New Paradigm in Explaining Dry Socket:  Case Studies

Khalil, Wael

doi:10.9734/jammr/2022/v34i2031495

Cited by 4 publications

(10 citation statements)

References 15 publications

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“…Based on a previous research, which involved positive bacterial cultures in four swabs out of six (P. aeruginosa and E. faecalis) [11], and the present study's findings showing a positive response in more than 86% of dry socket cases treated by ciprofloxacin, one can reach a conclusion that the pathogenesis of dry sockets cannot be solely attributed to a disorder in blood clot formation. The authors hypothesized that dry socket is a complication that may be caused by a specific bacterial infection, and the disorder in blood clot formation is considered a stage in the pathophysiological infectious process.…”

Section: Discussionsupporting

confidence: 70%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Khalil¹

2023

Cureus

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ObjectiveDry socket, a common complication following a tooth extraction, is characterized by severe and radiating pain that typically begins one to four days after the extraction. Despite several risk factors, the exact cause and underlying mechanisms of dry sockets remain unclear. This study aims to propose a novel pathogenesis and management approach for dry sockets based on an infectious process. MethodsThe study was conducted by reviewing medical records, at a private dental clinic, of patients who fit the inclusion criteria; these patients appeared to have come between April 2022 and April 2023. The study included all patients with age ≥17 years diagnosed with dry socket that was resistant to conventional topical treatment, and who received treatment with ciprofloxacin 500 mg three times per day during the study period. ResultsOut of 15 patients who received treatment with ciprofloxacin 500 mg three times per day during the study period, 11 patients (73.3%) were completely relieved of symptoms within 24 hours, with no need for additional painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, two patients (13.3%) had a partial response after 48 hours, where their pain was ameliorated from severe to moderate with the use of conventional painkillers (including paracetamol and NSAIDs) and steroidal anti-inflammatory drugs such as dexamethasone (8 mg IM daily) to have total relief. On the other hand, the other two patients (13.3%) had a negative response to the treatment and were out of reach for follow-up. ConclusionThese clinical outcomes, coupled with previous laboratory data, could explain all clinical aspects of dry sockets and provide substantial support for the hypothesis that an infectious mechanism plays the principal role in the pathophysiology of dry sockets.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Khalil¹

2023

Cureus

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“…Based on previous findings of bacterial culture and antibiogram on 3 reported cases of dry socket [9], this paper presents a serial case of dry socket of 6 patients aged 18 to 65 years old. For these patients, a topical treatment based on socket irrigation with saline followed by topical sedative dressing of eugenol was inefficient.…”

Section: Case Reportmentioning

confidence: 94%

“…Pseudomonas aeruginosa appeared in the bacterial culture was sensitive to ciprofloxacin antibiotic [9]. However, due to its broad-spectrum activity, the efficacy of ciprofloxacin is not limited to Pseudomonas aeruginosa, therefore, other species can be suspected in the pathogenesis of dry socket.…”

Section: *Heavy Smoker Is Considered If the Number Of Cigarettes Is G...mentioning

confidence: 99%

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

Khalil

2022

JAMMR

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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.

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Limosilactobacillus reuteri DSM 17938 Inhibition of Biofilm Formation by Prevotella intermedia and Fusobacterium nucleatum Across Salivary pH: An In Vitro Study

Ananda,

Julia,

Bachtiar

2024

Eur J Dent

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Objectives This study aims to investigate Limosilactobacillus reuteri DSM 17938's antibiofilm effects on Prevotella intermedia and Fusobacterium nucleatum, common causes of alveolar osteitis. It seeks topical alternatives to prevent this condition posttooth extraction. The secondary objective is to assess these effects under different pH conditions (pH 4.5 and pH 7), mimicking oral cavity saliva pH dynamics. Materials and Methods Ethical approval was secured for the saliva collection process involving five healthy adult participants who had undergone wisdom tooth extraction. Saliva samples were diligently collected on the 7th day post-surgery. The unstimulated saliva underwent a series of treatments, including the addition of phenylmethylsulfonyl fluoride (PMSF), pH adjustments, centrifugation, and filtration. The pH levels were re-measured, and subsequent adjustments were made to achieve pH values of 4.5 or 7. Limosilactobacillus reuteri DSM 17938, with a concentration of 1×108 colony-forming units (CFU) per 5 drops, was utilized in the study. Biofilm testing involved incubating saliva samples with varying pH (4.5 or 7) alongside bacterial suspensions (Prevotella intermedia, Fusobacterium nucleatum, or a mixed species). The Interlac suspension was introduced, and plates were anaerobically incubated for 24 hours. Biofilm results were obtained using a spectrometer. The test is conducted in triplicate. Statistical Analysis To scrutinize the impact of pH on biofilm development, the acquired data underwent a two-way ANOVA test in SPSS as part of the statistical analysis. A significance level of p<0.05 was used to determine statistical significance. Results Limosilactobacillus reuteri DSM 17938 significantly reduced biofilm formation across bacterial strains (p = 0.000). Statistical analysis indicated a significant impact of pH on biofilm development (p = 0.000) compared to no saliva samples, with higher formation observed under acidic conditions (pH 4.5). However, the pH levels of 4.5 and 7 did not result in significantly different bacterial biofilm formation (p = 0.529). Conclusion This research highlights Limosilactobacillus reuteri DSM 17938's potency in inhibiting biofilm formation of Prevotella intermedia and Fusobacterium nucleatum. Salivary pH variations significantly influence biofilm development, emphasizing the need to consider pH when assessing probiotic effectiveness. Despite limitations in saliva sample sterilization, this study provides valuable insights into alternative approaches for preventing alveolar osteitis. Further research should explore clinical applications and refine sterilization methods for more accurate results.

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New Paradigm in Explaining Dry Socket: Case Studies

Cited by 4 publications

References 15 publications

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

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

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

Limosilactobacillus reuteri DSM 17938 Inhibition of Biofilm Formation by Prevotella intermedia and Fusobacterium nucleatum Across Salivary pH: An In Vitro Study

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