THE INCIDENCE, PATHOGENESIS, PREVENTION AND MANAGEMENT OF ALVEOLAR OSTEITIS, CASE

STUDY OF SPECIALIST HOSPITAL BAUCHI.

CHAPTER ONE

1.0 Introduction

Alveolar osteitis ( Dry socket ) is one of the most common post operative complications following
extraction of permanent teeth, resulting in severe pain and discomfort for the patient. Definitions vary,
but centre around the total or partial loss/breakdown of the blood clot from the socket, resulting in a
localized inflammatory response and intense pain radiating to the auricular and temporal regions. This
typically occurs within 2-4 days after tooth extraction.

Alveolar osteitis It has been given a variety of different terms in surrounding literature:- localized
osteitis, post operative alveolitis, alveolagia, alveolitis sicca dolorosa, septic socket, necrotic socket and
fibrinolytic alveolitis.

Alveolar osteitis has an overall incidence of around 3-5% for all extractions, however, it is reported to
have a much greater incidence following extraction of mandibular teeth. The mandibular third molars
are reported to have a much varied rate of incidence of alveolar osteitis, any where as high as 47%, but
stronger studies suggest 25 - 30%. There are many factors influencing the occurance of post operative
complications which has a significant effect on the outcome. In addition to this, a diagnosis of alveolar
osteitis is based upon the judgement of the clinician, which can vary greatly between dentists.

1.1 Background of the study

Alveolar osteitis is one of the most common complication following tooth extractions. The
aetiopathogenesis and prevention of this condition has been Subject of debate throughout the years.
The assessment of risk factors can guide the physician to minimize the incidence of this complication.
Various types of treatment have been suggested although there is yet no universally accepted protocol.

According to world health organization ( WHO ) ( 2019 ), Alveolar osteitis is more common in females
than males. Gingigel and alveologyl were the topical agent that have been used intra - alveolar post
extraction. It is an element naturally found in the body's connective tissues and acts as a barriers and
repairs any damage, it is administered topically. Alveologyl is a paste for alveolar surgical dressing after
tooth extraction, it contains with peryhawar fibers. the paste promotes homeostasis by compression
and protects from super infection ( alveolar osteitis ) by its barrier affect introduced into the socket. It
gradually eliminates without an intervention by practitioner as the normal healing of the wound take
place, ( WHO, 2019 ).

Alveolar osteitis usually occur where the blood clot fails to form or its lost form the socket (i.e the defect
in the gum when a tooth is taken out). This leaves an empty socket where bone is exposed to the oral
cavity, causing a localized alveolar osteitis limited to the Lamina Dura (i.e the bone which lined the
socket). The specific type of alveolar osteitis is also known as dry socket or less commonly fabrinolytic
alveolar osteitis, and is associated with increased pain and delayed healing time. (Walinga, 2019).
According to Crawford (2018) alveolar osteitis literally mean dry appearance of the extraction site after
washing the blood clot which was first described. There is a post operative pain at the extraction site
that can be within two or four days of extraction. Blood clot within the alveolar socket may be
completely or partially disintegrated with possibility of halitosis.

Local signs such as often socket covered by food debris, halitosis, severe throbbing pain that may radiate
to the surrounding structures, like nose, ear and eye according to the extraction site, tender inflamed
gingival, pus formation and regional lymphadentitis. Systemic involvement may include fever, insomonia
and dizziness. (Neville, 2007).

1.2 Statement of the problem

Alveolar osteitis occurs in about 3 -5% of routine dental extractions, Alveolar osteitis has more incidence
in the extraction of impacted mandibular third molar. Alveolar osteitis mostly occurs where the blood
clot fails to form or is lost from the socket ( the defeat left in the germ when a tooth is taken out ). This
leaves an empty socket where bone is exposed to the oral cavity, causing a localized alveolar osteitis,
limited to the lamina dura ( the bone that lines the socket ), ( osterberg et Al 2004 ).

Alveolar osteitis is a well-known complication after extraction or surgical removal of tooth. Commonly
known as “dry socket” ths condition remains a common post operative problem that results in severe
pain and repeated practice/hospital visits. (Osborn TP, 2017).

