Oral manifestations in women using hormonal contraceptive methods: a systematic review

OBJECTIVES

To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods.

MATERIALS AND METHODS

This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined.

RESULTS

Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias.

CONCLUSIONS

Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome.

CLINICAL RELEVANCE

The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.

Prevalence of fibrinolytic alveolitis following extraction of impacted mandibular third molars: A systematic review and meta-analysis

Our research aims to assess the prevalence of alveolar osteitis (AO) following impacted mandibular third molar extractions and investigate the impact of potential moderating factors on this occurrence. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus, and Google Scholar databases. The pooled prevalence, accompanied by 95 % confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Our meta-analysis included twenty-eight eligible studies, encompassing a total of 41,859 impacted mandibular third molar extractions. The overall prevalence of dry socket (DS) following impacted mandibular third molar extractions was estimated at 6.7 % (95 % CI 4.6-9.1 %), indicating considerable heterogeneity among the studies. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.

Effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis: a scoping review

OBJECTIVES

The aim of this scoping review was to determine the effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis.

MATERIALS AND METHODS

Reporting was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A literature search was conducted in the PubMed and Scopus databases to identify all clinical studies on the application of platelet-rich fibrin in the control of pain caused by alveolar osteitis. Data were extracted independently by two reviewers and qualitatively described.

RESULTS

The initial search returned 81 articles, with 49 identified after duplicates removal; of these, 8 were selected according to the inclusion criteria. Three of the eight studies were randomized controlled clinical trials, and four were non-randomized clinical studies, two of which were controlled. One study was case series. In all of these studies, pain control was evaluated using the visual analog scale. Overall, the use of platelet-rich fibrin resulted effective in the control of pain determined by alveolar osteitis.

CONCLUSIONS

Within the limits of this scoping review, the application of platelet-rich fibrin in the post-extra-extraction alveolus reduced the pain associated with alveolar osteitis in almost all the included studies. Nevertheless, high-quality randomized trials with adequate sample size are warranted to draw firm conclusions.

CLINICAL RELEVANCE

Pain associated with alveolar osteitis causes discomfort to the patient and is challenging to be treated. Use of platelet-rich fibrin could be a promising clinical strategy for pain control in alveolar osteitis if its effectiveness will be confirmed by further high-quality studies.

Photobiomodulation for Managing "Dry Socket": A Randomised Controlled Trial

OBJECTIVE

There are no studies that have evaluated the effect of Alveogyl with and without adjunct photobiomodulation therapy (PBMT) in reducing self-rated post-operative pain (SPP) in patients with alveolar osteitis (AO; dry socket). The aim of the present randomised controlled trial was to assess the effectiveness of Alveogyl with and without PBMT for the management of SPP in patients with AO.

METHODS

Adult nonsmokers with diagnosed AO were included. Patients were randomly divided into 4 groups. In Group 1, patients underwent mechanical curettage (MC) with copious normal saline irrigation. In Group 2, patients underwent MC + Alveogyl dressings in extraction sites which were changed every 48 hours until cessation of pain. In Group 3, patients underwent MC + Alveogyl followed by PBMT using a 660-nm indium-gallium-aluminum-phosphide diode laser. In Group 4, patients were treated solely with PBMT. The visual analogue scale was used up to 3 postoperative days to assess SPP up to 3 days at 6- (T0) and 12-hour (T1) intervals. Statistical analyses were performed using the analysis of variance and Bonferroni post hoc adjustment tests. Correlation between SPP scores and age, sex, and eruption status of teeth was assessed using logistic regression models. P values <.01 were nominated as being statistically significant.

RESULTS

In all, 14, 13, 14, and 14 individuals with AO were included in groups 1, 2, 3 and 4, respectively. All patients had undergone extraction of mandibular third molars. At baseline and on day 1, there was no difference in SPP in all groups. On days 2 and 3, mean visual analogue scale (VAS) scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 2 compared with Group 3. On days 2 and 3, mean VAS scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 4 compared with Group 3. There was no difference in SPP in groups 3 and 4 on day 3 at T0 and T1 intervals.

CONCLUSIONS

PBMT following MC and Alveogyl dressing is more efficient in reducing SPP compared with MC with or without Alveogyl dressing in patients with AO.

Antimicrobial and bone repair effects of boric acid in a rat model of dry socket (alveolar osteitis) following dental extraction

BACKGROUND

Alveolitis occurs after dental extraction without blood clot formation, leading to an inflammatory process and bacterial contamination. Boric acid (BA) demonstrates anti-inflammatory, antimicrobial, and osteogenic properties. This study aims to evaluate the possible antimicrobial effects and bone repair of BA in a rat model of alveolitis (dry socket).

METHODS

33 male Wistar rats were submitted to the extraction of the upper right incisor and dry socket induction. They were first divided into two groups: dry socket (n = 17) and dry socket + 0.75 % BA (n = 16). Samples for the microbiological analysis were collected immediately after dental extraction, at the detection of clinical alveolitis, 7, and 14 days after BA application. For microCT and histological analysis, samples from euthanized rats were used in 14 and 28 days after alveolitis detection.

RESULTS

Higher bacterial counts were found in 4-5 days after alveolitis induction, compared to the baseline in both experimental groups, decreasing significantly after 7 and 14 days of treatment with BA (P < 0.05). The microCT evaluation displayed increased bone volume, bone volume fraction, trabecular thickness, and bone mineral density in a time-dependent manner, regardless of BA treatment. On the other hand, the number of trabeculae and total bone porosity decreased over the 28 days of the experiment in the dry-socket group and both groups, respectively (P < 0.05). Histological analysis did not differ on bone repair in both experimental groups.

CONCLUSION

This was the first report investigating the effects of BA in a rat model of alveolitis regarding microbiological and bone repair aspects. The BA local application decreased the total aerobic and facultative bacteria counts and does not seem to benefit the bone repair after alveolitis development. This study paves the way for more studies involving alveolitis and different BA applications.

The efficacy of minocycline hydrochloride ointment versus iodoform gauze for alveolar osteitis: A prospective cohort study

Background

Alveolar osteitis (AO) is one of the most commonly encountered complication following tooth extraction, however, to date there is no standard methods of prevention and treatment. The study aims to investigate the efficiency of minocycline hydrochloride ointment (MHO) for the treatment of alveolar osteitis compared with traditional treatment with iodoform gauze (IG).

