Dry Socket: An Infectious Process Treated by Ciprofloxacin: Case Studies

Abstract

Dry socket is considered as the most common complication following tooth extraction. The incidence of dry socket is around 3% for all routine extractions and might surpass 30% for impacted mandibular third molars. It is accompanied by a partially or totally disintegrated blood clot within the alveolar socket, with or without halitosis. Dry socket is mainly manifested by severe irradiating pain that starts 1 to 4 days after dental extraction where the socket becomes denuded, exposed and tender to touch. Based on findings following previous bacterial culture and antibiogram on alveolar swab of rebellion cases of dry socket, we proposed a new pathogenesis theory based on infectious process. Antibiogram showed sensitivity to ciprofloxacin. Based on this fact we proposed a new treatment that consists of prescribing ciprofloxacin to cases unresponsive to topical conventional treatment. In this paper, we present a serial of 6 cases of dry socket following simple and surgical extraction procedures which were mostly associated with previous infection. The onset of pain started after 1-4 days of extraction where it was radiating and nonresponsive to pain killers. Clinical examination revealed exposed denuded socket in all subjects. All 6 patients were ASA1 and none has allergy to ciprofloxacin where the later was prescribed at 500 mg 3 times per day for 5 days. All patients were totally relieved in 12 to 24 hours after antibiotic intake. This clinical result, in addition to previous laboratory findings, support more the infectious process in the pathogenesis of dry socket.

A New Approach for Explaining and Treating Dry Sockets: A Pilot Retrospective Study

“…While the two patients who had negative responses to ciprofloxacin were out of reach for follow-up, their experience can be attributed to either a misdiagnosis of their case or bacteria resistant to ciprofloxacin. These bacteria might be Pseudomonas aeruginosa , Enterococcus faecalis , or other bacteria having similar properties [ 10 , 11 ]. The positive response to ciprofloxacin supports the hypothesis of an infectious process behind the dry socket.…”

“…The first argument suggests that blood clot disorders do not explain all the clinical aspects of dry sockets. They can explain the delayed onset and the exposed alveolus seen in dry sockets, but cannot explain the severity of pain and lymphadenitis whereas the infectious process can better explain the pathophysiology of dry socket and its associated clinical manifestations, which include the following four hallmarks: the onset of clinical symptoms that aligns with the incubation time of some bacteria [ 8 ], the exposed and denuded alveolus due to the fibrinolytic action of P. aeruginosa or other potentially involved bacteria [ 9 , 10 , 15 ], the inflammation process and severity of pain that occurs due to the activation of several inflammatory pathways by multiple bacteria including P. aeruginosa and E. faecalis [ 16 , 17 ], and finally, the last hallmark, recurrent lymphadenitis that is usually a sign of an infectious process in the nearby area.…”

“…This finding indicates a possible association between P. aeruginosa , E. faecalis , and other bacteria having similar properties and the occurrence of dry sockets [ 21 , 22 ]. Furthermore, the antibiotic protocol specifically designed to target P. aeruginosa and possibly other bacteria, using ciprofloxacin at a dosage of 20 mg/kg/day, has demonstrated high efficacy in the treatment of dry sockets [ 10 ]. In contrast, the use of broad-spectrum antibiotics, such as penicillin A and clavulanic acid, which do not specifically target Pseudomonas , was found to be ineffective in treating dry sockets [ 9 ].…”

“…However, its use as a curative measure when prescribed systemically remains debatable [4,9]. This research's main aim is to propose a new paradigm for explaining and treating dry sockets based on an infectious process by presenting 15 cases of dry socket rebellion to topical treatment that were treated with ciprofloxacin based on previous findings of bacterial cultures and antibiograms to explore a new microbiological aspect of dry sockets [10,11].…”