1.3 Significance of the study

This study will not only benefit the patients attending specialist hospital bauchi, it will also benefit other
people in the society by helping them to know the incidence, pathogenesis, prevention as well as the
management of alveolar osteitis. This study will also provide an awareness to the public at the same
time will also enlighten the public to know that failure to follow post operative instructions given after
tooth extraction can lead to the development of alveolar osteitis. However, this study will benefit the
dental staff of specialist hospital bauchi

As they will develop more skills and know the current information on alveolar osteitis..

1.4.1 Aim of the study

The aim of this critical review is to highlight the oral surgeons, Dental therapists, doctors, other dental
staffs, if dental medicine about comprehensive concept about the incidence, pathogenesis, prevention
and management of alveolar osteitis.

1.4.2 Objectives of the study

1. To determine the prevalence/ incidence of Alveolar osteitis.

2. To investigate the pathogenesis of Alveolar osteitis

3. To find out the effects of alveolar osteitis.

4. Also to find out the preventive and management measures of alveolar osteitis.

1.5 Research questions

1. How the incidence / prevalence is alveolar osteitis among dental patients attending specialist hospital
bauchi

2. What are the pathogenesis of Alveolar osteitis

3. What are the preventive and management measures of alveolar osteitis.

1.6 Scope and limitation

This clinical review or study is limited to the incidence, pathogenesis, prevention and management of
Alveolar osteitis among the patients attending dental unit in specialist hospital bauchi.

1.7 Definition of terms

There are many definitions of alveolar osteitis. But alveolar osteitis is characterized with a partial or total
disintegrated blood clots between the 2 - 4 days after tooth extraction, accompanied by pain in the area
of alveolar socket that irradiates, with or without halitosis. That condition leads to delayed healing at
the extraction wound and requires multiple visit for treatment. This post operative complication can
cause significant pain and other symptoms which are not so typical but without the usual sings and
symptoms of the infections such as low grade fever, inflammed gingival margin, bare bone, grayish
discharge. The clinical course start with developing pain on the first to third day after tooth extraction.
On examination, the tooth socket appears to be empty, with partial or completely lost blood clot and
some bony surfaces of the socket are exposed. Therefore, Alveolar osteitis is inflammation of the
alveolar bone (i.e the alveolar process of the maxilla or mandible). Classically, this occurs as a post
operative complication of tooth extraction. (Neville, 2018).

CHAPTER TWO

2.0 Literature Review

2.1 Introduction

• Alveolar osteitis is the inflammation of the alveolar bone ( the alveolar process if maxilla and
mandibular ), ( Neville,Be, 2017 ).

• Alveolar osteitis is generally refers to localized inflammation of the bone with no progression through
the marrow spaces ( compared with osteomyelitis ), ( Crawford, 2019 ).

• Alveolar osteitis is defined as a post operative pain inside and around the extraction side, which
increase in severity at any time between the first to third day after tooth extraction, accompanied by a
partial or total disintegrated blood clot within the alveolar socket with or without halitosis. ( Blum IR,
2018 ).

2.2 Incidence of alveolar osteitis

The incidence of alveolar osteitis for routine dental extractions is reported to be around 0.5 - 5%. The
incidence of alveolar osteitis after surgical removal of the third molar is higher. It is found to be around 1
- 37.5%, it has been well documented that the changes of developing alveolar osteitis is approximately
10times higher in cases of surgically removed teeth ( surgical extraction ). The reported incidence are
still controversial due to the lack of high quality evidence in respect to alveolar osteitis.

2.3 Pathogenesis of alveolar osteitis

The onset of alveolar osteitis is typically around 2 - 4 days post extraction. Blum explains how it is
unlikely to occur before the first 24 hours due to the presence of antiplasmin ( plasmin inhibitor ) which
delays fibrinolysis; and it is only once levels of antiplasmin have been reduced that the breakdown of
clot occurs. It's duration varies,but it is speculated to range between 5 to 10 days.

Birn's fibrinolytic theory explains that marked or prolonged trauma during an extraction, or indeed
infection of the socket, causes an increased localized inflammation within the bone which triggers the
local release of plasminogen activators. These facilitate the conversion of plasminogen to plasmin, which
breaks down fibrin and leads to lysis of the blood clot.