Methods/design

STROBE checklist was followed to report this study. All patients underwent tooth extraction either in our department or other hospitals, whom presented with postoperative pain, were screened out to meet the inclusion and exclusion criteria of this study about AO. Patients who fulfilled the inclusion criteria were enrolled in our prospective cohort study, and MHO or IG was administered. The Visual analog scale scores were used to assess the pain score of patients. The healing status of the extraction sockets was followed up. Differences in responses between groups were analyzed using Mann-Whitney U tests. Chi-square test was performed to explore the differences in the teeth position of AO.

Results

Of 41,371 patients underwent tooth extraction with post-operative follow-up in our departments, only 20 patients (0.05%) suffered from AO. 31 patients with AO, whose teeth were extracted in other places, were also enrolled. The incidence of AO was significantly higher in third molars than other teeth (P < 0.01). In 28 patients that were treated with MHO, the pain was relieved substantially on day 3 and almost painless on day 7. And only 25% of cases required dressing change more than once. Whilst 23 patients treated with IG, the pain was relieved on day 5, and 56.5% of cases required multiple dressing change. The difference between the two groups of VAS scores had statistical significance during treatment at 8 h, 24 h, 3d, 5d, and 7d. No allergic reaction or further infection occurred.

Conclusion

MHO has a safer and higher therapeutic effect in the treatment of AO compared with traditional treatment with IG. MHO may become a preferred treatment modality for AO.

Supplementary information

The online version contains supplementary material available at 10.1186/s12903-022-02468-9.

Efficacy of tranexamic acid in prevention of alveolar osteitis following surgical removal of impacted mandibular third molar

CONTEXT

Many preventive measures are described to avoid alveolar osteitis (AO) during third molar surgery (TMS), but very few are found to be effective. Tranexamic acid (TA), an antifibrinolytic agent, impedes the proteolytic degradation of fibrin and prevents blood clot disintegration.

AIMS

The study was conducted to determine the efficacy of intra-alveolar application of TA soaked in Gelfoam in prevention of AO.

SETTINGS AND DESIGN

This was a randomized control trial.

MATERIALS AND METHODS

A total of 200 patients (100 in control group and 100 in study group) reporting for TMS were allocated randomly. Following surgery, TA soaked in gel foam was placed in socket and sutured in the study group, while in the control group, closure was done by suturing. Patients followed subsequently to observe the incidence of AO, pain severity, and duration of healing after AO.

STATISTICAL ANALYSIS

Z-test, Mann-Whitney test, and t-test were applied, respectively, to compare the incidence of AO, severity of pain, and duration of healing between the two groups.

RESULTS

The incidence of AO in the control group was 18% and 6% in the study group. Patients in the control group experienced severe pain as compared to patients in the study group. The duration of healing varied from 12 to 16 days in the control group, but in the study group, it was <10 days.

CONCLUSION

TA significantly reduces the incidence of AO in addition to the reduced severity of pain and enhanced healing. We recommend the routine use of TA, owing to its astonishing rewards.

Randomized Study on Postoperative Intra-alveolar Betadine Irrigation Versus Chlorhexidine Irrigation on the Incidence of Occurrence of Alveolar Osteitis After Mandibular Third Molar Surgery

Purpose

To compare the effectiveness of two different antiseptic solutions for irrigation of the extraction socket and the incidence of occurrence of dry socket in the sample population in Bhubaneswar, Odisha.

Patients and Methods

A prospective and randomized study among the patients reporting to the department of oral and maxillofacial surgery for surgical removal of impacted mandibular third molars under local anesthesia was done in a group of 100 patients meeting the inclusion and exclusion criteria. Two different intervention groups (groups A and B) were allocated which comprised irrigation of the extraction sockets continuously up to 7 postoperative days with chlorhexidine (hexidine 0.2% ICPA) and povidone iodine (Betadine^® mouthwash 1%), respectively. Pain, edema, trismus, alveolar osteitis, infection, wound dehiscence and food debris impaction were the various outcome variables.

Results

A total of 100 patients participated in this study, while there was a loss in the follow-up of 5 patients. Pain scores, edema and the incidence of occurrence of alveolar osteitis were significantly reduced in group A (p < 0.05). The effect on trismus was statistically insignificant. Pain scores had reduced significantly on the 7th-day follow-up in group A as compared to group B (p < 0.05).

Conclusion

Chlorhexidine is therefore a good option for irrigation of the surgical site. There is also a decrease in incidence of occurrence of AO with chlorhexidine irrigation than with that of povidone iodine irrigation. Hence, chlorhexidine can be preferred over betadine for the routine preparation and irrigation of the surgical site.

Effectiveness of warm saline mouth bath in preventing alveolar osteitis: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the effectiveness of a warm saline mouth bath (WSMB) in preventing dry socket after tooth extractions. A systematic search for randomized controlled trials published until August 30, 2020, in seven databases was conducted: Cochrane, PubMed, Ovid Medline, Google Scholar, and OpenGrey databases, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry. The inclusion criteria were studies investigating the use of a warm saline mouth bath postoperatively in a population of participants who had a tooth extraction, compared to no mouth rinse at all/any other mouth rinse. The primary outcome assessed in the studies was the incidence of alveolar osteitis. Only eight randomized studies met all inclusion criteria and were selected for qualitative analysis. Six of the studies compared WSMB with antimicrobial rinses, and two studies compared WSMB with no-rinse. This review found no significant difference (P > 0.05) in the incidence of alveolar osteitis between WSMB and other antimicrobial rinses. Based on the results of this review, WSMB has potential in reducing post-operative complications such as alveolar osteitis following a routine or surgical extraction of teeth. However, more studies are needed to validate these findings, as most of the studies reviewed had a high level of bias.

Initial Observation of Factors Interfering with the Treatment of Alveolar Osteitis Using Hyaluronic Acid with Octenidine-A Series of Case Reports

Alveolar osteitis (AO) is a common complication following the extraction of the teeth, particularly the lower third molars. It starts within a few days after the extraction and manifests mainly as pain in the extraction site. Several strategies of treatment are available in order to relieve pain and heal the extraction wound. Recently, a novel medical device combining hyaluronic acid (HA) and octenidine (OCT) was introduced for the treatment of AO. This series of case reports aims to summarize the initial clinical experiences with this new device and to highlight factors possibly interfering with this treatment. The medical documentation of five patients with similar initial situations treated for AO with HA + OCT device was analyzed in detail. Smoking and previous treatment with Alveogyl (Septodont, Saint-Maur-des-Fossés, France) were identified as factors interfering with the AO treatment with the HA + OCT device. In three patients without these risk factors, the treatment led to recovery within two or three days. The patient pretreated with Alveogyl and the smoker required six and seven applications of the HA + OCT device, respectively. According to these initial observations, it seems smoking and previous treatment with Alveogyl prolong the treatment of AO using the HA + OCT device that, in turn, shows a rapid effect if these risk factors are not present.

