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The results of a postal questionnaire completed by 360 patients with Paget's disease of bone, on behalf of themselves and their unaffected spouses, suggest that dental practitioners have some awareness of the potential problems associated with extractions for patients with Paget's disease, but that nevertheless patients still suffer from greater difficulty at extraction and more post-extraction complications than normal.

The objectives of this study were to determine the frequency of alveolar osteitis at Kenyatta National Hospital (KNH), most affected age group and the reasons for underlying extractions. Out of 8,393 extractions 273 (3.3%) developed alveolar osteitis. 98.5% of the teeth that developed alveolar osteitis were molars and premolars. 52% of the patients that developed alveolar osteitis were females and 48% were males. The mandible was more affected than the maxilla. The percentage distribution of alveolar osteitis according to age groups 10-19 year, 30-39 years, 40-49 years, 50-59 years and 60-69 years were 6.2%, 53.1%, 23.8%, 5.5%, 4.8% and 2.9% respectively. On the average, patients reported with alveolar osteitis 5.7 days following extraction. Out of 8,393 extractions, 72.5% were due to dental caries, 18% were due to periodontitis and the rest were due to other causes. It was concluded that the frequency and average, patients reported with alveolar osteitis 5.7 days following extraction. Out of 8,393 extractions, 72.5% were due to dental caries, 18% were due to periodontitis and the rest were due to other causes. It was concluded that the frequency and pattern of development of a alveolar osteitis at KNH was similar to that reported in developed countries.

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.

The relationship between smoking and localized osteitis was studied in 200 patients who had 400 mandibular third molars removed. Information on how much patients smoked each day and whether cigaretts, cigars, or a pipe was smoked, as well as the postoperative smoking habits of each patient, was recorded. Results indicated that there is a signficant difference in the incidence of postoperative localized osteitis at extraction sites of mandibular third molars between smokers and nonsmokers; smoking after extraction caused a definite increase in the incidence of localized osteitis.

A survey was conducted over a 3 month period in 1983 to examine the influence of clinical factors on the incidence of dry socket (DS) after extractions of permanent teeth under local analgesia. The findings were compared with those of a similar 3 month survey in the same hospital in 1971. Age, sex and extraction site each significantly influenced the incidence of DS. The major difference from the 1971 survey was an increase in the DS incidence from 3.0% to 4.0% of extractions. This occurred mainly following multiple extractions and may indicate that patients, particularly in this group, are nowadays less tolerant of any post-extraction discomfort and hence more readily return for attention. This is particularly relevant in the present study since the broad definition of DS used in both surveys embraced even the mildest presentations of disturbed socket healing.

The aim of the investigation was to study the occurrence of alveolitis and other side effects in women taking oral contraceptives after surgical removal of impacted mandibular third molars. Reactions to surgical removal of 156 bilateral third molars were examined in 78 patients. The material was divided into 2 groups. In 1 group, the patients took oral contraceptives of the combined type and in the other group the patients took no contraceptives. Each group was further divided into 2 subgroups: (1) removal of a molar during menstruation; and (2) removal of the contralateral molar in the same patient at the middle of the menstrual cycle. The results showed significantly more alveolitis in the group taking oral contraceptives and in women who were operated on during menstruation. These findings would suggest that oral surgery involving fertile women should be undertaken during periods free from oral contraceptives and menstruation.

1533 single intra-alveolar permanent tooth extractions in males were investigated in a study to determine if the type and technique of local anaesthesia influenced the occurrence of dry socket. The results show that the incidence of dry socket was significantly greater after the use of Xylocaine compared to Citanest and that the use of repeated injections or intraligamental techniques increased the likelihood of this painful post-extraction condition.

The effect of habitual smoking on post-extraction socket filling with blood and on the incidence of painful socket, was investigated. Data were collected from 2417 adult dental out-patients in whom 3541 extractions were performed under local anaesthesia. Post-operative socket filling with blood was significantly reduced in smokers, compared with non-smokers (p less than 0.01). There was a higher incidence of painful socket in heavy smokers (20 or more cigarettes per day), compared with nonsmokers (p less than 0.05). There was a significant relationship between immediate post-extraction socket blood level and the incidence of painful socket; sockets which showed poorer filling were more likely to develop painful socket (p less than 0.02). Smoking appeared to have an adverse effect upon the healing of extraction wounds.

Current literature has noted the various side effects of oral contraceptives. Oral surgeons have recently encountered an increased incidence of postoperative localized osteitis occurring with removal of manidibular third molars. This article documents the occurrence of this phenomenon among 105 women participating in a recent study at the Clinical Center of the National Institutes of Health.

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.

Use of oral contraceptives was associated with a significant increase in the frequency of dry socket after extraction of mandibular third molars. The probability of dry socket increases with the estrogen dose in the oral contraceptive. The risk of dry socket associated with oral contraceptives can be minimized by performing extractions during days 23 through 28 of the tablet cycle.

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.

Use of oral contraceptives and trauma during extraction are substantiated factors that contribute to dry socket. They appear to act by enhancing fibrinolytic activity in the alveolar bone followed by lysis of the clot. The influence of bacteria and antibiotics on the development and prevention of dry socket remains unclear. No convincing evidence can be found that factors such as age, sex, or nutritional status affect the incidence of dry socket.

A prospective study that evaluated the surgical and postsurgical problems of 9,574 patients of a wide range of ages who had had 16,127 third molars removed was performed. It was concluded that removal of mandibular third molar teeth during the teenage years resulted in decreased operative and postoperative morbidity.

One major school of thought regarding the pathogenesis of a dry socket occurring following tooth extraction is based on the concept that a blood clot fails to form, a concept that is, however, refuted by the clinical symptoms associated with the phenomena of a dry socket. A second theory maintains that, initially, clot formation takes place, but that the clot is subsequently lysed, bringing about the severe symptoms of a dry socket. Fibrinolysis generated by tissue activators only partly explains the occurrence of a dry socket. Based on the data accumulated in the literature, it is postulated that bacterial agents are involved in the fibrinolysis and that Treponema denticola may play a leading part in this process.