Evidence linking alveolar osteitis with poor oral hygiene, periodontal diseases and pericoronitis has
prompted an expanded theory, in corporating an entirely extrinsic eatiology Factor. There is evidence to
suggest that certain bacteria demonstrate fibrinolytic activity independent of the host response, and act
directly on the blood clot. Nitzan et al. Demonstrated fibrinolytic activity in treponema denticola which
produced its own fibrinolytic enzyme ( fibrinolysin ). In the same study the authors also commented on
how prevotella oralis releases proteases that convert plasminogen into plasmin and so further
increases fibrinolysis. With both of these bacteria being linked with periodontal disease, this strengthens
links between periodontal disease and alveolar osteitis, but should be considered carefully in cases of
periodontal with a smoking habit that could present an element of confounding.

2.4 Risk factors

1. Mechanical disruption of blood clot :- it would make sense that if blood clot is prematurely lost from
the socket, then this leave the bone exposed to bacterial ingress and subsequent inflammation leading
to alveolar osteitis, but no evidence could be found to support this theory. Specifically, the negative
pressure created intra - orally when using straws is often said to disrupt the clot which has formed and
subsequently lead to the development of alveolar osteitis, but this action has been suggested to have no
impact on the incidence of alveolar osteitis.

2. Smoking :- Smoking has long been associated with post operative complications, including alveolar
osteitis. This maybe as a result of vasoconstrictive action on small blood vessels. Abstaining from
smoking at least for a day after tooth extraction may reduce the high risk of alveolar osteitis occurance, (
Duly, 2017 ).

3. Lack of operators experience :- many studies claim that operator's experience is a risk factor for the
development of alveolar osteitis. Lersen concluded that that surgeon's inexperienced could be related
to a bigger trauma during tooth extraction, especially surgical extraction of mandibular third molar,
( killing et al, 2017 ).

4. Patient's gender :- Many authors claim that female gender regardless of oral contraceptive use, is
predisposition for development of alveolar osteitis, that means female genders are at high risk of
developing alveolar osteitis. Macareqor reported a 50% greater incidence of alveolar osteitis in women
than men, in a series of 4000 extractions. While cloby reported that no difference in the incidence of
alveolar osteitis associated with gender, ( Macgregor et al, 2018 ).

5. Oral hygiene :- it is accepted that bacteria have a role to play in the development of alveolar osteitis,
and so with greater localized bacterial counts such as in periodontal disease, pericoronitis and poor oral
hygiene, a higher incidence of alveolar osteitis can be expected.

6. Socket irrigation :- inadequate intra - operative irrigation where bone removal is required increases
the incidence of alveolar osteitis. However, Tolstunov reflects in his study to put forward that it maybe
the action of irrigating that disrupts the clotting process and thus promoting the occurance of alveolar
osteitis.

7. Oral contraceptives :- the only medication associated with developing alveolar osteitis, oral
contraceptives become popular in 2018, and the studies conducted after 2019 ( as opposed to studies
prior to 2018 ) show a significant higher incidence of alveolar osteitis in women. Sweet and buffer found
that this increase in the use of oral contraceptives positively with incidence of alveolar osteitis.

8. Systemic diseases :- Some researchers have suggested that systematic disease could be associated
with Alveolar osteitis. One article proposed immune-compromised or diabetic patients being prone to
development of Alveolar osteitis due to alter healing. But no scientific evidence exist to prove a
relationship between systematic diseases and Alveolar osteitis (Mitchell, 2018).

9. Surgical Trauma and Difficulty of surgery :- Most authors agree that surgical trauma and difficulty of
surgery play a significant role in the development of Alveolar osteitis. This could be due to more
liberation of direct tissue activators secondary to bone marrow inflammation following more difficult,
hence, more traumatic extractions. Surgical extractions, in comparison to no surgical extractions result
in alo-fold increase incidence of Alveolar osteitis. It found that surgical extractions involving reflection of
a flap and removal of bone are more likely to cause Alveolar osteitis. (Lilling et al, 2017).

