A man comes to the office 2 days after removal of his four third molars. He complains of severe pain in the lower left side of his mouth and says that taking ibuprofen doesn’t ease the discomfort. He feels that he followed the postoperative instructions that were given to him at the extraction appointment. What is this patient experiencing? What is the cause?
The correct answer and explanation is:
Based on the timing, location, severity, and nature of the pain, this patient is most likely experiencing Alveolar Osteitis, commonly known as dry socket.
Dry socket is a painful complication that can occur after a tooth extraction. It happens when the blood clot that should form in the socket is either dislodged, dissolves prematurely, or fails to form adequately. The blood clot is crucial for protecting the underlying bone and nerve endings and facilitating the healing process.
The cause of the severe pain is the exposure of the bone and nerve endings in the empty socket to air, food, and fluids. Without the protective clot, these sensitive tissues are irritated, leading to intense, throbbing pain that often radiates to the ear, eye, or neck. This pain is typically much more severe than normal post-operative discomfort and is often not effectively relieved by standard pain medications like ibuprofen, which the patient has noted.
Dry socket typically develops 2 to 4 days after the extraction, fitting this patient’s timeline. Lower molars, especially third molars, are more prone to dry socket compared to upper teeth due to factors like denser bone, reduced blood supply, and the complexity of extraction procedures. While the patient believes he followed instructions, numerous factors can contribute to a dry socket, including trauma during the extraction, smoking, forceful rinsing or spitting, using straws, poor oral hygiene, or even hormonal factors. Regardless of the specific trigger in this case, the underlying cause of the pain is the unprotected, exposed bone in the extraction site due to the absence of a stable blood clot.