Alveolitis after tooth extraction - symptoms and treatment of alveolitis

Alveolitis is an inflammation of the socket (alveoli) left after tooth extraction. This pathology does not always develop; its development depends on many factors. The disease is characterized by severe pain in the area of the hole formed after surgery, general weakness, fever, headache, enlarged submandibular lymph nodes, bad breath and other unpleasant symptoms.

Alveolitis is not only physically painful, but also a dangerous disease. In the absence of proper treatment for several days, the inflammatory process can result in limited osteomyelitis, purulent melting of the jaw bone, and then surgical intervention will be required again.

With timely diagnosis of pathology and proper sanitation of the socket, the treatment prognosis is favorable. The main thing is to detect the symptoms of the disease in time and begin to treat it.

Classification

Depending on the nature of the healing of the hole, dentists distinguish several main forms of dental alveolitis:

Serous. The initial stage of the disease usually appears 2–3 days after tooth extraction. This form is characterized by continuous pain that worsens while eating. Although the patient does not yet complain of feeling unwell, his lymph nodes are not enlarged, but he already feels that the disease is progressing.
Purulent. If the serous form of alveolitis is not treated, the disease turns into a purulent form. Most often it is diagnosed 6–7 days after tooth extraction. The painful sensations can no longer be ignored, the pain intensifies, radiating to the ear or temple. Exploring the affected area also causes severe pain. Purulent alveolitis is characterized by a dirty gray coating inside the socket, significant swelling around the wound, thickened alveolar process and other problems. The patient's general health deteriorates significantly. Lymph nodes enlarge and become painful on palpation. Often the patient cannot even eat or open his mouth.
Hypertrophic. At this stage, the symptoms of the disease subside. The patient notes a decrease in body temperature, improved well-being and decreased pain. However, at the hypertrophic stage, dangerous tissue proliferation occurs, which is clearly visible upon examination. When touched, pus is released from the inflamed area, and the mucous membrane acquires a bluish tint.

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How much does tooth extraction hurt the gums?

Assessing how severe the harm from tooth extraction will be is not always easy. Sometimes removal can take much longer and have a very negative impact on the condition of a person’s gums. And here it doesn’t really matter which doctor performs the procedure - there are many potential complications.

Among the most notable factors of injury are the following:

Rupture of the ligaments and muscles that hold the tooth. They help the tooth stay inside the socket and not become loose over time.
Tissue damage. We are talking about both periodontal and periodontal tissues. They can heal for quite a long time.
Impact on the vascular system and nerves. Serious damage to blood vessels and nerves can usually occur. It is precisely because of the likely contact of blood with pathogenic bacteria during the recovery period that it is important to observe hygiene standards.

When going through the recovery process, you should be prepared for the fact that signs characteristic of inflammation will be observed for some time. In this case, swelling may appear, the temperature of the tissue at the site of removal may increase, and bleeding may occur. Pain also becomes a frequent companion during the recovery period.

In our clinic, removal is performed as carefully and carefully as possible. The extensive experience of doctors allows us to minimize tissue damage and reduce trauma. We will also answer the question of how long it takes for gums to heal and how to properly care for the socket so that it heals as quickly as possible.

Causes of inflammation

The disease can develop only after tooth extraction. Most often, the hole formed after removal heals within a day after the operation, and the patient feels better. But if the blood clot that covers the open wound moves or becomes deformed, an infection can penetrate into the hole, in which case alveolitis of the gums develops. As a result, the surface of the wound heals for a long time, and the patient suffers from complex discomfort.

Predisposing factors for the development of inflammation:

Surgical injuries during complex removal. The more complex the operation, the more pronounced the postoperative inflammation of the bone tissue will be, and the more likely the release of direct plasminogen activators.
Complex extractions associated with tooth segmentation, osteotomy, detachment of the mucoperiosteal flap. Complex operations increase the chance of developing alveolitis 10 times.
Removal of wisdom teeth. The denser, less vascularized bone tissue adjacent to the figure eights is prone to the formation of dry sockets.
General diseases of the patient. Alveolitis often occurs against the background of concomitant diseases. For example, patients with diabetes mellitus or immunocompromised patients are more susceptible to alveolitis due to impaired healing processes in the tissues.
Taking oral contraceptives. The estrogen contained in these drugs may indirectly enhance the fibrinolytic process, causing the breakdown of the blood clot.
Smoking. The direct connection between smoking and alveolitis has been repeatedly proven clinically. According to studies, the risk of socket inflammation in smokers increased 4-5 times compared to non-smokers. The incidence increased by more than 20% in patients who smoked 1 pack per day and by 40% in patients who smoked immediately before and after surgery.
Dislocation of a bunch. If the socket is handled carelessly and there is negative pressure (for example, due to drinking through a straw), alveolitis may develop.
Bacterial infections. Dentists agree that bacterial infections are the main risk factor for dry socket.
Poor oral hygiene. The incidence of alveolitis increases significantly with poor oral hygiene.
Excessive use of local anesthetics. According to some studies, excessive use of an anesthetic with a high concentration of a vasoconstrictor can provoke ischemia and make it difficult for the socket to fill with blood. This condition also increases the risk of alveolitis.

In fact, alveolitis is a fairly rare disease. According to statistics, it affects approximately 3% of patients who have undergone tooth extraction surgery. More often than not, the socket is not formed properly when lower incisors and molars are removed.

But alveolitis is especially common when removing lower wisdom teeth: according to experts, in approximately 20% of cases, the removal of “eights” with difficult eruption is complicated by alveolitis. In addition, it is believed that the risk of developing the disease is inextricably linked with age. This is explained by the fact that metabolism slows down, immunity is weakened, and the regenerative abilities of the body deteriorate.

On the lower jaw

Standard and non-standard complications after pulling out figure eights on the lower jaw occur more often than on the upper jaw. The lower jaw has a number of features, and there are many obstacles in the area where the wisdom teeth are located.

Nerve damage

The mandibular and lingual nerves are at risk of injury, since they pass close to the wisdom tooth. Such damage causes paresthesia, which is manifested by impaired sensitivity:

sensory;
painful;
taste;
temperature

In the most severe cases, nerve damage negatively affects vision, hearing, and also provokes paralysis. Patients compare paresthesia with numbness of the jaw in the area of the removed molar. In most cases, this complication disappears on its own within a few days, but sometimes additional drug treatment is required.

Alveolar ridge fracture

A fracture of the alveolar process of the lower jaw occurs when the dentist does not grip the jaw correctly and applies more force than necessary. This is an unlikely complication as the mandible is quite strong. Treatment is carried out under conduction anesthesia and involves repositioning and fixing the fragment in the correct position.

Jaw damage

snapshot of the jaw
Jaw injuries (dislocations and even fractures) also often occur due to the fault of the doctor if the tooth is pulled out too intensely or abruptly. During surgery, it is necessary to remove a significant amount of lower jaw bone to provide access to the problematic molar. Because of this, the sections of the jaw are weakened, which increases the risk of fracture if excessive force is applied. A crack or fracture does not always appear immediately. It happens that the patient notices the first symptoms in the form of pain, swelling, and impaired mobility already at home. Sometimes it takes a week before they appear. Statistics show that jaw injuries during medical procedures account for no more than 0.2% of all jaw fractures.

Soft tissue injuries

By pulling out a molar, the doctor can injure the soft tissues surrounding the molar. We are talking not only about the gums, but also about the cheek, tongue, lips. Injuries are caused by dental instruments (scalpel, drill, forceps). The lip is also often injured by the thread used to suture the gums. This happens due to the carelessness of the doctor or the restlessness of the patient. To avoid complications, you need to sit quietly in the dental chair and not distract the doctor.

Symptoms of alveolitis

As a rule, the patient ignores the first symptoms of inflammation without due attention, considering them to be the norm after surgery. After tooth extraction, as already noted, pain within 24 hours is considered normal. As the hole heals, the pain subsides and completely disappears after a few days.

If the patient develops an inflammatory process, then the unpleasant sensations do not subside after a day or two, and 3–5 days after the operation, severe, throbbing pain in the socket occurs, which intensifies as the infection develops.

With alveolitis, patients may complain of both unbearable and moderate pain. Pulsation and pain are focused, as a rule, only in the removal area. However, in rare cases, the pain radiates to half of the face.

Other characteristic symptoms of alveolitis are:

a sharp rise in body temperature;
tooth sensitivity to hot/cold food;
enlargement of the submandibular lymph nodes;
decreased appetite;
increased salivation.

In rare cases, the disease causes weakness, increased fatigue, and secondary infectious foci appear on the oral mucosa.

