Generality
The dental alveolitis is an acute inflammation of the alveolus, that is the bone cavity in which the roots of the teeth lodge.
In most cases, this pathology is established after a dental extraction (or dental avulsion). Alveolitis is a rather rare complication (occurs in about 1-2% of cases) and is found above all when the removal involves a tooth severely compromised by pathological processes, as can happen in the presence of deep caries, pulpits or granulomas .
The exact causes of the dental alveolitis are still unknown, but some factors have been identified that could favor its onset, including: smoking, infections, increased fibrinolysis of the intralveolar clot, surgical trauma and ongoing drug therapies.
After 3-4 days after surgery, the inflammation of the dental alveolus manifests itself with intense pain, halitosis and swollen lymph nodes .
Alveolite involves a local anti-infective treatment, possibly associated with antibiotics, anti-inflammatories and specific oral hygiene maneuvers (eg rinses not too energetic with chlorhexidine-based mouthwashes, intralveolar positioning of a sterile gauze imbued with analgesic substances etc.).
What's this
What is Dental Alveolite?
Dental alveolitis is an inflammatory process that develops mainly at the alveolus of an extracted tooth, especially if the normal coagulation of the blood, in the cavity that remains from the avulsion, is dysfunctional.
The alveolar bone supports and surrounds the dental root (or roots, if the tooth is multi-rooted), with the interposition of the periodontal ligament. After extraction of the tooth, the alveolus communicates directly with the oral cavity.
What is a Dental Alveolus?
After extraction of a tooth, with alveolus (or alveolar cavity ) we mean the residual bone cavity; this can be unique or divided by interradicular bony septa, if the detached dental element is mono- or multi-rooted, respectively.
Causes and Risk Factors
Dental alveolitis: what are the causes?
The causes of dental alveolitis are not yet completely clear, but some factors have been identified that could predispose to the onset of the inflammatory process.
The theories that have appeared in the scientific literature to explain the reasons for inflammation are not, to date, fully shared and supported by agreed data. The only exception that has so far been confirmed is represented by smoking, as it has been shown by medical statistics that this habit increases the incidence of alveolitis, probably due to the fact that nicotine acts as an ischemic agent, ie it reduces the availability of oxygen needed by tissues to speed healing.
Among the various hypotheses formulated it is worth mentioning the contribution in the development of the alveolite that could have:
- Infections;
- Surgical trauma ;
- Early fibrinolysis of the clot ;
- Oral contraceptives ;
- Vasoconstrictors .
In most cases, the inflammation of a dental alveolus arises after an extraction. This complication is however infrequent, as it occurs in about 1-2% of cases, usually if the operation is performed on a tooth or a surrounding tissue already infected or severely injured, as can happen in case of deep caries, pulpits or granulomas .
Although they can appear following the extraction of any tooth, the most common alveolitis are those of the so-called " wisdom teeth ", that is the third series of lower and upper molars, respectively to the right and left of the dental arch.
Triggering and favoring factors
- Surgical trauma
The probability that the dental alveolitis develops after an extraction depends on the extent of the intervention and on the pathological condition for which this is practiced by the dentist.
The risk of incurring this complication increases in the case in which the intervention is particularly " difficult ", for example due to the presence of included teeth (ie not able to erupt through the gum or that only partially appear), poorly positioned or other situations that can make the operating procedures traumatizing for periodontal tissues.
- Pathological conditions prior to extraction
As anticipated, a pre-existing odontogenic infection, such as deep caries, pulpits or granulomas, can make tooth extraction and post-intervention healing more complicated. The likelihood of developing inflammation such as alveolitis can also increase based on the patient's general health, medication and the concomitant presence of other diseases (such as coagulation disorders, diabetes, etc.).
- Early fibrinolysis of the intralveolar coagulum
One of the most reliable hypotheses among those predisposing to alveolitis seems to be the early lysis of the intralveolar blood clot, probably due to its bacterial contamination. Normally, in fact, after tooth extraction, local bleeding is followed by the formation of a clot in the alveolus, which:
- Blocks bleeding;
- Protects underlying tissues;
- It serves as the basis for the organization of the granulation tissue, on which the formation of new bone in the alveolar cavity depends.