2.5.1 Sign of alveolar osteitis

Since the Alveolar osteitis is not primarily an infection, there is not usually any pyrexia (fever) and
cervical lymphadenitis (swollen glands in the neck), and only minimal edema (swelling) and erythema
(redness) is present in the soft tissues surrounding the socket.
The signs of alveolar osteitis may include the following :-

• Denuded (bare) bone walls

• Throbbing pain

• A foul odor and taste coming from the extraction site (Neville, 2017).

• An empty socket, which is partially or totally devoid of blood clot. Exposed bone may be visible or the
socket may be filled with food debris which revels the exposed bone once it is removed. The exposed
bone is extremely painful and sensitive to touch. Surrounding inflamed soft tissue may overlie the socket
and hide the Alveolar osteitis from casual examination.

2.5.2 Symptoms of alveolar osteitis

Characteristically, these symptoms do not appear until a few days after the tooth was removed.

• Dull, aching, throbbing pain in the area of the socket, which is moderate to severe may radiate to
others parts of the head such as the eye, ear, ample and neck. The pain after the extraction, and may be
so strong that even strong analgesics do not relieve it.

• Intra oral halitosis (oral malodor). (Daly, 2017).

2.6 Complications of alveolar osteitis

There is no evidence that alveolar osteitis can result in additional complications. There are reports for
allergy reaction to medications used for treatment of alveolar osteitis, there are documented cases of
hypersensitivity reactions to chlorhexidine or of minor adverse reactions after irrigation of an alveolar
osteitis socket with chlorhexidine mouthwash.

Other complication of alveolar osteitis is possible foreign body reactions to delivery vehicles of intra -
socket medicaments. It can delay healing and can cause granulomatous inflammation and the body's
inability to phagocytose foreign materials. These topical medicaments should be removed to prevent
this condition.

2.7 Prevention

Since alveolar osteitis is the most common post operative complications after extraction, many
researchers have attempted to find a successful method for prevention. Numerous methods and
techniques are proposed throughout the existing literature toassist with preventive of alveolar osteitis.
However, this area remains a controversial acceptance. (Bloom, 2017).

1. Chlorhexidine :- there are mixed opinions regarding chlorhexidine as an effective preventative

measure. A recent Cochrane review discussed how there was some evidence to show Peri - operative
chlorhexidine rinses ( 0.12% and 0.2% ), as well as immediate post - operative intra - alveolar placement
of chlorhexidine gel ( 0.2% ), both help to reduce the incidence of alveolar osteitis.
2. Systematic antibiotics :- several antibiotics have been investigated over years, but for prevention and
management of Alveolar osteitis the main focus has been on penicillins, macrolides, Clindamycin and
metronidazole, which have all been shown to be effective. The dosage will be based on physician or
dentists description.

3. Topical antibiotics :- Topical applications of Clindamycin, tetracycline and metronidazole all have
evidence to show effectiveness in reducing alveolar osteitis. But it is tetracycline which appears to have
the strongest position as topical agent.

4. Avoiding smoking or tobacco use for at least 1 to 2 days after tooth extraction will also help to
reduced the incidence of alveolar osteitis.

5. Avoiding drinking through a straws or spitting forcefully as this creates a negative pressure within the
oral cavity leading to an increased chance of blood clot instability ( Tucker, 2918 ).

2.8 Management

The treatment is usually symptomatic ( Analgesic medication ) and also the removal of the debris from
the socket by irrigation with saline or local anesthetic.

1. Eugenol - based medicaments :- alveogyl ( septodont, Kent, UK ) is a non-resorbable medicament

available in UK and is very popular choice for treating alveolar osteitis. It's composed of penghawar
djambi fibres with eugenol ( Alveogyl safety data sheet, septodont, 2011 ), and it is targeted at Alveolar
osteitis management based on the anaesthetic nature of the eugenol.

2. Salicept :- Salicept is shown to be an effective treatment for alveolar osteitis and comparable with
Alveogyl. But despite praise in the literature, it is unclear as to whether this product is still available in
the market, even though it has other applications within oral medicines.

3. Topical anaesthetic agents :- it is opinion of some authors that the only truly important aspect of
alveolar osteitis management should be pain control. When compared with eugenol - based
medicament, topical anaesthetic agents have been suggested to demonstrate a more controlled
reduction in pain with a marginally greater effect, but without a statistically significant result.

