Oral Surgery · patient case question
All of the following are true of a dry socket EXCEPT:
Patient case: Extraction, infection and a difficult healing
demo: 44-year-old female
chief: Severe throbbing pain and a foul taste four days after an extraction, plus swelling from a separate upper tooth.
history: Osteoporosis treated with intravenous zoledronic acid for three years. She smokes. She had corrective surgery for tetralogy of Fallot in childhood with no residual defect.
meds: Zoledronic acid, calcium and vitamin D.
findings: The socket at site 32 is empty of clot with exposed bone and exquisite tenderness. There is no purulence. Separately, tooth 4 is grossly carious with vestibular swelling and tenderness.
Show answer and explanation
Correct answer: A. It is straightforward to diagnose because it produces obvious swelling and pus
- A. Correct, and this is the exception. Dry socket is characteristically not accompanied by swelling, pus, fever or lymphadenopathy. It is diagnosed by the pattern of severe delayed pain with a denuded socket, and its absence of infective signs is exactly what distinguishes it from an infected socket.
- B. This is true. The delayed onset is characteristic; immediate postoperative pain is expected surgical pain, not alveolar osteitis.
- C. This is true. Loss of the clot exposes bare bone, which is intensely sensitive, and the socket has a distinctive foul odour and taste.
- D. This is true. Smoking, oral contraceptives, mandibular third molars, traumatic extraction and previous history all raise the risk.