To assess knowledge and awareness regarding treatment of dry socket among interns

INTRODUCTION

Alveolar osteitis, hemorrhage, discomfort, inferior alveolar nerve injury, oroantral communication, and periodontal disease are the potential side effects following tooth extraction.^[1,2]

Both odontogenic and non-odontogenic foci of persistent infection can provide access points for microorganisms to the post-extraction site. Data, however, suggest that bacteria might not be the main reason for the dry socket lesions connected to alveolar osteitis.^[3]

According to Lehner, using a vasoconstrictor in conjunction with local anesthetics results in extended vasospasm and avoids blood clot formation.^[4]

An inadequate degree of oral hygiene is thought to facilitate the development of dry socket, which is considered to be significantly influenced by infection. It has been demonstrated that patients with poor dental hygiene experience more dry sockets on average. Other factors include the location of extraction of site, surgical site trauma further risk factors.^[5]

The use of antibacterial medications following extraction and antiseptic rinses is two pharmacological techniques for preventing dryness.^[6,7]

Low-level laser treatment is offered in addition to well-known conventional therapies with the intention of promoting recovery. In their investigations, continuous diode laser irradiation followed by curettage and irrigation was a much more effective treatment for alveolar osteitis than curettage and irrigation followed with Alvogyl directly administered to the socket.^[8]

One of the physiotherapy techniques is magnetic-laser treatment, which reduces pain and swelling while hastening the regeneration of tissues following damage. A magnetic laser field acts on the chemicals that make up cell structures to drive cellular metabolism, enzymatic activity, and the respiration of lymphocytes and nerve cells. Improvements in microcirculation, rapid revascularization and reinnervation, a reduction in intracellular and intercellular edema are seen at the tissue level. Furthermore, the influence of a magnetic field on the surgical zone has analgesic, regenerative, and also accelerates tissue-healing.^[9]

One of the most prevalent linear extracellular matrix polysaccharides in the body’s tissues, particularly in connective tissue and synovial fluid, is hyaluronic acid (HA), a glycosaminoglycan.

It carries out a number of functions, such as regulating tissue hydration, the elastic viscosity of synovial fluid in joints, and the mechanism of cell detachment with effects that are both anti-inflammatory and anti-edematous. As a result of advancements in our comprehension of the inflammatory mechanisms and wound healing process associated with tooth sockets, many extracellular matrix components, including HA, chondroitin sulfate, and fibronectin, are recognized as promoters of periodontal healing and regeneration.

HA is also non-immunogenic and non-toxic, making its usage in medicine safe.^[10,11]

MATERIAL AND METHODS

In Nagpur, Maharashtra, between April 2022 and June 2022, the study was carried out. One hundred and four interns were included to take the cross-sectional survey. The Ranjeet Deshmukh Dental College and Research Center’s Institutional Ethical Committee reviewed the study’s proposal and gave its approval (IEC/VSPMDCRC/81/2022). One hundred and four consenting volunteers who agreed to participate in the study provided the data.

Through multiple-choice questions, the participants awareness of combined treatment of dry socket was evaluated. The interns were informed about the study’s purpose. A questionnaire was created online. Considering that it was simple to record and analyze the numbers, the online option was selected. Every participant’s summary was effortlessly captured, tabulated, and statistically analyzed.

To do a descriptive analysis, data were analyzed using the statistical software Statistical Package for the Social Sciences version 2022 (IBM). Mann–Whitney U-test is used to assess the relationship between gender and correct answers among interns regarding the combined treatment of dry socket.

RESULTS

The study included 104 patients in total. Out of 104, 72 (69.2%) were female and 32 (30.8%) were male [Tables 1-3].

DISCUSSION

Question number 1 depicts that seven participants responded damage to salivary gland, seven participants responded a displaced tooth, and 90 participants responded exposure of bone after extraction, 65 female interns and 25 male interns gave the correct answer, that is, exposure of bone after extraction [Figure 1].

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Figure 1:

What is a dry socket.

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Question number 2 depicts that 38 participants responded alveolar proteinosis, 62 participants responded fibrinolytic alveolitis, and four participants responded keratoconjunctivitis, 42 female interns and 20 male interns gave the correct answer, that is, fibrinolytic alveolitis.

Question number [Figure 2] 3 depicts that 26 participants responded prolactin, 39 participants responded estrogen, and 39 participants responded progesterone29 female interns and 10 male interns gave the correct answer, that is, responded estrogen [Figure 3].

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Figure 2:

Knowledge about the alternative name of the dry socket.

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Figure 3:

Hormone for which scientists have linked to an increased risk of developing dry socket.

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Question number 4 depicts that 14 participants responded primary molars, 10 participants canine, and 80 participants responded wisdom tooth 58 female interns and 22 male interns gave correct answer, that is, wisdom tooth [Figure 4]. Question number 5 depicts that 87 participants responded true and 17 participants responded false, 61 female interns and 26 male interns gave the correct answer, that is, true [Figure 5].

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Figure 4:

Believing that developing dry socket is more common after the extraction of the above type of tooth.

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Figure 5:

True or false: Drinking through a straw while healing from a tooth extraction increases your risk of developing dry socket.

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Question number 6 depicts that 15 participants responded <24 h, 75 participants responded 1–3 days, and 14 participants responded 1–3 weeks, 50 female interns and 25 male interns gave correct answer, that is, 1–3 days [Figure 6].