Can inflammatory cytokines be identified locally?

OBJECTIVES

The aims of the present study were to evaluate the relative incidence of alveolar osteitis (AO) after mandibular third molar surgery, post-operative findings and local expression of bone markers and cytokines.

STUDY DESIGN

In 445 patients, unilateral surgical third molars extractions were undertaken (584 teeth). Bone markers and cytokines were explored at the AO side and on the un-operated contralateral side and compared with the levels in samples from a control group of 18 persons without AO.

RESULTS

The relative incidence of AO was 4.6%. Patients (n = 27) with AO were invited to participate in the study and 21 (77.8%) did so. Patients with AO had 1-4 extra visits for treatment of AO, the mean follow-up time was 2.6 days for all patients. There were significantly higher levels of bone markers and cytokines in the AO site compared with the un-operated contralateral site, except for Epidermal growth factor (EGF). No significant difference in expression of bone markers and cytokines between the AO and control groups was found. Lower maximum inter-incisor opening (MIO) was correlated with increased Macrophage inflammatory protein 1 alpha. A negative correlation between patients' complaint of trismus and MIO was seen.

CONCLUSIONS

The relative incidence of AO was low in our patient group treated with surgical removal of third molars. AO was more frequently seen in female patients. Treatment of AO required up to four extra visits. The study provides some information on the role of cytokines in AO; but further studies are required.

The preventive effect of medicinal herbal extract and gelatin sponge on alveolar osteitis: An in vivo micro-computed tomography and immunohistochemical analysis in rats

OBJECTIVE

The purpose of this study was to evaluate the preventive effect of medicinal herbal extract (MHE) and gelatin sponge on alveolar osteitis (AO) in an experimental rat model.

DESIGN

Twenty-one Sprague-Dawley male rats with a mean age of 12 weeks were used. After extraction of the maxillary right first molar, an AO model was created for each animal. The animals were randomly separated to three equal groups. Group I served as a control, Group II was subjected to an intra-alveolar MHE application, and gelatin sponge was left in the sockets of Group III. On the 7th post-extraction day, the animals were sacrificed. The specimens were analyzed by micro-computed tomography (micro-CT), histopathologically and immunohistochemically.

RESULTS

Macroscopic evaluation revealed mild to intense signs of AO in all groups, but the difference was not significant (p < 0.05). Micro-CT analysis showed that bone formation was the highest in Group III (bone volume/total volume; 10.63 ± 4.9 %), whereas bone mineral density was the highest in Group I (2.05 ± 0.2 g/cm³). The difference was not significant (p > 0.05). In Group III, only 16.7 % of specimens showed no signal of inflammatory response (p < 0.01). The difference was not significant between the positive labeling for receptor activator of nuclear kappa-β (RANK), receptor activator of nuclear kappa-β ligand (RANKL), osteoprotegerin and osteopontin, but the intensity of Groups II and III was higher than the Group I for osteopontin (p < 0.01).

CONCLUSIONS

MHE and gelatin sponge were not effective enough to prevent alveolar osteitis, but positive results were obtained in bone healing.

Critical analysis of methodological quality of systematic reviews and meta-analysis of antibiotics in third molar surgeries using AMSTAR 2

The clinicians usually prescribe antibiotics to reduce post-operative complications during third molar surgeries. However, in the absence of clear conclusions regarding the use of antibiotics in third molar surgeries, present systematic review was planned to assess the quality of systematic reviews evaluating the efficiency of antibiotics in reducing post-operative complications. The literature search was done in Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, EMBASE, and Google scholar. Systematic reviews published in English during the period from January 1990 to December 2019 were included. The maxillary and mandibular third molars indicated for extraction either because of infection, orthodontic or prophylactic reasons were included. From 526 screened studies, thirteen reviews were qualified for qualitative analysis. The qualities of the included reviews were evaluated using the AMSTAR 2 tool. The included reviews were also evaluated based on the number of authors, geographic region, impact factor of the published journal, year of publication, and the number of citations for each review. One high quality, eight moderate quality, three low quality, and one critically low-quality reviews were observed in the present review. No statistically significant difference was observed between the included reviews based upon the analysis of the number of authors, geographic region, impact factor of the published journal, year of publication, and the number of citations for each review. Considering the observations form the high and moderate-quality reviews, the present systematic review concludes that antibiotics effectively aid in reducing the post-operative complications and frequency of observation of dry socket.

Microbiota of alveolar osteitis after permanent tooth extractions: A systematic review

Alveolar osteitis (AO) or dry socket after dental extractions is a common postoperative complication characterized by the presence of severe pain associated with an empty socket. Although some authors consider AO to be related to an alteration of the blood clot, the underlying etiology remains unclear, and recent reports suggest that bacteria might play an important role. A systematic review was made, compiling relevant references from PubMed, the Cochrane Library, Scopus and the Web of Science databases to determine which bacteria have been identified in AO sockets after dental extractions. Papers published between 1980-2019, identifying the bacteria present in AO sockets after tooth extractions, were included. Data were displayed in tables, and a descriptive analysis was carried out. After the screening process, four papers were analyzed, comprising a total of 138 samples from 138 patients with AO. The most commonly detected bacteria were Prevotella, Fusobacterium, Parvimonas and Peptostreptococcus. Two studies also showed the microbiota of patients that developed AO after dental extractions to be apparently different from that of patients without postoperative complications. These results indicate that bacteria may play an important role in the pathogenesis of AO, though further studies are needed to confirm these findings.

Effect of concentrated growth factors on frequency of alveolar Osteitis following partially-erupted mandibular third molar surgery: a randomized controlled clinical study

Background

The aim of this prospective study was to assess the effectiveness of concentrated growth factors (CGF) in preventing the development of alveolar osteitis (AO) after the extraction of partially-erupted mandibular third molars.

