Aetiology, Prevention and Management of Alveolar Osteitis—A Scoping Review

Abstract

Background Alveolar osteitis (AO) is a poorly understood, common, painful complication following exodontia. It is sometimes managed by inappropriate prescription of antibiotics which contributes to the global threat of antimicrobial resistance. Use of intra‐alveolar chlorhexidine also presents a serious risk of anaphylaxis to the patient. Objective This scoping review aims to investigate the aetiology, prevention and management of AO and highlight the extent of inappropriate prescribing and intra‐alveolar chlorhexidine use. Design A scoping review was undertaken using the PRISMA guidelines. Medline, Ovid and Pubmed were searched between 2010 and 2020, from which 63 studies were selected for review that related to the aetiology, prevention or management of AO. Data were analysed for frequency of studies reporting information on risk factors for aetiology, prevention strategies and management including inappropriate management using antibiotic prescribing and intra‐alveolar chlorhexidine. Results Impaired immune response, surgical technique and age were identified as significant factors in the development of AO, while there is conflicting evidence regarding the effects of smoking and gender. With regard to prevention, the use of prophylactic antibiotics is not supported within the literature. Saline irrigation and eugenol pastes used preventively have been shown to be cheap and effective alternatives to chlorhexidine with no adverse effects. Hyaluronic acid and low‐level laser therapies showed a significant reduction in pain and soft‐tissue inflammation in the management of AO compared to Alveogyl. Conclusions Further understanding of the pathophysiology of AO is needed, in addition to large high‐quality RCTs or long‐term observational studies into the aetiology, prevention, and management of AO to produce up‐to‐date evidence‐based clinical guidelines. Clinicians should also be mindful of their contribution to growing antimicrobial resistance and avoid inappropriate prescribing of antibiotics. Saline should replace chlorhexidine as the intra‐alveolar irrigant of choice.

A Comparison of Pre-Emptive Co-Amoxiclav, Postoperative Amoxicillin, and Metronidazole for Prevention of Postoperative Complications in Dentoalveolar Surgery: A Randomized Controlled Trial

“…This bacterial spot will eat the blood clot and dissolve it to expose the alveolar bone and fill it with infective substances [ 17 , 18 , 19 , 20 ]. Bacteria attack on the site of extraction increases dehydration and accelerates the formation of microscopic clots in the bony surfaces of the extracted tooth socket [ 4 , 8 ]. These microscopic clots impede blood flow at the site of extraction, causing a decreased ability to eliminate bacterial virulence [ 5 , 7 , 21 ].…”

“…This, in turn, will eliminate any role of aerobic and anaerobic microorganisms in causing dry socket or infection. Furthermore, antibiotics will be useful for elderly patients or those with impaired immune response because they are susceptible to dry socket after dental extraction [ 8 ]. However, the mechanical factors that lead to dissolving the formed blood clot such as frequent mouth rinses, smoking, surgical techniques or surgeons with poor experience are still happening and causing a number of postoperative complications in dentoalveolar surgery [ 27 , 28 , 29 , 30 ].…”

“…Failure to raise the mucoperiosteal flap well leads to its rupture [ 7 ]. It is known that the bone is nourished by blood supply from both bone marrow and periosteum [ 5 , 6 , 7 , 8 ]. Therefore, the rupture of the periosteum or its burning during the removal of the bone with the rotating surgical burs results in the formation of foci of periosteal necrosis [ 6 , 8 ].…”

“…It is known that the bone is nourished by blood supply from both bone marrow and periosteum [ 5 , 6 , 7 , 8 ]. Therefore, the rupture of the periosteum or its burning during the removal of the bone with the rotating surgical burs results in the formation of foci of periosteal necrosis [ 6 , 8 ]. These necrotic tissues are considered as blood-deprived and dehydrated areas, impeding the process of healthy granulation, and an easy target for bacteria to attack and multiply at the site of the surgical extraction [ 3 , 5 , 8 ].…”

“…Therefore, the rupture of the periosteum or its burning during the removal of the bone with the rotating surgical burs results in the formation of foci of periosteal necrosis [ 6 , 8 ]. These necrotic tissues are considered as blood-deprived and dehydrated areas, impeding the process of healthy granulation, and an easy target for bacteria to attack and multiply at the site of the surgical extraction [ 3 , 5 , 8 ]. Furthermore, surgical extractions are mostly carried out for grossly decayed teeth with apical lesions and abscesses.…”