What is the first step in managing a patient presenting with alveolar osteitis (dry socket)?

The initial management of alveolar osteitis consists of: gentle saline irrigation to remove food debris and loose necrotic material from the socket (without disturbing the socket walls or attempting to curette), followed by packing the socket with a medicated dressing (eugenol-impregnated gauze, such as Alvogyl or similar). The dressing provides significant pain relief within hours. It is changed every 24–72 hours until symptoms resolve. Systemic antibiotics are not indicated for uncomplicated alveolar osteitis. Curettage of the socket to stimulate bleeding is controversial and potentially harmful.