After extraction, to facilitate hemostasis and the formation of the intralveolar coagulum, a sterile cotton gauze pad is commonly applied to the residual alveolus; subsequently, the patient is asked to hold for about 20-30 minutes.
In the post-extractive alveolitis, the clot that develops in the alveolus after the operation comes off and dislocates or disintegrates before it is due to plasminogen activation in plasmin ( fibrinolysis ). In both cases, the tissues remain uncovered and are vulnerable to bacterial attack. Exposure of the alveolus results in a slowing down of normal healing after extraction.
- Estrogen effect
Compared to males, women undergoing dental extraction are more exposed to the risk of alveolitis. The probability of the appearance of the alveolitis appears to be influenced by the amount of estrogen in the blood: when the levels of these hormones are high (especially during the first few weeks of the menstrual cycle or in the case of oral contraceptives), the wound left on the gum after a dental avulsion it tends to heal more slowly.
For this purpose, dentists may advise you to undergo an extraction, preferably, in the last week of the menstrual cycle, a period in which the levels of estrogen in the blood are lower.
- Other predisposing conditions
Among the probable predisposing conditions were also identified:
- Poor oral hygiene ;
- Chronic periodontal disease ;
- Too vigorous and abundant rinses after extraction;
- Use of sutures ;
- Previous episodes of alveolitis ;
- Taking corticosteroids, such as prednisone.
Symptoms and Complications
Dental alveolitis is not a particularly serious condition, but it is annoying for those who suffer from it and exposure to the alveolus delays healing . Inflammation may persist for a few days or several weeks.
Dental alveolitis: how to recognize it?
Alveolite symptoms typically begin a few days after extraction:
- In the first days after extraction, patients typically report that the state of discomfort due to surgery tends to decrease progressively;
- After about 3-4 days, the pain intensifies unexpectedly in the area where the intervention was carried out;
- Subsequently, the pain of the alveolitis tends to radiate towards the areas adjacent to the affected alveolus and along the regions innervated by the branches of the trigeminal nerve (like the ear). Characteristically, this manifestation is resistant to common analgesic drugs.
Dental alveolitis: what are the symptoms?
The clinical picture of dental alveolitis includes pain, which intensifies after a few days after extraction, accompanied by bad breath and swelling of the regional lymph nodes . Often, soreness extends to the entire angular area of the jaw.
The alveolus appears empty and greyish, possibly occupied by food residues. Rarely, purulent secretion is present.
In the presence of a dental alveolitis, the pain increases during chewing and can also radiate to the ear and neck.
In most cases, therefore, dental alveolitis involves:
- Intense, pulsating and persistent pain in correspondence to the alveolus affected by inflammation;
- Slight redness and swelling of the gum;
- Halitosis;
- Bad taste in the mouth;
- Soreness or pain in the jaw.
In the presence of alveolitis, one or more of the following symptoms may also occur:
- Temperature;
- Enlarged submandibular lymph nodes;
- Neck pain;
- Ear pain.
In the most serious cases, they can occur:
- Headache;
- Cutaneous hyperesthesia;
- Facial swelling (swelling of the hemilateral face).
Possible complications
Dental alveolitis can involve, in particularly severe cases, bone tissue, so it could evolve into osteitis.
Diagnosis
If a dental alveolitis is suspected, it is always a good idea to consult your dentist or your doctor.
The diagnosis is formulated by inspection of the oral cavity (ie with direct observation), during which it is possible to find the lysis of the alveolar clot . In typical cases, the dental alveolus is smelly and has a greyish color. Instead, the patient reports a throbbing pain, which typically occurs on the second to fourth day and is often resistant to common analgesics.
After aspiration, the alveolar cavity is empty (hence the name " dry alveolite "), characteristically lacking in granulation tissue and with shiny bony walls .
