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Infected Socket
Infected Socket

Infected Socket

Introduction

A post extraction complication due to infection of the clot due to contamination (infected socket). The condition is painful and if not managed well could lead to osteomyelitis.

Pathophysiology

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Signs and symptoms

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Diagnostic criteria

• Severe painful socket 2–4 days after tooth extraction
• Fever
• Necrotic blood clot in the socket
• Swollen gingiva around the socket
• Sometimes there may be lymphadenopathy and trismus (inability to open the mouth)

Investigation

• Periapical X-ray of the socket may be necessary when there is limited improvement despite treatment.

Treatment

Non-pharmacological

    • Socket debridement under local anesthesia with lignocaine 2% and irrigate with hydrogen peroxide 3%. The procedure of irrigation is repeated the 2nd and 3rd day and where necessary can be extended to the 4th day if pain persists. On follow-up visits local anesthesia is avoided unless necessary.
    • Patient is instructed to rinse with warm saline (5ml spoonful salt in 200mls cup of warm water) or 3% hydrogen peroxide or 0.5% povidone iodine 3–4 times a day

Pharmacological

    Antibiotics should be prescribed to prevent progression to osteomyelitis:

    • Amoxicillin 500mg (PO) 8 hourly for 5–7 days
    OR
    • Azithromycin 500mg (PO) once a day for 3 days
    AND
    • Metronidazole 400mg (PO) 8 hourly for 5 days.

    Referral: Maxillofacial unit is considered in case of persistent pain and infection despite treatment for more than two weeks.

Prevention

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Updated on,

4 Novemba 2020 07:06:36

References

1.STG

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