Methods

Seventy patients (26 men and 44 women) 18 years or older (mean age 25.86; range 18–35) underwent 140 third molar extractions. All the patients presented with bilateral, partially-erupted mandibular third molars and underwent surgical extractions. In each case, one socket received CGF and the other served as a control. The predictor variable was the CGF application and the sides were categorized as ‘CGF’ and ‘non-CGF’. The outcome variable was the development of AO during the first postoperative week. Other study variables included age and gender. Data were analyzed using Cochran’s Q test with the significance level set at a P value less than 0.05.

Results

The overall frequency of AO was 11.4% for the control group. The frequency of AO in the CGF group was significantly lower than in the non-CGF group (p < 0.001).

Conclusions

Based on the results of this study, application of CGF fibrin gel may decrease the risk of AO development after mandibular third molar surgery.

Trial registration

This study was registered in ClinicalTrials.gov database on November 1, 2019 (ID: NCT04151147, retrospectively registered).

Evaluation of the effects of intra-alveolar irrigation with clindamycin, rifampicin and sterile saline in alveolar osteitis treatment

BACKGROUND

To evaluate the efficacy of intra-alveolar irrigation made with clindamycin, rifampicin and sterile saline on pain and alveolar mucosa healing in the treatment of alveolar osteitis (dry socket).

METHODS

Fifty-four patients diagnosed with alveolar osteitis were divided into three groups for the treatment protocol. Sterile saline was used in Group A, rifampicin was used in Group B and clindamycin was used in Group C for intra-alveolar irrigation. In the groups, the patients were evaluated for their pain levels and alveolar mucosa healing.

RESULTS

The incidence of alveolar osteitis was significantly higher in females and mandibles at a statistically significant. In the group that used clindamycin for intra-alveolar irrigation, the pain level was found lower than the two other groups. Clindamycin and rifampicin groups were superior to the sterile saline group in clinical alveolar mucosa healing.

CONCLUSION

Irrigation with clindamycin appears to reduce the pain associated with alveolar osteitis when compared to rifampicin and sterile saline. In the treatment of alveolar osteitis, irrigation with antibiotics following curettage was found effective for pain relief and alveolar mucosa healing.

Effectiveness of platelet-rich fibrin in the management of pain and delayed wound healing associated with established alveolar osteitis (dry socket)

Objective:

To assess the efficacy of platelet-rich fibrin (PRF) on the pain and healing of the extraction socket related with established alveolar osteitis (dry socket, AO) after the removal of maxillary and mandibular molars.

Materials and Methods:

One hundred consecutive adult patients with age group ranging from 18 to 40 years along with established dry socket after maxillary and mandibular molar extractions who have not received any treatment for the same were included in this single-arm clinical trial. PRF was placed in the maxillary and mandibular molar extraction sockets after adequate irrigation of the socket. All the patients evaluated for the various study variables which include pain, degree of inflammation, and healthy granulation tissue formation (wound healing) at the 1^st, 3^rd, 7^th, and 14^th post-PRF placement day in the alveolar socket. Data were analyzed using Shapiro-Wilk's test, Chi-square test and/or Student's t-test, Friedman's test, Wilcoxon signed-rank test, and Bonferroni test, with the significance level set at P < 0.05.

Results:

There was significant reduction in pain associated with AO at the 3^rd and 7^th post-PRF placement day in the extraction socket along with mark decrease in the degree of inflammation at the 3^rd post-PRF placement day, and there was better wound healing by the end of the 2^nd week.

Conclusion:

The use of PRF in this clinical trial illustrates the promising results in terms of reduced pain and better healing in the patients with sustained AO.

Potential effects of advanced platelet rich fibrin as a wound-healing accelerator in the management of alveolar osteitis: A randomized clinical trial

Aim

The aim of the present study was to determine whether the use of advanced platelet rich fibrin based on the low speed⁺ centrifugation concept (A-PRF⁺) might improve the pain management and healing of delayed wound healing among cases of alveolar osteitis following mandibular third molar extraction.

Materials and Methods

The patients (N = 40) with a complaint of alveolar osteitis following third molar extractions were divided into two groups: Group I (control; saline only); and Group II (use of A-PRF⁺). Pain was evaluated using the visual analogue scale (VAS). Soft tissue healing was assessed by the modified Index of Landry, Turnbull and Howley and bone density was assessed with the i-Dixel 2.1.8.2 software. Inter-group comparisons were analyzed by means of a student t-test and the Mann Whitney U test to identify group samples. Analysis of variance and the Friedman test were applied for repeated measurements. The Wilcoxon test and Bonferroni's test for multiple comparisons were conducted at the time-factor level. Yates Correction was used to compare qualitative data.

Results

In regard to pain, A-PRF⁺ application demonstrated rapidly and continually reduced pain intensity at each respective time in comparison to the control. Statistically, the healing rates of epithelium and hard tissue were significantly faster in the A-PRF⁺ application group (p: 0.000, P < 0.05).

Conclusions

The results show that A-PRF⁺ might represent an improved and accelerating therapeutic development for hard and soft tissue healing in management of alveolar osteitis that is also effective in reducing pain.

Preclinical assessment of the potential of a 3D chitosan drug delivery system with sodium meloxicam for treating complications following tooth extraction

Current medical healthcare has no sufficient innovative drug delivery formulations for treating patients with alveolar osteitis. This study presents a portion of research conducted to design, fabricate, and characterize systems for the treatment of alveolar osteitis. The results demonstrate that intra-alveolar formulations can be designed to function as drug carriers, facilitate wound dressing, and promote tissue regeneration. Our aim was to design cone-shaped implants made of microcrystalline chitosan filled with sodium meloxicam, i.e., a nonsteroidal anti-inflammatory agent. SEM analysis revealed the porous structure and monophasic characteristic of the formulation. Moreover, textural analysis demonstrated the effect of different factors (shape, hydration, addition of an active substance) on the hardness, springiness and cohesiveness of the studied systems. The active substance was released in a two-phase process. In vitro biocompatibility tests performed according to ISO 10993-5 confirmed the lack of cytotoxicity of the tested formulations. The designed formulations did not stimulate human THP1-XBlue™ monocytes to activate the transcription nuclear factor NF-κB, which ensures that the performed systems do not induce local inflammation. These initial results indicate that the innovative sodium meloxicam release system can improve safety and efficacy in clinical settings.

Necessity of Antibiotics to Reduce Inflammatory Complications after Third Molar Extractions: A Prospective Study

Aims and Objectives:

To determine the relationship between the usage of antibiotics postoperatively and inflammatory complications following third molar extractions.

