Dry Socket: An Infectious Process Treated by Ciprofloxacin: Case Studies

Abstract

Dry socket is considered as the most common complication following tooth extraction. The incidence of dry socket is around 3% for all routine extractions and might surpass 30% for impacted mandibular third molars. It is accompanied by a partially or totally disintegrated blood clot within the alveolar socket, with or without halitosis. Dry socket is mainly manifested by severe irradiating pain that starts 1 to 4 days after dental extraction where the socket becomes denuded, exposed and tender to touch. Based on findings following previous bacterial culture and antibiogram on alveolar swab of rebellion cases of dry socket, we proposed a new pathogenesis theory based on infectious process.  Antibiogram showed sensitivity to ciprofloxacin. Based on this fact we proposed a new treatment that consists of prescribing ciprofloxacin to cases unresponsive to topical conventional treatment. In this paper, we present a serial of 6 cases of dry socket following simple and surgical extraction procedures which were mostly associated with previous infection. The onset of pain started after 1-4 days of extraction where it was radiating and nonresponsive to pain killers. Clinical examination revealed exposed denuded socket in all subjects. All 6 patients were ASA1 and none has allergy to ciprofloxacin where the later was prescribed at 500 mg 3 times per day for 5 days. All patients were totally relieved in 12 to 24 hours after antibiotic intake. This clinical result, in addition to previous laboratory findings, support more the infectious process in the pathogenesis of dry socket.