4. Antibiotics:- limited evidence exists to support the use of systematic and topical antibiotics in the
management of alveolar osteitis. Although, evidence for use of systemic antibiotics is favourable, the
rationale is questionable, and other intervention maybe appropriate.

CHAPTER THREE

3.0 Research Methodology

3.1 Introduction
This chapter deals with the procedures to be adopted in carrying out the study in the incidence,
pathogenesis, prevention and management of alveolar osteitis as well as the risk factors on the patients
attending specialist hospital bauchi.

3.2 Research Design

The descriptive survey research method was used for the study. According to Nworgu (2017) stated that
survey research design is one in which group of people, items is studied by collection and analyzing of
data from only a few people or items considered to be representative of the entire groups.

3.3 Area of the study

This research work was conducted in specialist hospital bauchi, which where established at 5th, may,
1964, during Muhammad Bello Kaliel and registered as tertiary health care center. And it's renovated
during the administration of Isah Yuguda. The hospital comprises lots of units like; male, female, gynea,
accident and emergency, X-ray and ultra sound, dental, laboratory and pharmacy among others.

3.4 Population of the study

The population covered both male and female patients attending dental unit at specialist hospital
bauchi. The target population is 1187 patients as at 2028 to 2022 records in the hospital, 1187
questionnaires were distributed over the 1187 patients but only 1087 were successfully filled and
returned them.

3.5 Sample And Sampling Technique

About 30% of the total population was used as sample of the study which is about respondents. Simple
random sampling technique was used in selecting the respondents.

3.6 Instrument For Data Collection

The instrument used for data collection for this study is questionnaires for effective answers by
respondents. A set of questionnaire concerning the project topic ( the incidence, pathogenesis,
prevention and management of alveolar osteitis ). The questionnaires contain different questions which
allows the patient to personally respond to the statement by ticking the appropriate columns.

3.7 Validation Of The Instrument

The drafted questionnaire for data collection was carefully design and constructed which was shown to
the dental surgeon, where all necessary corrections where made and suggestions to ensure clarity of
expression and effectiveness of the instrument. It was further taken to the project supervisor for
approval.

3.8 Reliability Of The Instrument

The questionnaire was subjected to a pilot study. Seventeen (17 ) respondents outside the study
population were selected using a test to re-test method for consistency and high relationship to be
achieved.

3.9 Procedure For Data Analysis

The procedure for data analysis used in this research was mean statistic. The researcher used four point
(Likert) scales in analyzing the data. The formula for calculating the four point rating scale is given below
as;

X= Ex/n = 4+3+2+1/2 = 10/2 = 2.5

Note:- if less than 2.5 it is deemed as unacceptable. The decision level is arrived at from the point
obtained. The mean statistic is calculated for each item using the formula;

X= sax4+A×3+D×2+SD×1/n

Grand mean= summation of the average mean / no. Of the item

CHAPTER FOUR

4.0 Data Presentation And Analysis

4.1 Introduction

This chapter deals with presentation and analysis of data. A total number of 1187 questionnaires were
distributed to the respondents, 1087 questionnaires were dully answered and returned. 586 were
females ( 53.9% ) and 501 were males ( 46.1% ). The overall incidence of alveolar osteitis was 12.7%

4.2 Data Presentation

Section A:- Respondents Bio-data

I. Effect of gender :- The patients who returned with dry socket comprised 50 males and 88 females
corresponding to 4.6% and 8.1% of the whole sample respectively. By comparing the incidence of dry
socket in each group separately it was found that 15% of the female group and 10% of the male group
returned with dry socket (Table 4.1). The difference was found to be statistically significant. (χ²=6.18 , df
=1 and p<0.05).

Table 4.1- Distribution of Alveolar Osteitis ( DS ) According To Gender

MALE FEMALE TOTAL

DS -VE 451 498 949

DS +VE 50 88 138
TOTAL 501 586 1087

II. Effect Of Impaction Level:- The wisdom teeth were classified into 3 groups according to the level of
impaction as fully erupted, partially impacted, fully impacted. The highest incidence of alveolar osteitis
(dry socket) was found in the second group (13.4%), but the differences between the 3 groups was not
statistically significant (χ²= 2.22, df = 2 and p>0.05), Table 4.2.