Materials and Methods:

The sample was derived from Saudi Arabia private practitioners who were oral surgeons and was randomly categorized into two groups: group A, who took postoperative antibiotics, and group B, who have not taken antibiotics. The observed primary variable was the occurrence of inflammatory complications subsequent to removal of third molar.

Results:

The data were obtained from 35 oral surgeons, who gave details about 725 patients in whom 965 third molars were removed. A total of 455 (62.75%) patients have taken antibiotics postoperatively. The mean age was 28 ± 14.8 years. We noticed a very high male preponderance of 543 (74.89%). Mean body mass index was 26.7 ± 6.3 kg/m². The mean Preoperative Disease Severity Score and Operative Difficulty Score was 2.13 ± 2.1 and 12.1 ± 6.3, respectively.

Conclusion:

Fewer postoperative inflammatory complications were observed in subjects who have taken antibiotics after third molar removal.

A Study to Evaluate the Efficacy of Honey in the Management of Dry Socket

BACKGROUND

Natural products have been used for several years in folk medicine. Honey was used to treat infected wounds as long ago as 2000 years before bacteria was discovered to be the cause of infection. It has been reported from various clinical studies on the usage of honey as a dressing for infected wounds that the wound become sterile in 3-6 days.

AIM

This study aimed to find out the efficiency of naturally occurring honey in alveolar osteitis.

METHODOLOGY

Fifty patients of dry socket were selected from the outpatient department of oral and maxillofacial surgery. A diagnosis of dry socket was made clinically. Honey was used as a dry socket dressing in all these patients. Parameters such as mucosal edges, pain, and formation of granulation tissue were assessed in the postoperative period for a week.

STATISTICAL ANALYSIS USED

Analysis was done by paired t-test method using SPSS software version 17.

RESULTS

In this study, there was a significant reduction in inflammation, hyperemia, and mucosal edges that resulted in the reduction of pain and discomfort to the patient. There was no side effect of honey observed in our study, so it can be used as an alternative for the management of dry socket. Change in distance between mucosal edges when compared from the day of clinical presentation to 5th day postplacement was statistically significant (P < 0.001).

CONCLUSIONS

There are no side effects of honey. Excess use of eugenol can lead to necrosis of bone. Thus, honey can be used as a medicament for the management of dry socket.

Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study

Aim/Objective

The mandibular third molar is the most frequently impacted tooth with incidence varies from 9.5% to 68% in different populations. Hence, the aim was to study the prevalence and pattern of mandibular impacted third molar among Delhi-National Capital Region (NCR) population.

Materials and Methods

The study was conducted with data collected from registered hospitals and dental clinics of Delhi NCR region. The study represents a retrospective analysis of panoramic radiographs and intraoral periapical radiograph of patients at these centers from June 2014 to June 2016.

Results

Out of 960 patients with the third molar investigated, a total of 250 patients having impacted mandibular third molar (152 [60.8%] males and 98 [39.2%]) females between June 2014 and June 2016 were included in the study. The age ranged from 20 to 55 years, with a mean age of 27.6 years and the standard deviation was 5.8 years. The prevalence of impacted mandibular third molars for this study was 26.04%.

Conclusion

This study demonstrated that males (60.8%) were more likely to present with impacted mandibular third molars than females (39.2%). The prevalence of third molar impactions was almost the same on both the left (45.8%) and right (54.2%) sides. This study also noted that mesioangular impactions (49.2%) were the most common type of impaction. The least common form of impactions was the transverse types (2%). The prevalence of impacted mandibular third molars for this study was 26.04%.

Alveolar Osteitis: Patient's Compliance with Post-extraction Instructions Following Permanent Teeth Extraction

AIM

The study aims to evaluate the patients' compliance with post-extraction instructions to prevent the development of alveolar osteitis and keep the health of the socket. Alveolar osteitis "Dry socket" is considered one of the most common complications after extraction.

MATERIALS AND METHODS

Study was based on an observational cross-sectional design involving 201 subjects (individuals). The subjects were evaluated via a survey questionnaire and clinical examination after obtaining their verbal and written consent. The study questionnaire was divided into the following sections; section one records the demographic data about the subject while the second section focuses on self-assessment mainly regarding compliance with post-extraction instructions and pain.

RESULTS

A total number of patients included in the study was 201, 122 (60.7%) male and 79 (39.3%) female with an age of more than 18 years. No statistically significant association was reported between a medical condition and dry socket. Out of 201 patients came for clinical examination, 89 felt pain at the site of extraction at different period started from the day of extraction till the day of examination with various pain intensity. Females were the most to feel pain after tooth extraction with 78%. Regarding prevalence, 14 (7%) patients reported having dry socket and poor socket status. A statistically significant association of non-complying patients with the incidence of the dry socket was observed for a wide range of age (18 to 40 years) Conclusion: The study showed a high degree of association between the incidence of dry socket cases for patients with poor compliance with post-extraction instruction. A strong relation was observed between the patients who felt pain and their gender (females) Clinical significance: Based on the findings of the present study, we recommend the need to properly educate patients on the effect of compliance and the various complications and factors affecting the socket status after tooth extraction due to non-compliance.

Versatility of platelet rich fibrin in the management of alveolar osteitis-A clinical and prospective study

Objective

To assess the efficacy of Platelet Rich Fibrin (PRF) on the pain and healing of the extraction socket associated with Alveolar Osteitis (Dry Socket, AO) after removal of maxillary and mandibular molars.

Study design

100 adult patients with age group ranging from 18 to 40 years along with established dry socket after maxillary and mandibular molar extractions who have not received any treatment for the same were included in the study. PRF was placed in the maxillary and mandibular molar extraction sockets after adequate irrigation of the socket. All the patients evaluated for the various study variables which include pain, degree of inflammation, and healthy granulation tissue formation at 1st, 3rd, 7th, and 14th post operative day. Data were analyzed using Shapirowilk's test, chi square test and/or student-t test, Friedman's test, Wilcoxson's signed rank test, and Bonferroni test, with the significance level set at P < 0.05.

Results

There was significant reduction in pain associated with AO at the 3rd and 7th postoperative day along with better wound healing by the end of 2nd week.

Conclusion

Use of PRF in this study illustrates the promising results in terms of reduced pain and better healing in the patients with Alveolar Osteitits.

