What is dental alveolitis?

Dental alveolitis is a painful complication after an extraction, caused by the loss of the clot that protects the alveolus. It causes intense pain, bad breath and inflammation, especially after extracting teeth from the trial. Prevention is key: avoid smoking, do not use straw and follow the dentist’s instructions to the letter.

Dental alveolitis, known as dry alveolitis or alveolar osteitis, is a painful complication after dental extractionwhich develops in the alveolus, the bone cavity where the tooth was extracted. Its general incidence is 1% to 4% of all extractions, it is the most frequent postoperative complication. The probability of suffering it increases dramatically, between 20% and 30%, after the extraction of the teeth of the trial.

Normally, after an extraction, the alveolus is filled with blood, forming a clot that protects the bone and exposed nerve endingsfacilitating healing. Alveolitis occurs when this clot is not properly formed, it follows prematurely or dissolves before the Sane wound, leaving the bone exposed to the oral environment, which causes intense inflammation, pain and delays healing., Dry alveolitis is classified as:

• Primary dry alveolitis: It occurs immediately after extraction, without significant bleeding.
• Secondary dry alveolitis: It appears between the second and fourth post-extraction day, with total loss of the clot, bad taste in the mouth, intense and radiant pain, inflammation of the lymph nodes and mild halitosis.

Main symptoms

Alveolitis symptoms usually appear one to three days after extraction, when initial postoperative pain should be decreasing.

The main symptoms include:

• Intense and sharp pain: It is the most distinctive, severe and acute symptom, which increases significantly between 24 and 72 hours after extraction.
• Radiant pain: The pain extends to adjacent areas such as the ear, the eye, the temple or the neck on the same side of the extraction, due to the irritation of the trigeminal nerve.
• Persistent pain: The pain is constant and can be intensified during the night, making sleep difficult.
• Aggravation when chewing: The pressure or chewing in the affected area considerably exacerbly pain.
• Bad taste in the mouth and bad breath (Halitosis): An unpleasant, bitter or metallic flavor is frequent and a foul smell emanates from the mouth, indicating the presence of bacteria and tissue decomposition.
• Mild fever: In some cases, there may be a slight elevation of body temperature.
• Edema and redness: The areas around the alveolus may appear red and swollen.
• Lymphadenopathy: Inflammation of nearby lymph nodes, especially in secondary dry alveolitis.

Causes and Risk Factors

Alveolitis is multifactorial, the result of a combination of factors that prevent the formation or stability of the blood clot. The main cause is the failure in the formation or premature solution of the protective clot.

Risk factors identified include:

• Smoking: It is one of the most important risk factors; Chemists present in tobacco interfere with healing and suction when smoking can move the clot.
• Use of oral contraceptive pills: Estrogens can alter hormonal processes and interfere with the formation and stability of the clot, increasing fibrinolytic activity.
• Poor oral hygiene or pre -existing infection: The accumulation of bacteria increases the risk of infection and degradation of the clot.
• Traumatic or complicated dental extractions: Difficult extractions, especially molars or wishes of the trial, increase the risk due to greater tissue trauma, bone density and lower vascularization.
• Inadequate postoperative care: Do not follow the dentist’s instructions, such as drinking with straw or rinse strongly, you can dislodge the clot.
• Previous alveolitis history: significantly increases the risk of recurrence.
• Age and patient sex: greater probability in older patients and women, possibly related to thinner periodontal ligaments, reduction of blood flow with age and hormonal fluctuations.
• Systemic diseases: Immunocompromised patients (eg diabetes) have greater risk.
• Radiotherapy in maxillary and mandibular bones: It causes changes in tissues and reduces blood flow.
• Excessive use of vasoconstrictor anesthetics: It can reduce bleeding and oxygen tension, delaying healing.
• Local irrigation with excessive pressure: It can prevent the proper formation of the clot or extract it.
• Inappropriate extraction techniques or excessive use of anesthesia.

Treatment options

Alveolitis treatment focuses on pain relief, alveolus cleaning and healing promotion.

Professional management by the dentist

• Alveolus cleaning: Thorough irrigation with saline solution to eliminate remains. The aggressive curettage is advised.
• Placement of dressings or pasta: Alveolus are filled with gauze or pasta (eg alveogyl, collagen sponges with PRGF, GECBB pill) that act as a protective barrier and release analgesics/antiseptics. They require frequent changes.
• Medications:
  • Analgesics: To control the pain (eg ibuprofen, NSAIDs, Paracetamol with codeine, Ketorolaco, Celecoxib).
  • Antibiotics: Not always necessary routinely, they are prescribed whether there is a risk of severe or immunocompromis infection (eg amoxicillin, metronidazole, clindamycin).
• Special mouth rinses: chlorhexidine (0.12% or 0.2% in gel) or salt water solution to eliminate bacteria and keep the area clean.
• Surgical interventions: In complex cases, regularization of alveolar edges or use of flaps.
• Laser therapy: Low intensity laser therapy stimulates cellular metabolism, microcirculation, and provides analgesic, anti-edematous and anti-inflammatory effects, accelerating healing.

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Personal care

• Medications: Take analgesics and prescription antibiotics.
• Cold compresses: Apply on the outside of the jaw to reduce inflammation and pain.
• Careful rinse: Rinse the alveolus with salt water or special solution indicated by the dentist, avoiding sudden movements.
• Avoid harmful substances: Do not smoke, not consume tobacco, alcohol or carbonated drinks.
• Hydration: Drink plenty of water.

Dry alveolitis healing usually lasts between 10 and 15 days, varying according to the individual response to treatment and postoperative care.

Recommendations to favor healing and reducing discomfort

• Rigorous and careful oral hygiene: Maintain excellent oral hygiene before and after extraction to prevent bacterial plaque accumulation. Brush and use dental thread smoothly near the extraction area. Gently rinse with antiseptic rinse or lukewater water solution.
• Avoid factors that evict the clot:
  • Do not smoke or tobacco: Avoid at least 48 hours before and as long as possible after extraction, since suction and chemicals can evict the clot.
  • Do not drink with straw: Suction can create negative pressure and evict the clot.
  • Avoid rinse or spit hard: Vigorous movements can disturb the clot.
• Hydration and diet: Drink plenty of water. Avoid carbonated drinks. Consume soft foods and avoid directly on extraction.
• Follow all postoperative instructions: strictly adhere to the indications of the dentist.
• Pain Management at home: Take prescription analgesics and apply cold compresses.

Prevention, which includes a meticulous oral hygiene and strict fulfillment of postoperative instructions (especially avoiding suction and vigorous rinse), is the most effective strategy to mitigate the risk of alveolitis.

What you should know …

• Dental alveolitis is a painful complication after dental extraction caused by the loss or poor formation of the blood clot, leaving the bone exposed and causing inflammation and intense pain.
• Its main symptoms include intense and radiant pain, bad taste and bad breath, inflammation and redness, and can be caused or aggravated by factors such as smoking, poor hygiene and traumatic extractions.
• The treatment is based on relieving pain, cleaning the alveolus, using dressings and medications, and prevention through careful oral hygiene and following postoperative instructions to avoid loss of clot.