Oral Surgery · patient case question
What most likely caused the dry socket that developed after the previous extraction?
Patient case: Third Molar Surgery and Its Complications
demo: 24-year-old female
chief: “The gum over my lower wisdom tooth is swollen and I can barely open.”
history: Smokes 10 cigarettes daily. Takes combined oral contraceptives. Poor oral hygiene.
meds: Combined oral contraceptive pill
findings: Partially erupted #17 with an inflamed, edematous operculum, purulent exudate on pressure, trismus, and tenderness. Extraction is planned. Four days after a previous extraction of #32, she developed severe radiating pain with an empty socket and exposed bone.
Show answer and explanation
Correct answer: C. Smoking and estrogen-containing oral contraceptives, both of which promote premature clot breakdown
- A. Gentle irrigation with saline is standard and does not cause alveolar osteitis.
- B. Routine simple extraction sockets do not require suturing, and its absence is not a recognized cause.
- C. Correct. Smoking causes clot disruption through suction and local vasoconstriction, and estrogen raises fibrinolytic activity. Combined with poor hygiene, these are the strongest recognized risk factors for alveolar osteitis.
- D. Diet is not a recognized risk factor, though vigorous suction through a straw is.