ss logo
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Case Report
Editorial
Original Research Article
Review Article
Technical Note
ss logo
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Case Report
Editorial
Original Research Article
Review Article
Technical Note
ss logo
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Case Report
Editorial
Original Research Article
Review Article
Technical Note
View/Download PDF

Translate this page into:

Original Research Article
2 (
2
); 51-58
doi:
10.25259/JADPR_52_2022

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

Department of Oral and Maxillofacial Surgery, Ranjeet Deshmukh Dental College and Research Center, Lata Mangeshkar Hospital Hingna, Nagpur, Maharashtra, India
Corresponding author: Mahesh Satish Kharche, Department of Oral and Maxillofacial Surgery, Ranjeet Deshmukh Dental College and Research Center, Lata Mangeshkar Hospital Hingna, Nagpur, Maharashtra, India. maheshkharche443404@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Kharche MS, Khandaitkar S. To assess knowledge and awareness regarding treatment of dry socket among interns. J Adv Dental Pract Res. 2023;2:51-8. doi: 10.25259/JADPR_52_2022

Abstract

Objectives:

A painful dental condition known as a dry socket (also known as alveolar osteitis) can occasionally develop after the extraction of a tooth. A dry socket occurs when the blood clot at the site of the tooth extraction dislodges before it has healed. The idea of treating dry sockets with medication-related combined treatment is relatively new. Many drugs have the ability to treat dry sockets. The study aimed to assess the knowledge regarding the combined treatment of dry socket among interns.

Material and Methods:

This cross sectional study was carried out at a dental college to evaluate the knowledge and awareness of dental students regarding treatment of dry socket.

Results:

The statistical analysis showed significance in knowledge about the combined treatment of dry socket. The participants had basic knowledge regarding various aspects of dry socket except recent advances.. Female interns showed more knowledge than male counterparts however, due to the unequal number of male and female participants the difference is not statistically significant. Basic knowledge regarding dry socket management was satisfactory however, awareness regarding newer advances needs to be improved.

Conclusion:

It is strongly recommended that the students should update their knowledge using continuing education programmes, journal articles so that they can manage this clinical condition effectively.

Keywords

Dry socket
Alveolar osteitis
Hyaluronic acid
Lower laser therapy

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].

Table 1: Participants’ evaluation based on gender.
Gender Frequency Percent
Female 72 69.2
Male 32 30.8
Total 104 100
Table 2: Descriptive statistics of participants’ responses.
Questionnaire Frequency Percent
1. What is a dry socket?
  A) Damage to salivary gland 7 6.7
  B) A displaced tooth 7 6.7
  C) Exposure of bone after extraction 90 86.5
2. Dry socket is also known as?
  A) Alveolar proteinosis 38 36.5
  B) Fibrinolytic alveolitis 62 59.6
  C) Keratoconjuntivitis 4 3.8
3. Hormones increase the risk of dry socket
  A) Prolactin 26 25
  B) Estrogen 39 37.5
  C) Progesterone 39 37.5
4. The most common site of dry socket after extraction
  A) Primary molars 14 13.5
  B) Canine 10 9.6
  C) Wisdom tooth 80 76.9
5. True or False: Using straw after extraction of the risk of dry socket
  A) True 87 83.7
  B) False 17 16.3
6. Time of experiencing pain of dry socket after extraction of tooth
  A) <24h 15 14.4
  B) 1-3 days 75 72.1
  C) 1-3 weeks 14 13.5
7. True or False: Is dry socket recurrent or frequently occurring in adjacent tooth.
  A) True 42 40.4
  B) False 62 59.6
8. Which of the following is not a feature of dry socket?
  A) Halitosis 12 11.5
  B) Fever 29 27.9
  C) Bad taste 37 35.6
  D) Localized inflammation 16 15.4
  E) Moderate-severe pain 10 9.6
9. How many days after an extraction does a dry socket usually develop?
  A) 28 days 7 6.7
  B) 2-4 days 44 42.3
  C) 7-8 days 23 22.1
  D) 1-2 days 19 18.3
  E) Within 24 h 11 10.6
10. Known risk factor for development of a dry socket?
  A) Radiotherapy 25 24
  B) Infection 12 11.5
  C) Smoking 16 15.4
  D) Atraumatic extraction 41 39.4
  E) Contraceptive pills 10 9.6
11. Which of the following is not usually a part of management of a dry socket?
  A) Irrigation with saline 15 14.4
  B) Analgesic advice 14 13.5
  C) Prescription of antibiotics 8 7.7
  D) Packing with a sedative dressing 20 19.2
  E) Repetition of postoperative advice 47 45.2
12. Not a underlying cause of dry socket
  A) Bacteria in the tooth socket 14 13.5
  B) Severe trauma to surrounding bone 27 26
  C) Both of the above 63 60.6
13. Which are the new treatment modalities for dry socket?
  A) HA 7 6.7
  B) Magnetic laser therapy 13 12.5
  C) Citric acid 5 4.8
  D) Both A and B 79 76
14. What are the effects of HA on healing dry socket?
  A) Reduces pain 7 6.7
  B) Reduces local and systemic inflammation 14 13.5
  C) Regeneration and repair 15 14.4
  D) All of the above 68 65.4
15. How many sessions of magnetic laser therapy are required for treatment of dry socket?
  A) 2 40 38.5
  B) 5 28 26.9
  C) 7 29 27.9
  D) 10 7 6.7

