and courage to face the outer environment/ society by his/her own and eventually the thumb sucking habit should wear off.

What are the reason for prolonged use of thumb sucking habit and when it is considered abnormal?

Any imbalance in the above process will lead the child to prolong the habit of thumb sucking whereby then it become the negative reinforcement. On or after the age of 4, thumb sucking habit is considered as abnormal and should seek for attention.

The unsecured feel that the child developed during their course of development causes to prolong the habit. The most probable reasons could be due to 

  • Child having less attention from their parents
  • Over protective child where he/she fails to learn self defense
  • Presence of sibling where he/she starts to compare the parents attention between each and become submissive
  • Child left with care taker in the first three years of life
  • Abused child
  • Child grown up in the closed environment with minimal exposure to the outer world
  • Dominant parents where the child gets minimal or nil chance to express his/her thoughts or requirements

What are all the consequences of thumb sucking habit ?

  • Deprived mental health of the child.
  • The child may become an attention seeker even for the basic things or will prefer to be all alone everytime or may become exceptionally imaginative
  • Dental problem includes, proclination of front teeth, narrowing of upper arch form and development of malocclusion

How to manage thumb sucking habit?

Management takes place by two intervention

Psychological intervention, where parents play a major role.

  • Sit and talk to your child as long as you can and try to grab out the hidden emotion that he/she is going through ( can take the medical counsellors support if you cannot able to find out )
  • Make your child to understand that how much he/she is important in your life, rather than simply advising to break the habit
  • Understand the child’s need and go accordingly
  • Spend adequate time with your children and treat the siblings equally and do not compare one with the other
  •  Provide them opportunities to decide by their own with good guidance.

Dental intervention,

  • Use of habit breaking appliance, which is to be wear for 7-8 months along with the muscle strengthening exercises.
  • To undergo orthodontic treatment to correct malocclusion.