Acute alveolar osteitis

Background

• Osteomyelitis of alveolar bone d/t premature loss of healing clot after tooth extraction

Clinical Features

• Exposed bone with no clot in extraction site

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Diagnosis

• Occurs 2-4d after tooth extraction
• Initial post-extraction pain subsides followed by sudden/severe pain at extraction site
• Physical exam often unremarkable

Management

• Analgesia (often requires dental block)
• Irrigate and suction
• Pack with iodoform ribbon gauze soaked with eugenol (oil of cloves) or local anesthetic
• Penicillin VK 500mg PO QID OR clindamycin 300mg PO QID

Disposition

• Discharge with dental follow-up within 24 hours

See Also

• Dental Problems
• Dental Numbers

References

• Amsterdam JT: Oral Medicine, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 70: p 901. Chapter 70.