Plasminogen activators and inhibitor type-1 in alveolar osteitis

Alveolar osteitis (AO) is characterized by excess fibrinolysis, leading to early dissociation of the clot that normally follows tooth extraction. Nonetheless, scarce information is available on the fibrinolytic system in AO. In this study, we report on the differential composition of postextraction wound healing tissue and of peri-alveolar gingival epithelium from normal healing and AO patients in terms of plasminogen activators, plasminogen activator inhibitor-type 1, and urokinase-type plasminogen activator receptor. Plasminogen activators were studied by overlay zymography, western blotting, and enzyme-linked immunosorbent assay (ELISA). Plasminogen activator inhibitor-type 1 and urokinase receptor were measured by ELISA. In AO, the fibrinolytic activity of wound healing tissue was accounted for by an increase ( approximately 85%) of urokinase-type plasminogen activator, whereas tissue-type plasminogen activator was unchanged. Plasminogen activator inhibitor-type 1 showed a 6.7-fold increase in AO. These results point to key roles of urokinase in AO hyper-fibrinolysis and of plasminogen activator inhibitor type-1 in slowing down the healing response. Peri-alveolar gingival epithelium in AO showed an overall decrease of all the components of the fibrinolytic system, including the urokinase receptor, which indicates a decrease of the migration properties of epithelial cells.

Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review

The objective of this article is to harmonize descriptive definitions for the condition known as alveolar osteitis and to critically review and discuss the aetiology and pathogenesis of alveolar osteitis. In addition, the need for the identification and elimination of risk factors as well as the preventive and symptomatic management of the condition are discussed. The aim of this critical review is to provide a better basis for clinical management of the condition. A meta-analysis of data was not done.

Dental extraction wound management: medicating postextraction sockets

The rather impressive percentage of extraction sites undergoing clot loss and deranged healing results in significant morbidity for the patient and frequent visits to the surgeon to effect relief of discomfort, most often by the use of anodyne dressings. The amount of work lost by patients needing such palliative treatment, and loss of productive time for the surgeon, translate into an unknown, but potentially large, economic loss to society. This would mandate that economical methods of ensuring normal extraction socket healing with minimal morbidity be developed. The most useful socket medicaments to prevent socket healing derangements would include broad-spectrum antibiotics, specifically clindamycin and tetracycline. Not discussed in this article, but possibly germane to the subject of clot stabilization and healing, is consideration of resorbable substances such as gelatin sponge, polylactic acid, and methylcellulose as clot-stabilizing socket implants. The record of such substances in preventing AO is mixed, but the combinations of these inexpensive materials with topical socket medicaments may yield a decreased tendency for clot lysis and greater mechanical strength to the bulk blood clot, as has been demonstrated with difficult mandibular third molar impactions in one study involving polylactic acid, tetracycline, and hydrocortisone.

Effects of gender-related factors on the incidence of localized alveolar osteitis

Numerous literature references have suggested increased risk for localized alveolar osteitis associated with female gender, use of oral contraceptives, and point in menstrual/contraceptive cycle. However, the available information has not been systematically considered with the intent to accurately estimate the magnitude of these effects. The present review suggests that under certain conditions, some of which may be avoidable, females may have at least a two to threefold increase in osteitis risk compared with males. It appears that this greater risk may be reduced by considering hormonal cycles when scheduling elective exodontia.

[Dry socket. Prevention and treatment]

Although dry socket is a frequent and painful affection, its pathogenesis is still unknown. We present here a review of the literature to propose a logical preventive and therapeutic attitude. The clinical and histological aspects are also tackled.

[Etiopathology of dry socket: current data]

This review of the literature presents the current data and controversies regarding the etiology and pathogenesis of dry socket. After presenting arguments which support the theory of clot non-formation and those supporting its malformation, the thesis of fibrinolysis is discussed along with its mechanisms and origins. Finally, the various factors which could encourage this pathology are reviewed and the therapeutic and preventive management are presented.