On palpation or simple contact, the dentist can evoke intense pain, with redness of the mucosa and gum surrounding the affected alveolus.
To confirm the diagnosis or to exclude other conditions, it is possible to indicate the execution of an intraoral X-ray or an overview (orthopantomography).
Dental alveolitis: when to contact the dentist?
If after 2-3 days from a dental extraction, the pain tends to intensify rather than decrease, it is advisable to immediately contact the dentist to undergo further tests.
Treatment and Remedies
As anticipated, alveolitis is not a particularly serious condition, but it is rather annoying for those who suffer from it and exposure of the socket delays healing.
In order to have specific indications on alveolitis therapy and allow for better healing, it is always advisable to consult your dentist. Not knowing the exact causative factors of the disease, there is currently no specific etiological therapy. Therefore, the treatment is symptomatic and aimed above all at controlling pain and improving recovery and healing processes.
Although the pain symptoms tend to disappear spontaneously after 1 or 2 weeks, the dentist can insert an analgesic dressing into the post-extraction socket. This is replaced daily, until the patient stops feeling pain, after removing the gauze for a few hours.
Dental alveolitis: which treatment is expected?
According to the specific clinical case, the strategies to reduce the symptoms of this condition are different and may include the daily use of antiseptics (eg mouthwash or chlorhexidine 0.2% gel) and analgesics (eg lidocaine). These solutions to be applied topically are possibly used in combination with anti-inflammatories and antibiotics to be taken in the dosages and in the times recommended by the general practitioner or dentist.
At the same time, it is advisable to treat daily oral hygiene with particular care, using a soft-bristle toothbrush.
Washing with physiological water frees the alveolus from food residues and foreign bodies. The pain associated with alveolitis rapidly regresses following the topical application of eugenol (essence extracted from clove with analgesic action) or zinc oxide.
In the most serious cases, it is possible that the dentist performs cleaning of the dental alveolus (curettage, washing and application of an intralveolar pain-relieving dressing) or, rarely, proceeds with the ablation of a fragment of the bone involved in the pathological process.
Prevention
After a dental extraction operation, it is important, as well as essential, to follow the precious suggestions suggested by the general practitioner or dentist to the letter. It must be considered, in fact, that these professional figures know their patient and can interpret any problems, referring to the general context, to the pathologies he is suffering from and to the therapies in progress.
Dental alveolitis: tips for oral hygiene
To reduce the risk of incurring in a post-extractive dental alveolitis it is possible to adopt some tricks, useful also to alleviate painful symptoms and reduce complications.
Before a tooth extraction:
- Have a professional dental cleaning (scaling) ten days before surgery;
- In the days before tooth extraction and in those that follow, perform rinses with chlorhexidine-based mouthwashes to "control" the bacterial load in the oral cavity (note: the exact time is indicated by the dentist who prepares the patient for treatment, performs the operation and monitors the correct healing).
After extraction of a tooth:
- Keep the sterile gauze pad medicated on the gingival lesion to encourage blood clot formation;
- Do not carry out vigorous rinses for the first 24 hours and try to avoid maneuvers that could displace the clot such as: drinking with straws, sucking in the extraction area, spitting and gargle;
- Refrain from smoking for at least 48 hours after tooth extraction;
- Avoid touching the extraction area with your tongue;
- Wash the alveol daily with physiological water or, on the dentist's advice, with chlorhexidine at 0.20% or rifamycin;
- Avoid taking salicylate-based drugs (such as acetylsalicylic acid), as they can alter the correct coagulation process;
- Avoid using electric toothbrushes to avoid damaging the extraction area; in the post-extraction period it is best to use a soft bristle toothbrush, paying particular attention to cleaning operations in the area of the extracted tooth;
- Do not consume drinks or foods that are too hot or cold;
- As far as possible, avoid chewing on the side where a tooth has been removed, to prevent food debris from depositing in the extraction area.
Following these simple tips, combined with the practice of good oral hygiene, helps keep the area clean after a tooth is extracted and reduces the risk of infections, including alveolitis.
