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.

Comparative Study to Determine the efficacy of Zinc Oxide Eugenol and Alveogyl in Treatment of Dry Socket

Background Dry socket is one of the most common complications following permanent tooth extraction, especially mandibular third molar. Management remains controversial and different authors have shown different results with the use of zinc oxide eugenol and AlveogylTM, some preferring AlveogylTM over zinc oxide eugenol. Objective To determine the incidence, possible risk factors and compare the effectiveness of two most commonly used agents (Zinc oxide eugenol and AlveogylTM) for management of dry socket. Method Dry socket patients were randomly divided into two groups. Various risk factors were recorded through proper history. After thorough irrigation with normal saline, zinc oxide eugenol paste mixed with cotton pellet was placed in one group whereas AlveogylTM was placed in another group. Intensity of pain was recorded on visual analogue scale of Zero to ten. Pain score was recorded at the time of diagnosis, thirty and sixty minutes after placement of medication and on second, fifth, seventh and tenth day. The medication was changed every day until the pain subsided. The data were collected and analyzed using SPPS software (version 20). Result Incidence of dry socket was 4.70%, more common in males (59.09%). It was more common after extraction mandibular third molar. Initial and final pain relief on visual analogue scale was better with use of zinc oxide eugenol. Conclusion Zinc oxide Eugenol paste is more effective in management of dry socket for early as well as final pain relief compared to AlveogylTM.

Oronasal fistula in a 53-year-old hippopotamus (Hippopotamus amphibius)

An oronasal fistula is described in a 53-year-old captive hippopotamus, the animal having shown a nasal discharge, consisting mainly of food particles, during and after feeding for at least 15 years. Necropsy of the emaciated animal revealed an oronasal fistula, measuring 4.5 x 3.5 cm, adjacent to the third left molar tooth, the first and second molars being missing. The fistula was thought to have been caused by an earlier necrotizing alveolitis and osteitis. There was no evidence of rhinitis or aspiration pneumonia. Unrelated findings consisted of a follicular thyroid adenoma and generalized muscle atrophy.

Quantifying the healing of dry socket using a clinical volumetric method

OBJECTIVES

To quantify the healing of dry sockets using a simple clinical volumetric method that measures the reduction in the volume of dry sockets and to study the effects of sex and smoking on socket healing.

STUDY DESIGN

Volumes of 28 mandibular dry sockets were measured under standard conditions by injecting sterile normal saline solution into them and aspirating the solution back into a calibrated syringe. Measurements were done at diagnosis (T0), at 4 days after diagnosis (T4), at 7 days after diagnosis (T7), and at 14 days after diagnosis (T14). Differences in socket volumes at different intervals were analyzed using paired samples t test and differences between males and females or between smokers and nonsmokers were analyzed using independent samples t test.

RESULTS

Average socket volume in all patients decreased by an average of 5.16% daily from 1.44 (+/- 0.36) mL at T0 to 1.08 (+/- 0.43) mL at T4, 0.74 (+/- 0.35) mL at T7, and 0.40 (+/- 0.28) mL at T14. These differences were statistically significant (P = 0.00). No statistically significant difference in the rate of socket healing was found between males and females or between smokers and nonsmokers.

CONCLUSION

Dry socket healing can be quantified using the volumetric method described in this study. Sex and smoking do not appear to affect the rate of dry socket healing.

Post-extraction complications seen at a referral dental clinic in Dar Es Salaam, Tanzania

AIM

To investigate the types and magnitude of post extraction complications.

SETTING

A referral hospital in Dar es Salaam, Tanzania.

SUBJECTS

All dental patients who had their teeth extracted at the Muhimbili Medical Centre dental outpatient clinic during the study period (May September 1999). A total of 3,818 extractions were performed under local anaesthetic in 3,732 patients.

METHOD

Oral examination of all patients who reported back with post-extraction problems.

RESULTS

The frequency of post extraction complications was low (1.1 per cent), and was mainly due to; infected sockets (48.7 per cent), followed by bleeding sockets (41.0 per cent) and retained roots (10.3 per cent). There were eight 'other' complications suffered by 11 patients: necrotising fasciitis (n=l), herpes zoster (n=l), Ludwig's angina (n=l), infections of the submandibular (n=l), parapharyngeal (n=2), masticator (n=2) and submasseteric spaces (n =2), and reaction to local anaesthesia (2ml of 2 per cent lignocaine hydrochloride) (n=1).

CONCLUSION

The results of this study indicate that post-extraction complications are few, mostly minor, self-limiting and easily treatable. The study does not support routine antibiotic prophylaxis or special pre-extraction procedures, even in this patient population with poor oral hygiene and high HIV seroprevalence.

Postsurgical complications

The most common complications of oral surgery include bleeding, pain, swelling, infection, dry socket, and fracture. Bleeding can be controlled by applying gauze pressure to the area or through the use of hemostatic agents. A dry socket should have a dressing with eugenol applied, whereas a prescription for antibiotics or analgesics can take care of some of the other problems. Patients with fractures should be referred to a dentist or oral surgeon for treatment.

Treatment of fibrinolytic alveolitis with rifamycin B diethylamide associated with gelfoam: a histological study

The most common complication in the healing of extraction wounds is fibrinolytic alveolitis, which may also be termed "dry socket". Reduction in the incidence of this condition after the application of topical antibiotics and the use of systemic antibiotics has been reported. A histological study of disturbed alveolar socket healing in rats was carried out to analyze the influence of application of rifamycin B diethylamide (Rifocin M) associated or not with Gelfoam. Sixty-four male rats (Rattus norvegicus albinus, Wistar), weighing 120-150 g, were divided into 4 groups of 16 animals each. In the second group of rats which received implants of Gelfoam, there was an intense resorption of bone walls in the initial stage. The rats that received implants of Gelfoam saturated with Rifocin M (fourth group) showed better results than the second group. The third group (only irrigation with rifamycin) showed better bone formation in the alveolar socket compared to the first, second and fourth groups. Thus, these results showed that rifamycin irrigation is useful in the control of alveolar infections.

Trabecular bone formation in the healing of the rodent molar tooth extraction socket

The aim of this study was to investigate the nature of the template structure on which trabecular bone formation occurs during healing of the rodent tooth extraction socket, a well studied bone healing system. The presence of collagen type II mRNA has previously been described in the healing socket, although the formation of the protein or cartilage has not been observed. However, recent evidence from developmental and other bone healing studies indicates that collagen type III may be important in forming the preliminary scaffold on which bone trabeculae are formed. The maxillary right molar teeth were removed from rats under general anaesthesia and the animals killed at various times afterward. The tissues were examined using histological, in situ hybridization, and immunohistochemical staining techniques. It was concluded that collagen type IIA mRNA was produced by osteoblast cells of the socket, but that collagen type II, if present, would account for less than 0.01% of the total proteins extracted. During bone formation, Sharpey's fibers were seen radiating from the peripheral bone toward the center of the socket. These optically active collagen fibers were inserted into the forming bone trabeculae and were recognized by antibodies raised against collagen type III. The arrangement and composition of these fibers therefore suggest that they form a preliminary framework on which deposition of woven bone trabeculae occurs.

[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.

[Brephoplasty of an inflamed alveolus with bone chips (histological research)]

Bone tissue regeneration and abatement of inflammatory processes in the well after tooth extraction were examined in experimental dogs treated with iodoform and crushed brefobone preserved in 0.5 percent formalin. Histologic study has confirmed the efficacy of crushed brefobone employment for the inflamed well plasty, for such treatment was conducive to a sooner abatement of the inflammation and regeneration of bone tissue in the well.