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Figure 6:

If you are developing dry socket, how soon after a tooth extraction would you begin to feel severe pain?

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Question number 7 depicts that 42 participants responded true and 62 participants responded false, 19 female interns and 10 male interns gave correct answer, that is, false [Figure 7].

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Figure 7:

True or false: Having a dry socket once makes you more susceptible for it in the future.

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Question number 8 depicts that 12 participants responded halitosis, and 29 participants responded fever, 37 participants responded bad taste, 16 participants responded localized inflammation, and 10 participants responded moderate-severe pain, 27 female interns and 17 male interns gave the correct answer, that is, fever [Figure 8].

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Figure 8:

Which of the following is not a feature of dry socket.

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Question number 9 depicts that seven participants responded 28 days, 44 participants responded 2–4 days, 23 participants responded 7–8 days, 19 participants responded 1–2 days, and 11 participants responded within 24 h, 28 female interns and 13 male interns gave correct answer, that is, 2–4 days [Figure 9].

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Figure 9:

A pie chart showing percentage of responses showing awareness about the duration of occurrence of dry socket after extraction.

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Question number 10 depicts that 25 participants responded radiotherapy, 12 participants responded Infection, 16 participants responded smoking, 41 participants responded atraumatic extraction, and 10 participants responded contraceptive pills, 3 female interns and 5 male interns gave correct answer, that is, atraumatic extraction, p value significant (0.044) [Figure 10].

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Figure 10:

A pie chart showing percentage of responses showing awareness about the known risk factor for development of dry socket.

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Question number 11 depicts that 15 participants responded irrigation with saline, 14 participants responded analgesic device, eight participants responded prescription of antibiotics, 20 participants responded packing with a sedative dressing, and 47 participants responded repetition of postoperative advice, 16 female interns and 11 male interns gave correct answer, that is, prescription of antibiotics [Figure 11].

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Figure 11:

Which of the following is not usually a part of management of a dry socket.

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Question number 12 depicts that 14 participants responded with bacteria in the tooth socket, 27 participants responded with severe trauma to the surrounding bone, and 63 participants responded. Both of the above, 60 female interns and 19 male interns gave the correct answer, that is, severe trauma to surrounding bone, P-value significant (0.009) [Figure 12].

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Figure 12:

Which of the following do researchers suspect may be an underlying cause of dry socket.

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Question number 13 depicts that seven participants responded HA, 13 participants responded to magnetic laser therapy, five participants responded citric acid, and 79 participants responded. Both A and B, 52 female interns and 16 male interns, gave correct answers, that is, both A and B, P-value significant (0.029) [Figure 13].

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Figure 13:

Which are the new treatment modalities for dry socket.

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Question number 14 depicts that seven participants responded that it reduces pain, 14 participants responded reduces local and systemic inflammation, 15 participants responded regeneration and repair, and 69 participants responded. All of the above, 17 female interns and 12 male interns gave the correct answer, that is, all of the above [Figure 14].

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Figure 14:

Which are the effects of hyaluronic acid on healing dry socket.

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Question number 15 depicts that 40 participants responded 2, 28 participants responded 5, 29 participants responded 7, and seven participants responded 10, 44 female interns and 18 male interns gave correct answers, that is, 7 [Figure 15]. Numerous authors claim that alveolar osteitis, a common condition, is responsible for between 24% and 35% of all complications experienced by patients following tooth extraction.^[12,13]

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Figure 15:

How many sessions of magnetic laser therapy are required for treatment of dry socket.

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Alveolar osteitis treatment with magnetic-laser supportive therapy may be used in addition to more traditional surgical methods.^[14]

HA regulates a variety of biological processes and keeps the body’s equilibrium in check. The extracellular matrix’s elasticity and viscosity are crucially maintained by HA, a vital component of connective tissue.^[15]

A course of magnetic-laser treatment should be added to the complex of therapeutic procedures used to treat dry sockets that develop following removal.

The healing process of the mucous membrane surrounding the tooth’s extraction is accelerated by magnetic-laser treatment, which also reduces the inflammatory symptoms of dry sockets that develop following tooth extraction. One of the reasons for such rapid changes should be the restoration of microcirculation in the inflammatory area as a result of the reduction in microvessel thrombosis and the activation of anti-inflammatory mechanisms in response to oxygen ions. The ability of magnetic-laser treatment to reduce pain is explained by the fact that laser light is absorbed by nociceptors and inhibits A and C pain fibers.^[16]

HA gel was used as an adjuvant in the treatment of dry socket based on the aforesaid concepts and treatment approaches. In our investigation, it was determined that knowledge of the use of HA to reduce pain was sufficient. Thus, it was determined that HA lessens both local and systemic inflammation in addition to pain. Knowledge about the application of combined exposure to a steady magnetic field and laser radiation was discovered in our research to promote effective therapies for alveolar osteitis.

The study was impeded by the fact that it was conducted in a single institution and only used a limited sample size. Due to informal talks among the respondents, there may not have been much diversity in the responses. Since the sample sizes in both groups were unequal, the findings cannot be generalized to all dental practitioners.

CONCLUSION

We conclude that there is a difference between male and female interns regarding the knowledge about the combined treatment of dry socket. However due to the unequal number of male and female participants, this difference was not statistically significant. In some areas students need to improve their understanding such as newer treatment options for management of dry socket. Continuous knowledge update is recommended for all students.