How to make regeneration faster

To make the recovery period shorter, you should treat the hole as carefully as possible. Several central means help speed up regeneration:

Brush your teeth correctly. It is important that the oral cavity is cleaned properly and that pathogenic bacteria that can cause inflammation and other problems do not multiply in it.
Use antiseptics. They need to be rinsed after eating. But from the side of the extracted tooth, you should not rinse your mouth too much, creating a vacuum inside the mouth.
Try not to put pressure on the gum so that the socket is constantly at rest. Strong mechanical pressure and other similar effects on tissue are especially dangerous.

Diagnostics

The main symptom of the disease is the appearance of acute pain, which does not subside either 24 hours or 2–3 days after tooth extraction. Sometimes a dentist can identify chronic alveolitis during routine oral examinations. In this case, an empty socket without granulation tissue appears in place of the impacted tooth. The bone is already visible at the bottom of the hole.

The dentist will be able to determine the presence of tissue changes during the examination; radiography and radiovisiography of the affected area may also be prescribed.

Can there be complications after tooth extraction?

The issue of complications always worries patients. But if you do not have concomitant infectious diseases, and the operation is performed by an experienced doctor, the risk is very small.

There are several common likely problems:

Hematoma at the site of removal.
Severe swelling of the cheek.
Numbness in the area near the extracted tooth.
Bleeding.

In some cases, flux may also appear. Dentists should be careful when administering anesthesia. If you do not make sure that the patient does not have an allergic reaction to the drug, you may encounter a number of problems.

Treatment of alveolitis

When the socket becomes inflamed, the main thing is to eliminate the source of infection, prevent the development of inflammation and preserve the dentition. In order to alleviate the patient’s condition, the dentist uses the following therapy methods:

Mechanical cleansing of the hole, washing out purulent residues with a solution of nitrofural or hydrogen peroxide.
Anesthesia of the hole. The pain syndrome is relieved with the help of local applications with anesthetics and analgesics. To do this, the doctor applies the lotion for half an hour and then removes it to prevent the proliferation of microbes in the area. The dentist will advise the patient to repeat the procedure several times a day. Taking painkillers orally is not recommended.
Taking antibiotics. In the presence of concomitant diseases, alveolitis is treated with antibiotics.

With the right approach, the signs of alveolitis subside 2-3 days after the start of treatment. If therapy was not started on time, residual pain may drag on for 2–3 weeks.

With the permission of the dentist, additional treatment of alveolitis with folk remedies is possible:

Sage rinses. To prepare the solution, brew a large spoonful of dry sage in 250 ml of boiling water, leave the mixture for an hour, wrapping the container in a towel. After this, the liquid should be filtered and used for rinsing.
Gargling with chamomile flowers. To prepare the composition, brew a large spoonful of chamomile flowers in a glass of water for 15 minutes, insulating the container with a towel. The infusion should be strained and rinsed your mouth up to 12 times a day.
Poplar buds. To prepare, take half a glass of buds, pour into a glass container and pour in 500 ml of vodka. The product should be infused for 10 days in the dark and cool, then filtered, soaked in cotton swabs and applied to the inflamed area.
A soda rinse solution can also be an effective addition in the treatment of alveolitis. You should take a large spoonful of powder in a glass of warm water or mix soda with water to obtain a paste-like mass, which then needs to be used to treat the hole.
Burdock leaves. To prepare a medicinal decoction of burdock leaves, you need to pour 20 grams of raw material with 2 glasses of water, and then simmer the mixture over low heat for about 40 minutes. The resulting solution should be cooled and filtered, and then used for rinsing.
Aspen bark. Pour 1 tablespoon of crushed aspen bark into one glass of boiling water. It is important to leave the solution in an airtight container for 3 hours, and then use 100 ml of strained warm liquid at least 3 times a day.
Anise infusion. To prepare the infusion, pour 1 tablespoon of anise into 200 ml of boiling water, and then keep in a thermos for 50 minutes. The liquid should be filtered and used to rinse 3 times a day.

After 2–3 months and beyond

The gum gradually hardens, and the space remaining from the tooth is filled with maturing bone tissue. By the beginning of the 4th month, the gum bone tissue completes its formation. The gum can be called completely healed.

If the wound heals with suppuration, then healing of the wound can last up to six months.