Evaluation of the Effect of Platelet-Rich Fibrin on the Alveolar Osteitis Incidence and Periodontal Probing Depth after Extracting Partially Erupted Mandibular Third Molars Extraction

Aims

To evaluate whether the alveolar osteitis (AO) incidence after extracting partially erupted third molars differs when platelet-rich fibrin (PRF) is administered in the alveolar socket and to assess the influence of PRF on postoperative pain levels and periodontal probing depth.

Settings and Design

In this split-mouth randomized study, 50 patients (17 men/ 33 women; mean age, 23.96 years) with bilateral symmetric partially erupted mandibular third molars were enrolled.

Material and Methods

PRF was randomly placed in one extraction socket, whereas the other socket was left empty. A verbal rating scale was used to evaluate postoperative pain levels. AO development was evaluated on the 7th postoperative day. At 3 months postoperatively, periodontal probing depth was measured on the distal surface of the second molars.

Results

In total, 8% of patients in the PRF group and 18% of the patients in the control group were diagnosed with AO. None of the smokers in the PRF group and 37.5% smokers in the control group were diagnosed with AO. Mean postoperative pain levels were lower in the PRF group than in the control group at all time points. At 3 months postoperatively, periodontal probing depths were found to be ≤3 mm in both groups.

Conclusions

PRF significantly reduced the AO incidence among smokers and had a positive effect on postoperative pain levels but not on periodontal healing.

Efficacy of Alvogyl (Combination of Iodoform + Butylparaminobenzoate) and Zinc Oxide Eugenol for Dry Socket

Context

Alveolar osteitis (AO) (dry socket) is a postoperative healing complication after tooth extraction. Pain is considered the most important symptom of dry socket which can vary in frequency and intensity.

Aim

The aim of the present study was to evaluate the management of AO with alvogyl and zinc oxide eugenol (ZOE).

Study Design

This study was designed as a single-blinded prospective study with a sample size of fifty patients included in the study after obtaining the informed consent.

Materials and Methods

All the fifty patients with dry socket were randomly selected and divided into two groups as follows: (1) Group I: Patients who received alvogyl paste as an intrasocket medication and (2) Group II: Patients who received ZOE as an obtundant dressing.

Statistical Analysis Used

Data were analyzed using t-test and Chi-square test.

Results

The mean number of dressings required was less in Group I as compared to Group II, and thus Group I showed faster healing. In addition, the intensity of pain decreased more rapidly in Group I as compared to Group II. The mean time required for complete pain relief was less in Group I as compared to Group II, and thus Group I showed faster relief from pain.

Conclusion

Alvogyl is better for the management of dry socket by virtue of shorter time required for complete pain relief, fewer visits for dressing change, and faster clinical healing of the socket.

Infection, Alveolar Osteitis, and Adverse Effects Using Metronidazole in Healthy Patients Undergoing Third Molar Surgery: A Meta-analysis

Purpose

The aim of this systematic review and meta-analysis was to evaluate the risk of surgical infection, alveolar osteitis, and adverse effects using systemic metronidazole in comparison with placebo in healthy patients undergoing third molar surgery.

Materials and Methods

The eligible reports were identified from diverse science sources. Clinical trials meeting the inclusion and exclusion criteria and an acceptable Oxford Quality Score were included in this study. The evaluation of risk was done using the Risk Reduction Calculator and Review Manager 5.3., from the Cochrane Library. A significant risk reduction was assumed when the upper limit of the 95% confidence intervals was <1 and the lower limit did not cross zero (negative number) alongside a p value of <0.05 for the overall test. Data of 667 patients from five clinical trials were used for the assessment of risk.

Results

Our analysis showed no reduction of the risk of infection or dry socket in patients receiving metronidazole compared to whom took placebo. Meanwhile, the adverse effects did not exhibit a difference between the studied groups.

Conclusion

The routine use of systemic metronidazole to prevent surgical site infection and/or dry socket in healthy patients undergoing third molar surgery is not recommended.

The efficacy of chlorhexidine gel in the prevention of alveolar osteitis after mandibular third molar extraction: a systematic review and meta-analysis

BACKGROUND

Alveolar osteitis is a very painful and distressing condition for a patient who has recently undergone a tooth extraction and has led dental professionals to search for preventive measures. The aim of this meta-analysis to determine the effect of chlorhexidine (CHX) gel on the incidence of alveolar osteitis after mandibular third molar extraction.

METHODS

Studies were searched for on electronic search engines using Medline (PubMed), Cochrane central, Scopus and advanced Google Scholar from May 2015 to December 2015. Randomized controlled trial studies with a history of mandibular third molar extraction, along with the administration of topical chlorhexidine gel were included. The risk of bias of the selected articles was assessed using the Cochrane risk of bias assessment tool. RevMan 5.3 Software was used to analyze the pooled effect. I2 was calculated to determine heterogeneity and a funnel plot was used to check the risk of bias. Subgroup analysis was also done based on the presence of confounding factors (smoking, oral contraceptive etc.) and on split mouth design.

RESULTS

Out of 52 articles, ten met the inclusion criteria. 862 participants were involved in the selected studies with a mean age range from 24.15 ± 5.02 to 36.65 ± 11. The overall RR was 0.43 (95% CI: 0.32, 0.58, p < 0.00001). Three studies used a split-mouth design to check the effect of chlorhexidine gel in the prevention of alveolar osteitis incidence. There was a pooled effect of 0.29 (95% CI: 0.16, 0.50) for the intervention group in the split mouth design studies. A stratified analysis was done to check the effect of CHX gel in patients with confounding factors and a significant reduction of AO incidence was found; 0.60 (95% CI: 0.41, 0.87; p = 0.05) in the intervention. There was no reported adverse reaction. The heterogeneity (I2) was 40%. The funnel plot showed that there was no significant publication bias.

CONCLUSION

This meta-analysis suggests that CHX gel is superior to a placebo in reducing the incidence of alveolar osteitis after mandibular third molar extraction.

Platelet-rich Plasma and Incidence of Alveolar Osteitis in High-risk Patients Undergoing Extractions of Mandibular Molars: A Case-control Study

Background

To evaluate the efficiency of platelet-rich plasma (PRP) on the incidence of alveolar osteitis (AO) in patients with potential risk factors for the development of AO.