HA: Hyaluronic acid

Table 3: Detailed results of questionnaire.
Questionnaire Gender Total P-value
Female Male
1. What is a dry socket?
  Responses
    Incorrect 7 7 14 0.095
    Correct 65 25 90
2. Dry socket is also known as?
  Responses
    Incorrect 30 12 42 0.691
    Correct 42 20 62
3. Hormones increases risk of dry socket
  Responses
    Incorrect 43 22 65 0.382
    Correct 29 10 39
4. The most common site of dry socket after extraction
  Responses
    Incorrect 14 10 24 0.189
    Correct 58 22 80
5. True or False: Using the straw immediately after tooth extraction increases the risk of dry socket
  Responses
    Incorrect 11 6 17 0.660
    Correct 61 26 87
6. If you are developing dry socket, how soon after a tooth extraction would you begin to feel severe pain?
  Responses
    Incorrect 22 7 29 0.365
    Correct 50 25 75
7. True or False: Is Dry socket recurrent or frequently occurring in adjacent tooth.
  Responses
    Incorrect 53 22 75 0.612
    Correct 19 10 29
8. Which of the following is not feature of dry socket?
  Responses
    Incorrect 45 15 60 0.138
    Correct 27 17 44
9. How many days after an extraction does a dry socket usually develop?
  Responses
    Incorrect 44 19 63 0.868
    Correct 28 13 41
10. Known risk factor for development of a dry socket?
  Responses
    Incorrect 69 27 96 0.044*
    Correct 3 5 8
11. Not usually a part of management of a dry socket?
  Responses
    Incorrect 56 21 77 0.194
    Correct 16 11 27
12. Not a Underlying cause of dry socket?
  Responses
    Incorrect 12 13 25 0.009*
    Correct 60 19 79
13. Treatment modalities for dry socket?
  Responses
    Incorrect 20 16 36 0.029*
    Correct 52 16 68
14. What are the effects of hyaluronic acid on healing dry socket?
  Responses
    Incorrect 55 20 75 0.147
    Correct 17 12 29
15. How many sessions of magnetic laser therapy are required for treatment of dry socket?
  Responses
    Incorrect 28 14 42 0.643
    Correct 44 18 62
P value statistically significant

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].

Figure 1:
What is a dry socket.

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].

Figure 2:
Knowledge about the alternative name of the dry socket.
Figure 3:
Hormone for which scientists have linked to an increased risk of developing dry socket.

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].

Figure 4:
Believing that developing dry socket is more common after the extraction of the above type of tooth.
Figure 5:
True or false: Drinking through a straw while healing from a tooth extraction increases your risk of developing dry socket.

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].

Figure 6:
If you are developing dry socket, how soon after a tooth extraction would you begin to feel severe pain?

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].

Figure 7:
True or false: Having a dry socket once makes you more susceptible for it in the future.