Prevention

The best prevention of pathology after tooth extraction is to be attentive to yourself and follow all the surgeon’s recommendations. While the hole is healing, give up bad habits, eating too hot, spicy, sweet foods, and if possible, switch to pureed foods. And if you suspect inflammation, contact your dentist as soon as possible.

Under no circumstances should the first symptoms of alveolitis be ignored. Against the background of inflammation, more serious problems may arise:

Phlegmon is an acute diffuse purulent inflammation.
An abscess is a purulent inflammation of tissues with their melting.
Osteomyelitis is a purulent-necrotic process that can develop in the bone and bone marrow, as well as in the surrounding soft tissues.
Periostitis is inflammation of the periosteum.
Sepsis is a severe systemic inflammatory reaction.
Tissue necrosis is local tissue death.

Modern methods of treating alveolitis make it possible to quickly relieve the symptoms of inflammation and avoid the complex consequences of the disease. The sooner the patient consults a doctor, the less likely it is to develop complications.

On the top

The most common complication of extraction of figure eights in the upper jaw is a puncture of the base of the maxillary sinus (maxillary sinus).

Puncture of the bottom of the maxillary sinus

The dental roots of molars number three in the upper jaw are located too close to the base of the sinus, and sometimes even grow into it. Chronic inflammation of the periapical tissue provokes resorption of the axillary septum, due to which the roots of the molars fuse with the mucous membrane inside the sinus. It is this part that most often ruptures during the extraction of the right or left tooth. This complication can be noticed by the following symptoms:

nasal sound, bleeding air bubbles;
blood from the nose on the side of the figure eight.

In such a situation, urgent medical assistance is necessary.

Treatment of alveolitis in STOMA clinics

Surgeons at STOMA clinics are required to examine patients and give recommendations on how to care for the hole formed after tooth extraction. If problems arise after extraction, the patient can always call the clinic and clarify whether inflammation has really begun and what to do to reduce pain.

At any time after removal, the patient can contact our clinics. The attending surgeon will examine him and prescribe appropriate therapy.

Feel free to call us at any time and consult about your condition. The sooner we start treating alveolitis, the lower the risk of complications.

Carrying out the procedure

The tooth extraction procedure is carried out using effective, modern painkillers, so, as a rule, there is no pain during the operation itself.
The operation begins immediately after the anesthesia takes effect. A scalpel is used to loosen the ligament supporting the tooth.

If the procedure was traumatic, or the edges of the wound are too wide, the dental surgeon may use self-absorbing sutures. But most often, the wound is simply closed with a gauze pad with a special hemostatic agent. To stop bleeding, you need to lightly but firmly press the tampon onto the wound with closed jaws. After 20 minutes, the gauze can be spat out.

Functions: what are alveolar sockets for?

The main function of the alveolar cells is to fix the tooth root and hold the tooth in an anatomically correct position. If there is an age-related decrease in the interalveolar height, trauma to the tooth socket or its inflammation, a violation of the fixation ability of the alveoli and gradual loosening of the teeth with subsequent loss are possible. Diseases of the soft tissues of the oral cavity (periodontitis, parodontitis) can also cause unreliable fixation of the tooth root, destruction and loss of the tooth from the bone alveolus.

Periodontitis and healthy teeth

Holding the tooth and fixing it to the jaw is not the only functional purpose of the tooth socket. Alveoli are also necessary to perform the following functions:

After tooth extraction, the socket is dry

formation of correct diction and implementation of speech function (if even one tooth is missing in the mouth, the quality of speech can significantly decrease);
giving the dentition a stable position;
reducing the load on the tooth;
preventing premature tooth decay.

Restoring a lost tooth

It is especially important to monitor the condition of the tooth socket after tooth root extraction until it is completely healed, since various complications during this period can negatively affect the condition and health of neighboring alveoli and the teeth located in them.

How many tooth sockets are there in the mouth?

The number of alveoli in humans ranges from 28 to 32 and corresponds to the number of teeth. The size, shape, and height of the alveolar fossae are individual for each person and are multifactorial indicators, that is, they depend on a combination of several factors: age, degree and quality of hygienic oral care, the presence of dental and endocrinological diseases, history of surgical treatment of teeth and gums .

There are 28 to 32 tooth sockets in the human mouth

Unlike teeth, the number of which can decrease with age (tooth loss or surgical extraction), the number of dental sockets is a constant value. Alveoli, which lack teeth, overgrow over time and lose their functional significance, but still remain an anatomical unit of the jaw system.