Materials and Methods

This study was conducted in 150 patients visiting the outpatient department of oral and maxillofacial surgery. Patients with potential risk factors for the development of AO which included smokers, alcoholics, postmenopausal women, patients on oral contraceptives, pericoronitis, and bruxism were included for the study. Patients were randomly divided into two groups. Group A consisted of 75 patients in which PRP was placed in the socket after extraction. Group B consisted of 75 patients in which sockets were left for normal healing without the placement of PRP. The patients were assessed for pain and dry socket on the 3^rd and 5^th postoperative day.

Results

All the local signs and symptoms of inflammation were mild to moderate and subsided in normal course of time. Pain was less in Group A where the extraction sockets were treated with PRP. Soft-tissue healing was also statistically significant on the PRP treated site when compared to the other group where PRP was not placed into the socket after extraction. The incidence of AO among the patients who have the potential risk factor for the development of the same was significantly reduced in Group A.

Conclusion

The study showed that autologous PRP is a biocompatible material and has significantly improved the process of soft-tissue healing, reduced pain, and decreased the incidence of AO in the extraction socket when treated with PRP.

Effects of honey in the management of alveolar osteitis: A study

Introduction:

Alveolar osteitis (AO) is a complication of tooth extraction which indicates inflammation of alveolar bone of either maxilla or mandible. This study uses Apitherapy where honey catalyses biological reactions to improve immune system, makes local environment unbearable for microorganisms in the affected socket and enhances healing.

Materials and Methods:

50 patients of AO were included in the study. After cleansing of the affected socket, honey dressing was applied. Dressings were changed daily for first 2 days and then altenatively. In biochemical investigations, CRP levels in the body were measured using Nephelometry method. Microbiological examination was done for the identification of microorganism and semi quantitative count of colony forming units.

Result:

Results were assessed from clinical, microbiological, biochemical and radiological findings at 1^st, 2^nd, 3^rd, 5^th, 7^th day based on VAS score, erythema, pus discharge, swelling, lymphadenitis, fever, bleeding on probing, exposed bone and necrotic debris. Pre-Treatment CRP was 2.08 ± 1.62 which significantly (P = 0.0001) decreased to 0.82 ± 0.48. Mean change and average percentage change were 1.25 ± 1.51 and 44.1% respectively.

Conclusion:

Majority of the patients with exposed bone got healed socket with evidance of granulation tissue and healing gingiva in about one week. CRP levels at the completion of treatment of AO with honey dressing showed a significant decrease from the pre-treatment values indicating fast recovery. Microbiological examination showed presence of normal commensal flora at AO sites like Streptococcus, Staphyloccocus and Enterococcus. So, the role of bacteria in the genesis of AO, if any, appears unclear.

Comparative Evaluation of Er:Cr:YSGG, Diode Laser and Alvogyl in the Management of Alveolar Osteitis: A Prospective Randomized Clinical Study

INTRODUCTION

Alveolar osteitis (AO) is a well-known complication following tooth extraction. Plethora of literature is available regarding its treatment modalities signifying that none of the treatment is as effective as any another treatment. LASER on the other hand, has been used to promote soft tissue healing.

MATERIAL AND METHOD

In order to evaluate the effects of laser on healing of AO we undertook a randomized clinical trial. In the trial, sixty patients diagnosed with AO were randomly divided into three groups viz: alvogyl, diode laser and Er:Cr:YSGG laser (erbium chromium yttrium scandium gallium garnet).

RESULTS

On analyzing the results, diode laser at 1.0 W power settings (energy: 20-25 J/cm²) in non-contact, continuous mode was found to be the most effective for both pain relief and healing improvement.

CONCLUSION

The diode laser is an acceptable and effective non-dressing treatment modality for alveolar osteitis, which is the most common painful complication following extraction.

The Efficacy of Tranexamic Acid in the Reduction of Incidence of Dry Socket: An Institutional Double Blind Study

BACKGROUND

Alveolar osteitis (AO) is an important postoperative problem with an incidence of 20% to 35% especially prevalent after the removal of mandibular molars. Fibrinolysis with subsequent loss of blood clotting is believed to be the general cause of AO.

OBJECTIVES

This study aims to evaluate the efficacy of tranexamic acid, an antifibrinolytic agent in comparison with a placebo with respect to the reduction of incidence of AO after the extraction of mandibular molars by using following parameters: Pain, disintegration of Clot, halitosis.

MATERIALS AND METHODS

A double blind study consisted of 60 patients, who underwent routine dental extractions of mandibular molar teeth. Group A (30 patients) requiring routine dental extractions of mandibular teeth was randomly selected and was administered a dose of tranexamic acid orally (Pause 500mg) one hour prior to extraction of teeth. Gel foam soaked in tranexamic acid (160mg) was placed into the extraction socket postoperatively. A figure of eight silk suture was placed over the socket to secure the gelfoam. Group B (30 patients); a placebo (crocin) was given orally one hour prior to the extraction and gel foam soaked in saline was placed into the extraction socket postoperatively. A figure of eight silk suture was placed over the socket. Pain was rated individually by each patient at 3(rd), 7(th), 14(th) day after extraction and the results was statistically analysed.

RESULTS

This study supports that the use of tranexamic acid both locally and systemically following the removal of the teeth reduces the incidence of AO associated with the extraction of mandibular molars.

CONCLUSION

Tranexamic acid has several advantages also when used for simple dental extractions, namely: low cost and ready availability and therefore we recommend this treatment modality.

Mandibular third molar surgery in 396 patients at a Norwegian university clinic: Morbidity recorded after 1 week utilizing an e-infrastructure for clinical research

OBJECTIVE

To evaluate morbidity 1 week after mandibular third molar (3M) surgery in the authors' department.

MATERIALS AND METHODS

A prospective 1-year clinical study of patients followed up for 1 week after 3M surgery was performed. Consecutive patients of 18 years or older having 3M surgery under local anaesthesia were included. Patients not able to attend a follow-up appointment after 1 week were excluded. Demographic data, indication for surgery and clinical findings were recorded. Outcome variables were days requiring analgesic, days absent from work/school and complications. All data recording was performed utilizing an e-infrastructure for clinical research (InReach, University Health Network, www.uhnsl.com).

RESULTS

Three hundred and ninety-six patients were examined 1 week after surgery. Mean number of days requiring analgesics was 3.8 and mean number of days absent from work/school after surgery was 0.6. Minor complications were reported by 7% of patients. Female patients reported more days requiring analgesics compared to male patients. Smokers had a higher odds ratio for being absent ≥ 3 days. Prophylactic removal of 3Ms was associated with fewer days requiring analgesics and days absent from work/school as compared to teeth with local disease.

