Objectives Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. Methods This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). Results The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. Conclusions and clinical relevance Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.

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AimOur previous study proposed a technique of inserting gauze coated with oxytetracycline–hydrocortisone ointment into the extraction socket that suppressed the occurrence of dry socket and post‐extraction pain compared with the gauze‐free group. In this study, we estimated the incidence of dry socket and post‐extraction infection in patients with ointment gauze insertion and identified predictors of post‐extraction pain and change in maximum opening volume.MethodsThis retrospective study was carried out on patients who underwent lower third molar extraction in the Department of Oral Surgery at a general hospital in Japan.ResultsThe incidence of dry socket and infection after tooth extraction was 1.05% and 0.35%. The mean visual analog scale (VAS) on the operative day was 4.15; the VAS for postoperative day (POD)1 and POD7 were 2.28 and 0.55, respectively. The percentage change in maximum mouth opening on POD1 was −9.88%, and that on POD7 was −1.51%. Multivariable analysis indicated that age and Winter position classification were predictors of POD1 VAS, and female sex, smoking, and Winter position classification were predictors of POD7 VAS. Winter position classification and preoperative maximum mouth opening, respectively, were identified as predictors of maximum mouth opening percent change on POD1 and POD7.ConclusionsThe insertion of gauze coated with oxytetracycline–hydrocortisone ointment into the extraction socket of the mandibular third molar showed a low incidence of dry socket and post‐extraction infection. Moreover, the Winter position classification was suggested to be an independent predictor of postoperative pain and the maximum mouth opening percent change.