Table 4.2:- Distribution Of Alveolar Osteitis ( DS ) According To Level Of Impaction

LEVEL OF IMPACTION

FULLY ERUPTED PARTIALLY FULLY IMPACTED TOTAL

IMPACTED

DS -VE 95 742 112 949

DS +VE 9 115 14 138

TOTAL 104 857 126 1087

III. Effect Of Age :- All the patients who underwent wisdom teeth extraction were between 16 and 35
year old, the highest incidence of dry socket was observed in patients between 20 and 26 year old, but
this relationship between the age and the dry socket was not significant (χ²=23.65, df = 19 and p>0.05),
Table 4.3.

Table 4.3 :- Distribution Of Alveolar Osteitis ( DS ) According To Age

AGE 16 - 20 21 - 25 26 - 30 31 - 35 TOTAL

DS -VE 369 279 170 131 949

DS +VE 24 50 46 18 138

TOTAL 393 629 216 149 1087

IV. Effect Of Surgeon Experience :- The patients were distributed randomly between the surgeons who
were classified into 2 categories: either Junior Surgeon or Senior Surgeon. As with other complications of
wisdom teeth extraction, the incidence of dry socket was higher in patients operated by junior surgeons.
The difference between the 2 groups was statistically significant. (χ²=36.75, df =1 and p<0.05), Table 4.4.

Table 4.4 :- Distribution Of Alveolar Osteitis ( DS ) According To Surgeons Experience

SURGEON

JUNIOR SURGEON SENIOR SURGEON TOTAL

DS -VE 419 530 949

DS +VE 99 39 138

TOTAL 518 569 1087

V. Effect Of Surgical Duration:- The operation time was between 4 and 39 minutes for all patients, there
was no evidence of a strong relationship between surgery duration and the incidence of dry socket.
(χ²=43.25, df= 33 and p>0.05).

VI. Effect Of Oral Contraceptives:- Two hundred forty five females were taking oral contraceptives
during the period of surgery, 39 patients returned with dry socket, this number of patients correspond
to 15.9 % of the female sample. The difference was not statistically significant. (χ²= 2.96, df = 1 and
p>0.05), Table 4.5.

Table 4.5. :- Distribution Of Alveolar Osteitis ( DS ) According To The Use Of Oral Contraceptives

ORAL CONTRACEPTIVES

NO YES TOTAL

DS-VE 743 206 949

DS +VE 99 39 138

TOTAL 842 245 1087

VII. Effect Of Smoking:- Fifty four patients out of 208 smokers returned with dry socket. The smokers
sample corresponds to 19.1% of the whole sample. The difference of incidence of dry socket between
smokers and non smokers samples was statistically significant (χ²=40.84, df = 1 and p<0.05), Table 4.6.

Table 4.6 :- Distribution Of Alveolar Osteitis ( DS ) According To Smoking

 SMOKING

NO YES TOTAL

DS -VE 795 154 949

DS +VE 84 54 138

TOTAL 879 208 1087

4.3 Discussion

The development of alveolar osteitis (dry socket) after tooth extraction is a complication of exodontia
that has been a source of discomfort and pain for patients and of frustration for dentists, and it is a well
recognized complication of mandibular third molar extraction.

Alveolar osteitis (dry socket) is a disruption of the healing process at the extraction site after clot
formation but before wound organization. It is characterized by moderate to severe pain at the
extraction site that usually begins 2 to 3 days after surgery, often in the presence of a necrotic odor and
a grayish discharge The pain is frequently refractory to the usual postoperative analgesics, with 45% of
patients requiring 4 or more postoperative appointments before resolution of the symptoms.