CONCLUSION

Overall morbidity after 3M surgery was low. Compared to patients subjected to therapeutic removal of 3Ms, patients undergoing prophylactic removal seem to have less pain and a faster return to normal activities.

Effectiveness of 0.2% chlorhexidine gel and a eugenol-based paste on postoperative alveolar osteitis in patients having third molars extracted: a randomised controlled clinical trial

The aim of this study was to compare the effect of application of 0.2% chlorhexidine gel, a eugenol-based paste, together with a control group on the postoperative incidence of alveolar osteitis in patients having third molars extracted. A total of 270 patients who had this procedure at the Dept of Oral and Maxillofacial Surgery, Saveetha Dental College and who met the inclusion criteria were enrolled in the study and divided into 3 groups: the first had a 0.2% chlorhexidine-based gel applied to the alveolar socket once after extraction; the second had a eugenol-based paste applied to the alveolar socket once after extraction; and the third group acted as controls, with no treatment. The incidence of alveolar osteitis was recorded for 7 days. We also recorded postoperative pain, inflammation, infection, and wound healing. Nine of the control group (10%) and 2 (2%) of the chlorhexidine group developed alveolar osteitis on the seventh postoperative day. The overall incidence (11/270) was 4%, which is less than reported elsewhere. The distribution of alveolar osteitis among the 3 groups was significant (p=0.002), with the eugenol group having no cases. The chlorhexidine group showed less incidence of alveolar osteitis than other reported studies and also less pain, inflammation, infection, and better wound healing than the control group. We conclude that eugenol was the better of the 2 interventions.

Alveolar Osteitis: Patients' compliance to post-extraction instructions following extraction of molar teeth

Background:

To evaluate the effect of various combination of post-extraction regimen administered to patients who had intra-alveolar molar tooth extraction.

Patients and Methods:

One year prospective study involving 76 consenting patients who came for 1-week post-extraction review. The patients were placed on warm saline mouth rinse with (verbal instruction) or without antibiotic and or analgesic therapy (written prescription), after intra-alveolar molar tooth extraction. Information was obtained from the patients through questionnaire and clinical examination.

Results:

The patients were placed on warm saline mouth rinse (n = 29, 38.2%) only, warm saline rinse, antibiotics (Amoxicillin and metronidazole) and Paracetamol (n = 31, 40.8%), Paracetamol and warm saline rinse (n = 12, 15.8%) and antibiotics (Amoxicillin and metronidazole) and Paracetamol (n = 4, 5.3%). A total of 63 (82.9%) patients complied with the post-extraction regimen, giving a significant high compliance to the post-extraction instructions (P = 0.001). There were 10 (13.2%) cases of post-extraction localised alveolar osteitis, with predilection for the lower molar teeth (n = 6, 7.9%) and a significant predilection for females (n = 8, 10.5%) [P = 0.005]. Overall, there were five (6.6%) cases each of localised alveolar osteitis in the compliant patients (n = 63, 82.9%) and non-compliant patients (n = 13, 17.1%), giving a ratio of 1:13 and 1:3, respectively. There was significant association of compliance with post-extraction instruction and the reduced incidence of localized alveolar osteitis (P = 0.015).

Conclusion:

This study showed a significant patients’ compliance with post-extraction warm saline rinse, prophylactic antibiotics and analgesic and a corresponding significant reduction in the incidence of localised alveolar osteitis following intra-alveolar molar tooth extraction. This study emphasises the need to properly educate patients on the effect of compliance to various combination of post-extraction regimen.

Fabrication and anti-microbial evaluation of drug loaded polylactide space filler intended for ridge preservation following tooth extraction

Background:

The preservation or reduction of alveolar ridge resorption following tooth extraction is important in patients especially for those intended for implants at a later stage. One way to achieve this is by using membranes, graft materials, and biodegradable space fillers to prevent alveolar bone resorption and promote regeneration. A major attraction for using biodegradable and biocompatible polymers as space fillers for ridge preservation is their safety profile in comparison to xenograft materials like lyophilized bone and collagen.

Materials and Methods:

Biocompatible polylactide space fillers were fabricated by fusing porous polylactide particles. The sponges were loaded with drugs by placing them in the respective solutions. Pseudomonas aeruginosa was isolated from a chronic periodontitis patient and in vitro anti-microbial evaluation was done with the drug loaded sponges.

Results:

Chlorhexidine loaded space filler showed significant anti microbial effect against multiple drug resistant Pseudomonas aeruginosa isolated from a patient with chronic periodontitis.

Conclusion:

The results of this study indicate that biodegradable drug releasing polylactide space fillers has the potential to be used for ridge preservation following tooth extraction. Release of drugs in the socket may prove useful in preventing development of alveolar osteitis post extraction which can interfere with normal healing of the socket. Synthetic biodegradable polymers also exhibit a controlled degradation rate to achieve complete resorption within the intended time.

Evaluation of the perioperative use of 0.2% chlorhexidine gluconate for the prevention of alveolar osteitis after the extraction of impacted mandibular third molars: a clinical study

PURPOSE

To clinically evaluate the perioperative use of 0.2% chlorhexidine gluconate for the prevention of alveolar osteitis, to assess the patient compliance to chlorhexidine and to prepare a comprehensive treatment plan to prevent alveolar osteitis after removal of an impacted third molar extraction.

METHODS

A prospective study was done on 50 patients with bilaterally impacted lower third molars which were indicated for extraction. Extraction of impacted mandibular third molar on one side was done without using any mouthrinse. While extracting the third molar on the other side, patients were instructed to use chlorhexidine 0.2% mouth rinse for 8 days, 1 day preceding and 7 days following the surgery. They were instructed to use chlorhexidine 0.2% (Rexidine) mouth rinse for 30 s twice a day (before breakfast and after dinner) with 15 ml of the rinse with 1:1 dilution with clean water. All the patients were evaluated for pain, presence or absence of clot and condition of the alveolar bone for the diagnosis of dry socket.

RESULTS

Incidence of dry sockets was 8%, when patients did not use 0.2% chlorhexidine gluconate perioperatively which is statistically significant.

CONCLUSIONS

It appeared that the incidence of dry socket can be reduced significantly by using 0.2% chlorhexidne gluconate mouth rinse perioperatively (twice daily, 1 day before and 7 days after surgical extraction.