After tooth extraction, a deep cavity forms in the jaw area — the alveolus, or socket. In some cases, the patient develops alveolitis of the socket — an inflammatory process that causes pain and poses a potential threat to the health of the surrounding tissues, such as the periodontium and jawbone. Timely contact with a dental clinic will allow the disease to be diagnosed in time, therapy to be started, and dangerous complications to be avoided.
What Is Alveolitis of the Tooth Socket? Types of Inflammation
Under favorable circumstances, a blood clot forms at the site of tooth extraction. It consists of protein cells that participate in thrombus formation. The clot completely fills the socket and covers its walls. Its main task is to protect the tissues damaged during extraction from infection. Soon, the wound heals, and then new bone tissue forms.
However, sometimes the natural healing process is disrupted. This happens when the thrombus does not form, does not adhere tightly enough to the wound surface, or is mechanically damaged. After the extraction surgery, the coagulation process begins, as in any wound, with the function of protecting the underlying structures, bones, nerve endings, and so on. If at this phase something does not occur as expected, the tissues are exposed to the accumulation of food debris, oral microorganisms, and other materials; they become inflamed, and symptoms of alveolitis appear. This condition is the most common complication of tooth extraction.
Alveolitis after tooth extraction — inflammation of the socket — has several stages:
- Serous alveolitis is the first stage of the inflammatory process. Its signs appear 2–3 days after tooth extraction and are accompanied by constant pain and gradual deterioration of the patient’s well-being.
- Purulent alveolitis develops if the patient does not consult a dentist in time and does not receive the necessary treatment. The purulent form develops approximately 6–7 days after surgery. At this stage, pain symptoms intensify. Other symptoms are added: enlargement and tenderness of the lymph nodes, formation of gray plaque on the surface of the socket, swelling of the surrounding tissues, and deterioration of the patient’s general condition.
- Hypertrophic alveolitis is the last stage of the disease, in which weakening of general symptoms, including pain, and improvement in well-being are observed. This is a dangerous condition because, against the background of apparent relief, the disease progresses; inflammation causes impaired blood supply, suppuration, and tissue necrosis.
In the chronic course of the disease and in the presence of granulations, alveolitis may progress to the stage of sequestration — rejection of individual areas of infected tissue or bone.
Symptoms
Many patients mistakenly believe that an inflamed socket after tooth extraction does not require treatment, and that pain and other unpleasant symptoms are normal after such surgery.
During the first 3 days, painful sensations — both severe and moderate — are indeed normal, but then the pain should gradually subside. If this does not happen after 2–4 days, and on the contrary, the pain intensifies, it is necessary to urgently make an appointment with a doctor.
Basically, alveolitis of the socket can be recognized by the nature and intensity of the pain.
The pain is usually:
- increasing;
- pulsating;
- spreading to half of the face on the side of the extracted tooth;
- in later stages — unbearable, radiating to the temple and ear.
Other symptoms of alveolitis include:
- temperature rise to 38°C and above;
- swelling and inflammation of the gums in the wound area;
- periostitis — inflammation of the periosteum;
- absence or damage of the blood clot;
- formation of gray plaque;
- appearance of purulent exudate from the socket;
- unpleasant breath odor;
- enlargement of lymph nodes — submandibular and cervical — and their tenderness on palpation;
- sensitivity of inflamed tissues to hot and cold;
- excessive salivation;
- loss of appetite.
Less commonly, with alveolitis, other infections of the oral mucosa, such as stomatitis, develop simultaneously, and immunity decreases, which may lead to dangerous complications — osteomyelitis, lymphadenitis, and osteophlegmon.
The patient experiences a general deterioration in well-being, including weakness and fatigue.
Causes
Post-extraction alveolitis usually develops when the blood clot has not formed or has been damaged. Then the wound becomes open to infection, which quickly affects the soft tissues and jawbone. There are also a number of factors that lead to inflammation:
- complex surgical extraction, during which the tissues of the alveoli are inevitably damaged;
- extraction of third molars — alveolitis develops more often after wisdom tooth extraction because the bone tissue in this segment has a denser structure;
- non-compliance with tissue processing standards during surgery: improper antiseptic treatment, incomplete removal of tooth fragments or infected tissues, such as granulomas;
- poor-quality postoperative oral hygiene;
- failure to follow the dentist’s prescriptions and recommendations during the tissue healing period;
- consumption of rough, cold, or hot food that can disrupt the integrity of the blood clot;
- smoking — scientists have proven that smokers have a 20–40% higher risk of developing alveolitis;
- weakened immunity;
- presence of diseases of internal organs in the patient, for example, diabetes mellitus, blood clotting disorders, or bacterial infection in the body;
- exceeding the dose of local anesthetic.
