Prevention of Dry Socket by Means of Single Preoperative Antibiotics Compared to Conventional Therapy
Condition: Dry Socket
MeSH terms: Dry Socket
Study type: Interventional
Phase: Phase 2

Summary: 
      Background: One of the commonest post-operative complications after tooth extraction is dry
      socket; it can be defined as postoperative pain in and around the tooth extraction site,
      which increases in severity at any time between 3rd to 5th post-operative days along with
      disintegrated blood clot within the tooth extraction socket with or without halitosis. The
      exact etiology is unclear therefor prevention remains the main beneficial therapy. Various
      factors are thought to play an important role in etiology of dry socket including, anaerobes,
      fibrinolysis, traumatic extractions, frequent spiting and rinsing, oral contraceptive pill
      and smoking.

      Numerous approaches have been tried for prevention of dry socket; include antiseptic
      mouthwashes, anti-fibrinolytic agents, antibiotics, intra-socket dressings and medicated
      packing into the extraction wound for example chlorohexidine mouthwashes, warm saline rinses,
      gelatin sponges, occlusive dressings and oxidized cellulose sponge.

      Purpose of the study is to compare the role of single preoperative oral dose of metronidazole
      with amoxicillin in hindrance of dry socket compared to conventional therapy after removal of
      mandibular third molar of class 2 impaction.

      Objectives: To find out effective treatment for prevention of dry socket among preoperative
      single oral dose of metronidazole and amoxicillin compared to conventional therapy.

      Methods: A double blind randomized control trial in which patients requiring surgical
      extraction of lower 3rd molar of class 2 impactions were selected for this study. Patients
      were randomly divided into 3 groups, one of the groups had received single preoperative oral
      dose of metronidazole one hour before extraction, second group was treated with single oral
      dose of amoxicillin an hour before tooth extraction and third group was treated with
      conventional therapy. Patients were asked to visit on 5th postoperative day or before it in
      case the pain persist or reoccur.
    

Detailed description: 
      Background Dry socket is one of the commonest problems that occur after extraction of molars.
      It can be described as a painful inflammatory condition that occurs due to non-formation or
      early displacement of a blood clot from a tooth extraction site before the healing of wound
      occurs. Clinical presentation of dry socket is intense ache, bad breath, hollow socket due to
      displacement of blood clot and exposure of bone. Pain produced by dry socket is known to last
      from 7 to 14 days. Incidence of dry socket is approximately 3% for routine extractions and
      can go beyond 30% for impacted lower third molars.

      Tooth impaction is a pathological condition in which a tooth fails to erupt to the occlusal
      level of its normal position. Lower third molars are the most commonly impacted teeth. The
      prevalence of third molar impaction ranges from 16.7% to 68.6%.

      Multiple factors are associated with dry socket formation. such as patient's age, Gender,
      extraction in posterior region of mouth, smoking status, oral contraceptive.

      Incidence of dry socket perhaps lies somewhere from 5% to 20% worldwide.It ranges broadly
      between 0.9% and 21% in United Kingdom and 3.5% in Siri-Lankan. Incidence of dry socket in
      Pakistani population is reported 13.8%20.

      Incidence of dry socket after extraction of impacted third molars is about 25-30%33.

      Third molar is the most frequently impacted tooth and its prevalence ranges from 16.7% to
      68.6%.

      Methods Data collection was done from the patients requiring surgical extraction of
      mandibular third molars class two impaction, at outpatient department of oral and
      maxillofacial department of Dow university health sciences.

      Patients were selected according to the inclusion and exclusion criteria. After explaining
      the purpose of the study and its associated benefits and risks, consent was obtained from the
      patients. Patients were randomly divided into 3 groups. Ethical approval was obtained from
      institutional review board of DUHS, Karachi.

      Lower 3rd molars with class 2 impaction, both genders, aged between 18 to 40 years were
      included in the trail. Whereas smokers, alcoholic patients, pregnant and nursing mothers,
      those taking anticoagulant, oral contraceptives, already taking antibiotics, with renal or
      hepatic dysfunction, allergic to antibiotics and reluctant to participate were excluded from
      the trail.

      All of the patients were operated by R2 postgraduate trainee of oral and maxillofacial
      surgery department, under local anesthesia, inferior alveolar and long buccal nerves were
      anesthetized. Incision was given, flap was elevated and osteotomy and/or tooth section was
      done depending on the case. Round and fissured burs were used to remove the bone with low
      speed micrometer straight hand piece. Normal saline was used as coolant and irrigating
      solution. After extraction of the tooth, socket was irrigated and flushed with normal saline.
      Sutures were given with 3-0 silk material and a roll of sanitized gauze was placed over the
      extraction socket and patients were asked to bite on it for at least 40 minutes. prescribed.
      Post-operative instructions were given to the patients both verbally as well as in written
      form. On fifth post-operative day patients were examined with naked eye under the light of
      dental unite. Those diagnosed with dry socket were treated with alveogel after irrigating and
      flushing the socket with normal saline.
    

Intervention name(s): Amoxicillin 500 Mg; metronidazole 400mg; metronidazol 400mg and amoxicillin 500mg
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Amoxicillin 500mg an hour before tooth extraction; 400mg of metronidazole an hour before extraction; 400mg metronidazole TDS, amoxicillin 500mg BD for 5 days after extraction
Other intervention name(s): amoxill 500mg; flygel 400mg
Intervention MeSH terms: Amoxicillin; Metronidazole
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: dry socket; metronidazole; amoxicillin; lower 3rd molars