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].

Figure 8:
Which of the following is not a feature of dry socket.

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].

Figure 9:
A pie chart showing percentage of responses showing awareness about the duration of occurrence of dry socket after extraction.

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].

Figure 10:
A pie chart showing percentage of responses showing awareness about the known risk factor for development of dry socket.

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].

Figure 11:
Which of the following is not usually a part of management of a dry socket.

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].

Figure 12:
Which of the following do researchers suspect may be an underlying cause of dry socket.

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].

Figure 13:
Which are the new treatment modalities for dry socket.

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].

Figure 14:
Which are the effects of hyaluronic acid on healing dry socket.

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]

Figure 15:
How many sessions of magnetic laser therapy are required for treatment of dry socket.

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.

Ethical approval

The research/study is approved by the Institutional Ethics Committee at VSPM Dental College and Research Center, number IEC/VSPMDCRC/81/2022

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship

Nil.

References

  1. . Dry socket etiology, diagnosis, and clinical treatment techniques. J Korean Assoc Oral Maxillofac Surg. 2018;44:52-8.
    [CrossRef] [PubMed] [Google Scholar]
  2. . Contemporary views on dry socket (alveolar osteitis): A clinical appraisal of standardization, aetiopathogenesis and management: A critical review. Int J Oral Maxillofac Surg. 2002;31:309-17.
    [CrossRef] [PubMed] [Google Scholar]
  3. . The general practitioner's perspective of the etiology, prevention, and treatment of dry socket. Gen Dent. 1997;45:461-7. quiz 471-2
    [Google Scholar]
  4. . Analysis of one hundred cases of dry socket. Dent Pract Dent Rec. 1958;8:275-9.
    [Google Scholar]
  5. , . Prevalence, clinical picture, and risk factors of dry socket in a Jordanian dental teaching center. J Contemp Dent Pract. 2007;8:53-63.
    [CrossRef] [Google Scholar]
  6. , , , . Pathogenesis and management of dry socket (alveolar osteitis) Pak Oral Dent J. 2010;38:323-6.
    [Google Scholar]
  7. , , , , . Oral hygiene and postoperative pain after mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. 2001;92:260-4.
    [CrossRef] [PubMed] [Google Scholar]
  8. , , . Laser therapy for treatment of peri-implant mucositis and peri-implantitis: An American Academy of Periodontology best evidence review. J Periodontol. 2018;89:766-82.
    [Google Scholar]
  9. , . Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE J Sel Top Quantum Electron. 2016;22:7000417.
    [CrossRef] [PubMed] [Google Scholar]
  10. , , . Static magnetic field (SMF) as a regulator of stem cell fate-new perspectives in regenerative medicine arising from an underestimated tool. Stem Cell Rev. 2018;14:785-92.
    [CrossRef] [PubMed] [Google Scholar]
  11. , , . Radiodensitometric assessment of the effect of pulsed electromagnetic field stimulation versus low intensity laser irradiation on mandibular fracture repair: A preliminary clinical trial. J Maxillofac Oral Surg. 2014;13:451-7.
    [CrossRef] [PubMed] [Google Scholar]
  12. , , . An evaluation of 0.2% hyaluronic acid gel (Gengigel (R) in the treatment of gingivitis: A clinical and microbiological study. Oral Health Dent Manag. 2014;13:779-85.
    [Google Scholar]
  13. , , . Evaluating the effectiveness of visual analog scales: A web experiment. Soc Sci Comput Rev. 2006;24:227-45.
    [CrossRef] [Google Scholar]
  14. , , . Low level laser therapy: A panacea for oral maladies. Laser Ther. 2015;24:215-23.
    [CrossRef] [PubMed] [Google Scholar]
  15. , , . Effect of pulsed electromagnetic field on healing of mandibular fracture: A preliminary clinical study. J Oral Maxillofac Surg. 2011;69:17081717.
    [CrossRef] [PubMed] [Google Scholar]
  16. , , . Effects of static magnetic and pulsed electromagnetic fields on bone healing. Int J Adult Orthodon Orthognath Surg. 1997;12:43-53.
    [Google Scholar]
Show Sections