Despite many predisposing factors, in modern dentistry, when a tooth is extracted by an experienced doctor in compliance with protocols and with the use of high-quality anesthetic and antiseptic materials, alveolitis develops in rare cases — about 3%.
The highest probability of inflammation occurs when extracting molars and incisors of the lower row, but the pathology especially often occurs after wisdom tooth extraction.
Complications of Post-Extraction Alveolitis
Alveolitis is a dangerous disease that, with improper or untimely treatment, may have serious consequences:
- odontogenic sinusitis — infection of the maxillary sinus when the socket becomes inflamed after extraction of upper jaw molars;
- phlegmon — infectious damage to soft tissues, in which purulent destruction of tissues occurs; it has an aggressive nature, spreads rapidly through the bloodstream, affects the vessels of the throat, neck, esophagus, and mediastinum, and may have serious health consequences and even lead to death;
- periostitis — purulent inflammation of the periosteum;
- odontogenic osteomyelitis — development of a purulent-necrotic process in bone tissue;
- sepsis — blood infection.
Treatment
When alveolitis of the tooth socket is diagnosed, treatment is aimed at solving the following problems:
- relieving inflammation;
- removing infected tissues, tooth fragments, and other foreign bodies from the socket;
- complete tissue regeneration;
- prevention of complications.
The first stage of alveolitis treatment is diagnostics. The doctor visually examines the site of inflammation and, if necessary, takes an X-ray to detect tooth remnants in the wound.
Treatment consists of cleaning and disinfecting the infected area and is carried out in several stages:
- Anesthesia — all medical procedures are performed under local anesthesia.
- Removal from the socket of thrombus fragments, necrotic masses, and food debris, followed by rinsing with an antiseptic solution.
- Removal of detected fragments of the extracted tooth.
- If a necrotic process has begun, the doctor rinses the area with a solution containing enzymes that break down dead tissues, help remove pus, and reduce swelling and inflammation.
- Disinfection.
- Insertion of a tampon soaked with preparations that have antiseptic and anesthetic effects.
- The doctor prescribes medication therapy for the patient — a course of antibiotics and rinses — gives recommendations for oral care, and schedules the next visit, when repeated antiseptic sanitation of the socket must be performed.
In rare cases, the doctor may remove a fragment of bone involved in the pathological process.
In cases of severe pain, the patient may take painkillers recommended by the doctor. The result of treatment of post-extraction alveolitis largely depends on the patient. In order for the wound to heal faster, it is necessary to strictly follow the prescribed treatment protocol and the dentist’s recommendations regarding tooth brushing, diet, and lifestyle.
It is within your power to protect yourself from alveolitis and other unpleasant complications after tooth extraction. To do this, it is necessary to take care of disease prevention.
After tooth extraction, you must not:
- touch the tooth extraction site with your tongue or fingers, so as not to damage the blood clot;
- rinse the mouth intensively;
- eat hard or tough food;
- actively engage in sports or heavy physical labor;
- take a hot bath or visit a sauna;
- smoke or drink alcohol.
How to Help Tissues Recover Faster
First of all, it is worth excluding from the diet any foods that may irritate the mucosa — sour, salty, spicy foods — as well as hot and cold dishes. Give preference to soft or finely chopped food.
Carefully monitor oral cleanliness, regularly perform the hygiene procedures and antiseptic baths recommended by the doctor in order to avoid infection of the socket. When brushing your teeth, try not to touch the blood clot, and gently rinse your mouth with water after every meal or snack.
How a Dentist Can Prevent the Development of Alveolitis
Tooth extraction is a complex operation. The doctor’s tasks include maximum control during anesthesia, precise atraumatic tooth extraction, high-quality cleaning of the socket — especially when extracting a destroyed tooth — prescribing the correct postoperative therapy, and monitoring the results.
Your health depends on the professionalism of the surgeon and their accuracy during the operation, so when choosing a dental clinic, it is very important to consider the level of equipment of the clinic, as well as the training and experience of the specialists.
This article does not replace a medical consultation. For complete and personalized information, please consult your dentist.