Dry Socket. Pain and Treatment .How to cure the excruciating pain of Dry Socket.
Dr Seow Onn Choong
As a dentist it is inevitable to end up with a conversation over problems of dental care when you meet strangers and they found out that you are a dentist.
Last Sunday I manage to squeeze myself into a flight of three golfers to play a round of golf. At the end of game we always sit down for drinks.The usual conversation popped up.
One of them shared with us his bad experience of dry socket after a wisdom tooth surgery four years ago. His description of the surgery was already bad enough.
But his statement really caught me. “ I do not wish upon others the excruciating pain from a dry socket. The pain was so bad that I cried. The whole episode lasted for nearly ten days and I was suffering throughout that period.”
Obviously he had returned to the dental clinic for treatment but it was to no avail. I looked at him. He is around my age and of fairly big built. For him to said that the pain had caused him to cry must be pretty significant.
Well this is not the first time I have heard of such an outcome. Just last year a patient turn up at my clinic to fix up a chipped incisor. Just as he was sitting down he shed a tear.He said he had another problem. He showed me a healing socket on his right lower jaw where his first molar had been. It still looked raw. This patient had seen me twice for extractions of his upper molars.
He does not see me for other work as he is a regular patient of the national dental centre. Three weeks ago he went for his routine scaling. The young dentist suggested to him to take a set of x-rays. Lo and behold he found a cavity below a crown. His treatment option was to extract the tooth. Seems drastic but after some persuasion he agreed to it. Then his regret started. One hour into the procedure the tooth was broken down but still in his mouth. The nurse advice the young dentist to ask for help. Well with a more experienced person it was done in ten minutes. Now the pain has started. It was subdued with analgesics. However on the third day it became quite unbearable. So he returned to the centre. They proceeded to clean the wound without anaesthetic and his remarks was the same as the golfer, he was crying. They asked him to bite a piece of gauze and he told them off.He told them over the last two years he had come to see me for two extractions. Each time he was surprised that the tooth had been removed without him feeling any discomfort. Both times healing was so asymptomatic that he did not felt that he had an extraction. How is that their method was so painful and different. I told him they have not change their technique of extracting difficult tooth resulting in a Dry Socket . The method of managing the wound is very classical and textbook method.
I prescribed him an antibiotic and a pain killer, asking him to return the next day with the X-ray so that I may know the reason for the extraction. He came back the next day and told me the medication was like magic.
Dry Socket
The term Dry Socket is really a misnomer. It is the name describing a very painful condition involving the bone socket two to three days after a dental extraction. It is usually associated with the extraction of a lower molar especially the wisdom tooth . As no one knows the cause of this problem, thus here is no prevention and worst of all the whole dental world has no good solution to managing the problem.
Usually the patient can suffer for around 7 to 10 days. Some sort of relief can be obtained through analgesics but usually is inadequate.
The condition is fairly common. Some articles quote around 4% of extractions will result in some sort of dry socket.
The worst case is when a dentist tries to clean the socket to speed up healing. The socket is ultra sensitive and usually most people will shed tears of pain during the procedure. Ironically this procedure does not work at all.
Some dentist will place some foul smelling paste known as alvogel or cotton soak medicament (eugenol) into the socket hopefully to ameliorate the pain. Not only it does not work , it makes the patient have this horrible tasting mouth for days. It also contravenes surgical principle by placing a foreign body to expose bone.
I do not want to elaborate more of this condition as on the internet it is already very well written and documented.
This site gives you a very good understanding of the condition.
When I was a young dentist this condition had baffled me. I would follow the procedures as outlined in textbooks and taught to me by the dental school. The results are the same suffering of the patient. Without fail that is also the last time he or she will use me as their dentist.
In the early eighties extractions were fairly common daily procedures and with this condition occurring I felt it was not good for business.
One day I had lunch with a prominent orthopaedic surgeon. So I outlined to him my problem of managing dry socket.
He laughed and said it was such a small matter as he has to deal with much more serious bone infection especially in cases involving road traffic accidents.
He was kind enough to tell me the answer.
That year was 1982
From that day on wards no dental infections were beyond my control and dry sockets was just a temporary irritation.
Many times I have tried to share with my dental colleagues this information and many times I have been rebutted by the oral surgeons.
One of them told me the golden rule in managing dry socket is curettage follow by a course of Amoxycillin and Flagyll.
I am sure he knows Amoxycillin has many resistant strains.
Worst of all Flagyl is a terrible gastric irritating drug and in the oral cavity its ability to eliminate anaerobes is really doubtful
Have you heard of mega doses of Penicillin. I am not too sure whether it is still used today. I dread the risk of seeing the patient going into anaphylactic shock
Let me share my trade secret with the whole world.
From all the literature we know Dry Socket is a very localised bone infection because the bone in the extraction site is exposed to bacteria.
So all we need is an antibiotic that can reach the site and also effective against the bacteria involved.
And that antibiotic is Clindamycin
Clindamycin is used primarily to treat anaerobic infections caused by susceptible anaerobic bacteria, including dental infections and infections of the respiratory tract, skin, and soft tissue, and
peritonitis. In people with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible aerobic bacteria, as well. It is also used to treat bone and joint infections, particularly those caused by staphylococcus aureus
This was a fairly expensive antibiotic back in the 80’s but now the generic version is widely available.
In severe cases the Injection version known as Lincomycin is needed. In fact the injection version is very effective against all severe dental infections as most of them are anaerobic in nature. In Brunei because of my ability to treat dental infections I was like a local hero.
Painkiller is also needed to overcome the pain. Nowadays we are very lucky to have so many variety of good painkillers. I used to experiment with lots of them and the one of the most effective was Feldene. You can hardly find it today.
Nowadays the drug of my choice is Arcoxia.
To my patients they really think I am a magician. This combination is very effective as the pain will disappear in as little as two to three hours. When I call my patients they will tell me they feel much better already.
Well if you are suffering from Dry Socket now please contact your doctor for the above prescriptions.
If you are a dentist try using it on the next dry socket that turns up. It will save you a lot of your precious clinical time and also the angst of your patients.
As dentists there are many things we can do for our patients and one of them is definitely not to make them suffer.
Many dentists will not believe what I have written. I hope the original manufacturer Pfizer will undertake a study to prove my claim. Then this method will be taught in dental schools and accepted by the dental profession.
Many dentists will not believe what I have written. I hope the original manufacturer Pfizer will undertake a study to prove my claim. Then this method will be taught in dental schools and accepted by the dental profession.
To the whole world I sincerely apologise for those who had suffered the excruciating pain of dry socket by keeping this knowledge to myself. ( actually I had tried sharing. The few dentists I demonstrated to in Cambodia agrees) I can assure you I have no shares in the drug companies that sells the above drugs.
I wish nobody in the world will suffer from the excruciating pain of Dry Socket again.