The aetiology of dry socket: a review

The aetiology of dry socket continues to be the subject of intense research. Local disturbances of fibrinolytic activity appear to be the most satisfactory explanation for the pathogenesis of this disorder. The factors that are responsible for local changes in fibrinolytic activity are reviewed and evaluated. In the management of this disorder attention should be directed towards the prevention of local changes in fibrinolytic activity.

[The healing characteristics of the sockets following surgery in tooth extraction in workers in viscose manufacturing]

The study of cicatrization after the teeth extraction in workers of viscous rayon industry which had had a long contact with sulfuric carbon revealed a lower regeneration potential and increased complication incidence as compared to control patient group. Preventive measures are designed providing for control check-ups 3 to 5 days after the intervention and the use of rehabilitation period in presurgical preparation of the patients.

The effect of smoking on immediate post-extraction socket filling with blood and on the incidence of painful socket

The effect of habitual smoking on post-extraction socket filling with blood and on the incidence of painful socket, was investigated. Data were collected from 2417 adult dental out-patients in whom 3541 extractions were performed under local anaesthesia. Post-operative socket filling with blood was significantly reduced in smokers, compared with non-smokers (p less than 0.01). There was a higher incidence of painful socket in heavy smokers (20 or more cigarettes per day), compared with nonsmokers (p less than 0.05). There was a significant relationship between immediate post-extraction socket blood level and the incidence of painful socket; sockets which showed poorer filling were more likely to develop painful socket (p less than 0.02). Smoking appeared to have an adverse effect upon the healing of extraction wounds.

Treatment of fibrinolytic alveolitis by a collagen paste (Formula K). A preliminary report

Treatment of dry socket using a specially formulated collagen paste was found to be more effective than a treaditional method (zinc oxide/oil of cloves). Collagen-treated patients were less likely to return for review, experienced less pain, showed less tissue reaction and required fewer treatments than zinc oxide-treated controls.

A clinical investigation into the incidence of dry socket

A clinical investigation was undertaken to find the incidence of dry socket as a post-operative complication of dental extraction on an out-patient basis. Two thousand three hundred and sixty three extractions were carried out under local anaesthesia by clinical staff and students over a four month period. The results are presented and their significance discussed, the incidence of dry socket being found to be dependent upon the site of the tooth extracted, the relative difficulty of the extraction and upon the integrity and size of the blood clot in the extraction socket.

On the genesis of "dry socket"

One major school of thought regarding the pathogenesis of a dry socket occurring following tooth extraction is based on the concept that a blood clot fails to form, a concept that is, however, refuted by the clinical symptoms associated with the phenomena of a dry socket. A second theory maintains that, initially, clot formation takes place, but that the clot is subsequently lysed, bringing about the severe symptoms of a dry socket. Fibrinolysis generated by tissue activators only partly explains the occurrence of a dry socket. Based on the data accumulated in the literature, it is postulated that bacterial agents are involved in the fibrinolysis and that Treponema denticola may play a leading part in this process.

Metronidazole in the prevention of 'dry socket'

Prophylactic metronidazole was found to be an effective means of preventing 'dry socket' after routine dental extractions. The oral anaerobic bacterial may be implicated therefore in the development of the disorder. It has been confirmed in this study that 'dry socket' occurs following three per cent of routine dental extractions and almost exclusively in the mandible. The causes of the condition are probably numerous and may even vary from patient to patient, but the control of infection by anerobic organisms may be important in its prevention or early resolution. The prophylactic administration of metronidazole (Flagyl) has been shown to be a simple and effective method of prevention which would suggest the implication of anaerobic organisms in 'dry socket'. The drug appears to be free from side effects when a dosage of 200 mgs eight hourly for three days is given.

Review of factors contributing to dry socket through enhanced fibrinolysis

Use of oral contraceptives and trauma during extraction are substantiated factors that contribute to dry socket. They appear to act by enhancing fibrinolytic activity in the alveolar bone followed by lysis of the clot. The influence of bacteria and antibiotics on the development and prevention of dry socket remains unclear. No convincing evidence can be found that factors such as age, sex, or nutritional status affect the incidence of dry socket.