Perawatan ditujukan untuk melindungi soket selama produksi jaringan granulasi di atas dinding

soket yang terbuka. Bahan pembungkus yang mengandung beberapa sifat analgesik dan obat
penenang bersama dengan antiseptik digunakan setelah soket diirigasi dengan salin hangat atau
klorheksidin untuk menghilangkan kotoran. Berbagai bahan tersedia seperti Alvogyl®, dressing
iodoform yang tidak perlu dihilangkan, dan bismut, iodoform, dan pasta parafin (BIPP®) pada kasa
pita. Pembalut ini mungkin harus dilepas dan diganti pada kesempatan sampai soket telah epitelisasi
setelah sekitar 3 minggu.

Kondisi ini memiliki sejumlah nama berbeda,

dan terjadi pada sekitar 3% ekstraksi rutin dan hingga 20% ekstraksi bedah (Gambar 6.27 dan 6.28).
Nyeri terlokalisasi

ke situs ekstraksi dan sering berdenyut dan sangat parah. Ini akan sering membuat pasien terjaga di
malam hari, dan deskripsi klasiknya adalah sakit gigi yang tidak pernah hilang ketika gigi itu

dihapus. Beberapa soket kering mungkin mulai dari awal

gigi dihilangkan, dan rasa sakit tidak mulai sampai gumpalan telah benar-benar rusak dan
peradangan tulang telah dimulai. Meskipun beberapa pasien mendapat manfaat dari penggunaan
obat antiinflamasi nonsteroid (NSAID) seperti ibuprofen, rasa sakitnya sering kali sangat parah
sehingga analgesik ini tidak terlalu membantu.

Established localized alveolar osteitis such as

this is best treated by local means. If the patient can
tolerate the application of a local anaesthetic, then
cleaning out the socket and dressing it with either
commercially available resorbable antiseptic or an
analgesic pack (Alvogyl) will oftn be all that is
needed. If this approach has already been tried and
is ineffctive, and particularly if a number of other
treatments have been tried, including analgesics,
then applying a local anaesthetic, cleaning out the
socket and placing a pack made up of cotton wool, a
small amount of zinc oxide powder and eugenol will
provide complete pain relief. Ths pack will have to
be removed and sometimes has to be replaced, but it
is almost unique in providing complete pain relief
in patients with really intractable dry socket pain.
If the patient is not prepared to tolerate a local
anaesthetic, then provision of antibiotics (particularly an anaerobicidal drug such as metronidazole)
and of systemic analgesics (NSAID with or without
codeine/paracetamol) with an antiseptic mouthwash is just about all that can be achieved.

This postoperative complication appears 2–3 days after the extraction. During this period, the blood clot
disintegrates and is dislodged, resulting in delayed
healing and necrosis of the bone surface of the socket
(Fig. 8.58). This disturbance is termed fibrinolytic
alveolitis and is characterized by an empty socket,
fetid breath odor, a bad taste in the mouth, denuded
bone walls, and severe pain that radiates to other areas
of the head.
As for the etiology and pathogenesis of dry socket,
various factors have been cited, some of which include
dense and sclerotic bone surrounding the tooth, infection during or after the extraction, injury of the alveolus,
and infiltration anesthesia.
Treatment. This type of complication is treated by
gently irrigating the socket with warm saline solution,
and placing gauze impregnated with eugenol, which is
replaced approximately every 24 h, until the pain subsides. Also, gauze soaked in zinc-oxide/eugenol may
be used, which remains inside the alveolus for 5 days;
alternatively iodoform gauze or enzymes are applied
locally. Recent studies have shown Matthews’ (1982)
and Mitchell’s (1986) techniques to be very effective.
They used dextranomer granules (Debrisan) and collagen paste (Formula K) without observing a foreign
body reaction like that observed with the zinc-oxide/
eugenol mix. With this palliative treatment, the pain
gradually subsides, and the patient is given instructions to avoid mastication on the affected side while
good oral hygiene is emphasized.