The prevention of 'dry socket' with topical metronidazole in general dental practice

Abstract

Objective The purpose of the study was to determine if the intra-alveolar application of topical metronidazole gel could reduce the incidence of alveolar osteitis (dry socket) following routine tooth extraction in molar and premolar extraction sites. Design This was a multicentre, double blind, randomised, placebocontrolled clinical trial. A total of 302 patients took part, of which 23 returned with alveolar osteitis. Of these, eight had received the metronidazole gel and 15 the placebo. Setting The study was carried out in three general dental practices by general dental practitioners working in England over the period [2000][2001][2002][2003]. Main outcome measures Following extraction of either a molar or premolar tooth, either a 25% metronidazole gel or KY Jelly was syringed gently into the socket. A painful post operative complication was recorded if either a dry socket was present or the patient returned with pain. Results and conclusions The difference in the incidence of alveolar osteitis between the placebo and the active gel groups was not significant and it was concluded that 25% topical metronidazole gel was not effective in reducing the incidence of alveolar osteitis. It was found that the incidence of alveolar osteitis reduced with increasing age and was more likely to occur in a patient with a previous history of the condition.

Antibiotic prophylaxis in third molar surgery: A randomized double-blind placebo-controlled clinical trial using split-mouth technique

“…SEKHAR et al 29 and BERGDAHL & HEDSTRÖ M. 7 in their prospective studies compared the systemic perioperative use of metronidazole with placebo and found the incidence of alveolar osteitis and early postoperative infection to be the same in both groups. REEKIE et al 27 in their double-blind study, found no significant difference between the metronidazole and placebo groups. In the present study, only one patient (single socket) developed alveolar osteitis (0.3%) after mandibular third molar removal.…”

An audit of 600 referrals to a primary care based oral surgery service

“…32,33 While it has been demonstrated that metronidazole may reduce the incidence of dry socket, 34 the findings of several research papers do not show any reduction. 25,[35][36][37] The referrals in this audit relate mostly to the main disease processes that dentists treat on a regular basis, namely den tal caries, gingival and periodontal disease, pulpal and peri apical disease. To date surgical dental specialists working in the primary healthcare setting, particularly those relying on NHS funding have restricted most of their clinical activity to these three disease processes, and may have only cared for patients on a short term basis.…”

Platelet rich fibrin in the management of established dry socket

“…The management of dry socket is varied34567891112131415, and strategies have varying rate of success19101112131415. Kaya et al11 showed use of alvogyl, Salicept patch, low laser therapy, and curettage with irrigation in dry sockets of 104 patients divided into four groups.…”

“…Management of dry socket was initially with anti-bacterial agents458, lavage, anti-fibrinolytic agents, steroidal anti-inflammatory agents, obtundents, and clot supportive agents139101112. The concept of dry socket management is changing toward alternative interventions including plasma rich growth factors, low level laser therapy1112, and other treatments such as the use of honey.…”