The exact pathophysiology and etiology of alveolar osteitis (dry socket) is not clearly known yet, there
are many factors (local and systemic) that may play role in the development of this condition. Studies
that attribute alveolar osteitis to increased fibrinolytic activity within the alveolus and clot are most
widely accepted.It is unclear whether it is a local or systemic process and what factors lead to the
initiation of the process. Risk factors contributing to the occurrence of alveolar osteitis (dry socket) may
include higher microbial counts, surgical difficulty, flap design and extent, experience of the surgeon
leading to unnecessary trauma, presurgical pathologic factors, (such as unclean mouth) inadequate
intraoperative lavage, a reactivated herpes simplex virus infection, increased age, female gender, oral
contraceptive use, tobacco use, and a variety of other factors. However, the mechanism by which most
of these factors increase the risk of alveolar osteitis is not clearly defined.

In our group of patients the most affecting observed factors that play a role in development of alveolar
osteitis (dry socket) were, gender, the experience of the operating surgeons, and at last smoking. On the
other hand the level of impaction of the wisdom teeth, the use of contraceptives, duration of surgery,
and the age of patient all have a less prominent role in the development of alveolar osteitis (dry socket)
as they found to be statistically not significant.

Smoking was also found to be a significant risk factor for the development of alveolar osteitis, no exact
explanation for this correlation could be advanced but it could be due to the introduction of a foreign
substance that could act as a contaminant in the surgical site, and/or the suction applied to the cigarette
which might dislodge the clot from the socket and interrupt healing. No references exist in the literature
correlating the effects of heat from burning tobacco, contaminants in the smoke, or the systemic effects
of the ingredients in cigarettes with alveolar osteitis.

As with other surgical complications, the incidence of alveolar osteitis became also higher in the patient
sample treated by less experienced surgeons, more attention and experience is always required to
reduce this complication.

Recognition of predisposing factors and application of relevant prevention methods are considered to
be the key of success in the management of alveolar osteitis. Most of our results were consistent with
the previously reported results in other studies, with some variations in the values and some exceptions.

Section B:- Research questions

Table 4.7: How prevalence is Alveolar Osteitis among the patients attending specialist hospital bauchi

S/N ITEMS SA A D SD X REMARK

1 Alveolar Osteitis is Common

2 Alveolar Osteitis is the most common

disturbance of tooth extraction

3 I had been once treated for dry socket

4 My visit to dental clinic was for tooth

extraction

5 I experienced pain for 2-5 days after

extraction

Table 4.8: what are the common causes/pathogenesis of Alveolar osteitis

S/N ITEMS SA A D SD X REMARK

6 Failure to follow the post operative

instruction after extraction results to alveolar
osteitis.

7 Throughout mouth rinsing immediately tooth

extraction results to alveolar osteitis.

8 Failure to use cotton wool in the site of the

extraction causes alveolar asteitis.

9 Using tongue or hand in the site of the

extraction causes alveolar osteitis.
10 Strenuous exercise result to alveolar osteitis.

11 Dentist inexperience result to alveolar

osteitis.

12 Use of excessive pressure on the alveolar

bone result to alveolar osteitis.

13 Disorder of blood clot lead alveolar osteitis.

14 Avoiding foods after tooth extractions cause

alveolar osteitis.

Table 4.9: what are the preventive and management measures of alveolar osteitis

S/N ITEMS SA A D SD X REMARK

15 Rinsing mouth with warm saline water helps

to prevent alveolar oestesis.

16 Oral health education to individual and group

help to reduce the occurrence of alveolar
oestetis.

17 Dressing of alveolar socket should be done at

least twice a week.

18 Advising patients not to drink through straw

after tooth extraction help to reduce the
occurrence of alveolar osteitis.

19 Following dentist instruction help to prevent

alveolar oesteitis.

20 Immediate taking of drugs after extraction

help to prevent alveolar oesteitis.

21 Pre-operative scaling prior to tooth

extractions help to prevent alveolar oesteitis.

22 Alveologyl is used to treat dry socket.

CHAPTER FIVE

5.0 SUMMARY, FINDINGS, DISCUSSION OF FINDINGS, RECOMMENDATION AND CONCLUSION

5.1 Introduction
This chapter focuses on the summary, findings, discussion of findings, recommendation and conclusion
based on the research carried out to determined the causes and effects of alveolar osteitis among the
patients in the area of study.

