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A prospective, controlled trial was performed to investigate the effect of a prophylactic socket medicament containing chlortetracycline, aspirin, and local anesthetics, in reducing the incidence of postextraction pain and infection in patients who are HIV-seropositive. Fifty patients were in the study; 25 received the experimental dressing and 25 had no dressing. Patients were asked to complete a questionnaire rating the pain at 24 hours and 48 hours after surgery. Seven days after extraction, socket healing was scored, and sockets with delayed healing sampled for culture. Four of 25 (16%) patients who received the experimental dressing and 8 of 25 (32%) controls experienced pain during the 48 hours after extraction (p = not significant). None of the group who received the experimental dressing and 7 of 25 (28%) in the control group had delayed healing, of these 4 had alveolar osteitis and three had infected sockets (p = 0.0096). We conclude that the experimental agent is useful as a prophylactic agent to reduce delayed healing in HIV-positive patients who undergo exodontia.

A retrospective analysis of complications and side effects associated with surgery for 1000 mandibular and 500 maxillary impacted third molars was performed. The analysis included 614 patients with impacted mandibular third molars and 274 with impacted maxillary third molars who were treated in a 5-year timeframe from 1987 to 1992. The incidence of intraoperative complications and side effects of mandibular third molar surgery was 1.1% and 4% for maxillary third molar surgery whereas postoperative complications were 4.3% and 1.2%, respectively.

Post tooth extraction infective complications have occasionally been described in HIV-infected persons. However, there is little objective data as to the frequency of this and the need for antibiotic prophylaxis. Similarly the frequency of postextraction bleeding in patients infected with HIV, who may have thrombocytopenia, is unknown. In the present study the frequency of postextraction complications has been investigated in a group of 38 persons at stages 2 to 4 of HIV infection and 26 matched subjects from patients groups commonly at risk of HIV infection but not seropositive. During 40 clinical procedures in HIV-infected patients, 100 (range 1 to 23, median 1) teeth were extracted. Three episodes of delayed postextraction healing were recorded. During 30 procedures in the non-HIV-infected persons, 68 (range 1 to 5, median, 2) teeth were extracted, and two episodes of delayed postextraction healing were recorded. These differences were not significant. Only one HIV-infected patient had an episode of severe postextraction bleeding: this was a hemophiliac who bled despite receiving factor VIII prophylaxis. The bleeding occurred 7 days after the extraction and ceased with tranexamic acid and additional factor VIII. No control subject had severe postextraction hemorrhage. It is concluded that postextraction complications are uncommon in HIV-infected patients and that routine antibiotic prophylaxis is not indicated.

One hundred thirty-eight impacted mandibular third molars were surgically removed. A prospective study of risk factors associated with the development of alveolar osteitis (dry socket) postoperatively was undertaken. Two surgeons, one experienced and one inexperienced, removed the teeth. Patients were controlled for age, sex, use of oral contraceptives, radiographic difficulty of the extraction, and tobacco use. Patients treated by the inexperienced surgeon and those using tobacco had a significantly greater incidence of alveolar osteitis. Previously identified risk factors of increased age, female sex, oral contraceptive use, and increased surgical time were not associated with an increased incidence of dry socket. Recommendations are made regarding prevention of alveolar osteitis in those patients identified as being at high risk.

Four hundred twenty-two mandibular third molars were extracted in 211 patients. After extraction, one half of the surgical sites were subjected to a 175 ml. lavage with normal saline solution, and the other half received a lavage of less than 25 ml. of normal saline solution. Comparisons revealed the following: 1. The overall incidence of localized osteitis was 8.3 per cent (thirty-five of 422 sites). 2. Localized osteitis occurred at twelve of 211 (5.7 per cent) sites which were subjected to the higher-volume lavage. 3. Localized osteitis occurred at twenty-three of 211 (10.9 per cent) sites which were subjected to minimal lavage. 4. The incidence of localized osteitis was determined in the various age groups as follows: ages 15 to 20, 5.0 per cent; ages 21 to 35, 10.4 per cent; ages 26 to 30, 14.7 per cent. 5. Localized osteitis occurred at eight of 175 (4.5 per cent) partial-impaction sites, whereas it occurred at twenty-seven of 246 (11 per cent) complete-impaction sites. 6. The incidence of localized osteitis at extraction sites in female patients taking oral contraceptives was 19.4 per cent (seven of thirty-six sites). 7. Postoperative infection occurred at seven of 422 extraction sites (1.4 per cent); six of these occurred at sites which were subjected to minimal lavage. These results indicate that the use of a 175 ml. lavage with normal saline solution after extraction of mandibular third molars will significantly reduce the incidence of localized osteitis to approximately one half of that observed when only a minimal-volume lavage is used. The results also suggest that age, type of impaction, and whether the patient is taking oral contraceptives are all important factors to be considered in the incidence of localized osteitis.

A comparison study of 206 mandibular third-molar surgical sites, half of which were irrigated with high volumes of isotonic normal saline solution with a conventional hand syringe and half of which were irrigated with high volumes of isotonic normal saline solution by means of a mechanical pulsating lavage instrument, revealed the following: 1. No cases of localized osteitis occurred with the use of mechanical irrigation in 103 surgical sites (0%). 2. One case of localized osteitis occurred with regular irrigation in 103 surgical sites (0.97%). 3. The over-all incidence of localized osteitis was one case in 206 surgical sites (0.49%). 4. One case of infection occurred with mechanical lavage (0.97%). 5. Two cases of infection occurred with conventional lavage (1.96%). 6. The over-all incidence of infection was three cases in 206 surgical sites (1.45%). 7. No significant differences occurred at the 0.95 level of confidence when the two groups' 3- and 5-day healing were compared. 8. A fairly even distribution of postoperative infections and/or localized osteitis was noted among the cases handled by the three surgeons directly involved in the performance of the operations. 9. Three hundred fifty milliliters of isotonic normal saline solution under pressure (whether electrical or conventional) appreciably reduced the reported incidence of localized osteitis without the use of antibiotics. 10. The mechanical irrigator was less cumbersome and faster (30 seconds for 350 ml.) than the conventional hand syringe (4 to 5 minutes for 350 ml.). 11. The sterilization procedure was more complicated for the mechanical irrigator (gas autoclave) than for the conventional hand syringe (presterilized disposable type). 12. Loose (unattached) soft tissue and bony spicules were thoroughly removed by 350 ml. of irrigation.

Mandibular third molars were removed from 400 patients who were divided into four different preoperative and postoperative rinsing groups using either normal saline solution, chloramine-T, povidone iodine, or sodium bicarbonate. The overall incidence of localized alveolitis and infection was 4.5% and 1.7%, respectfully. The incidence of the two postoperative problems proved not to be statistically significant when the four groups were compared with each other. There seems to be no apparent advantage to the preoperative and postoperative use of an antimicrobial mouth rinse in place of normal saline solution in reducing the incidence of either localized alveolitis or postoperative infections.

Five hundred and four bilateral mandibular third-molar extraction sites were examined postoperatively for localized osteitis. All sites received a mechanical lavage of either 350 ml, or 175 ml. of sterile normal saline solution. No significant differences were observed relative to the effect of lavage volume on the incidence of iocalized osteitis. A preoperative antimicrobial mouthrinse of chloramine-T (sodium-p-toluene sulfonchloramide) was also used by one half of the patients. Although only slight differences were noted in healing with the different lavage volumes of the chloramine-T, certain predisposing factors contributed significant differences.