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You are seeing a 17 year old male who had his left upper impacted wisdom tooth extracted 3 days ago. He comes in complaining of unbearable pain despite taking ibuprofen and one oxycodone. He has had no fever. Exam is unrevealing – there is no swelling around the socket, no discharge, no foul odor.
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May 2, 2023 at 9:20 am
C) Gentle irrigation of the socket with warm normal saline
The patient likely has dry socket syndrome, which presents with severe pain 2-5 days post-extraction, particularly extraction of mandibular third molars. Etiology is thought to be due to the clot falling out of the socket, exposing alveolar bone, which is very sensitive, leading to severe pain. Treatment includes gentle irrigation, but deep suctioning or manual removal of any remaining clot should not be performed. If available, filling the socket with dry socket paste relieves pain immediately. If dry socket paste is not available, ribbon gauze or gelfoam impregnated with iodine can be used temporarily. Antibiotics (if no other signs of infection) and emergent OMFS consult are not needed, but patients should follow-up closely with their oral surgeon in the next 1-2 days.