5.2 Summary

This research work was carried out under five chapters;

CHAPTER ONE:- Deals with introduction, background of the study, statement of the problem,
significance of the study, aim and objectives, research questions, scope and limitations as well as
definition of terms.

CHAPTER TWO:- Deals with review of related literature based on the definition, incidence,
pathogenesis,risk factors, sign and symptoms, complications, prevention and management of alveolar
osteitis.

CHAPTER THREE:- Deals with research methodology and procedure used in gathering information for
this study which include research design, area of the study, population of the study, sample and
sampling technique, instrument for data collection, validation of the instrument, reliability of the
instrument, and procedure for data analysis.

CHAPTER FOUR:- Deals with the presentation and discussion of the result based on the data collected.

CHAPTER FIVE:- Deals with the summary, finding, discussion of the findings, recommendation and
conclusion.

5.3 Findings

1. It has been found that alveolar osteitis is the most common disturbance of extraction. This indicate
that 69.9% complication is alveolar osteitis.

2. Failure to follow the post operative instructions after extraction result to alveolar osteitis, it has been
seen that 86.02% of the patients who had alveolar osteitis was as a result of failure to follow post
operative instruction.

3. Dentist inexperience result to alveolar osteitis. It has been observed that 64.52% cases of alveolar
osteitis was a result of Dentist inexperience.

4. pre-operative scaling prior to tooth extraction help to prevent alveolar osteitis.

5.4 Discussion of the Findings

Finding 1:- Alveolar osteitis is the most common disturbance of extraction alveolar osteitis is a well-
known complication after extraction or surgical removal of tooth. Commonly Known as “dry socket” this
condition remains a common post operative problem that results in severe pain and repeated
practice/hospitals visit. (Osborn,2004).
Finding 2 :- Failure to follow post-operative instructions can results alveolar osteitis, hot fluids raise local
blood flow and foods are encouraged, which facilitate clot formation and prevent its disintegration.
Avoiding smoking, it reduce the blood supply leading to tissue ischema; reduce of tissue perfusion and
eventually higher incidence of painful socket. (Tucker, 2008).

Finding 3: Dentist inexperience result to alveolar osteitis many studies claim that operator’s experience
is a risk factor for the development of alveolar osteitis. Larsen concluded that surgeon’s inexperience
could be related to a bigger trauma during extraction, especially.

Findings 4:Pre-operative scaling prior to tooth extraction help to prevent alveolar osteitis is more likely
to occur where there is pre-existing infection in the mouth, such as nectorizing ulcerative gingivitis or
chronic periocoronitis. Wisdom teeth not associated with periocoronitis are less likely to cause alveolar
osteitis when extracted. Therefore, pre-operative scaling is indicated before carrying out the extraction,
( Wray, 2003 ).

5.5 Recommendation

The researcher wish to humbly and generally make the following recommendations to the local and
state government authorities based on the findings of the research work with hope that is approved and
implemented. And it will also go a long way in reducing the incidence of alveolar osteitis in the
community which include:-

1. Government should work with non-governmental organizations to ensure the availability of facilities
in order to reduce the occurrence of alveolar osteitis.

2. World Health Organisation should collaborate with local and state government to employ more
experienced dentist at various hospital in reducing the occurrence of alveolar osteitis.

3. Oral health care clinics in conjunction with primary health care should be established in all destricts of
local government with qualified medical personnel.

4. The government should make policies that will bring about cooperation witin dental health workers
and other health professional in meeeting the health needs of the public.

5. Government should improve the provision of enough instrument , equipment and material for the
treatment of alveolar osteitis among patients in every government hospital.

5.6 Conclusion

Alveolar Osteitis is one of the most common complication after tooth extractions. The aetiopathogenesis
is multifactorial and is associated with microorganisms, smoking, surgical trauma, age, gender, and
others. The management of alveolar osteitis is mostly symptomatic, the usage of chlorhexidine before
and after tooth extraction is satisfactory means of prevention. In addition, irrigation, dressing and
proper suturing can help with the management. The patient has to be monitored regularly to ensure
proper healing of the wound. More evidence is needed it prove the scientific validity of techniques of
dry socket lesion treatment and to determine which factors mainly cause alveolar osteitis lesions for
more effective preventing measurement.

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