Alveolitis

It is, in most cases, an inflammatory pathology that appears after tooth extraction ( alveolitis after wisdom tooth extraction is very frequent), especially if the normal blood coagulation in the area of the extracted tooth is altered.

It is a rare disease, with an incidence that ranges between 1 and 4% and that reaches its peak when the affected tooth is the third molar, commonly known as wisdom tooth.

What is alveolitis?

Dental alveolitis is an inflammatory process that develops in the socket of an extracted tooth, especially if the normal coagulation of blood in the cavity remaining after extraction is dysfunctional.

The alveolar bone supports and surrounds the root of the tooth, or the roots, if the tooth has several roots, with the interposition of the periodontal ligament. After tooth extraction, the alveolus enters into direct communication with the oral cavity.

What is a dental alveolus?

After tooth extraction, the alveolus, or alveolar cavity, refers to the remaining bony cavity; this may be single or subdivided by interradicular bony septa, if the extracted tooth is respectively single or multirooted.

Causes

The causes of alveolitis are largely unknown. It is believed to occur when the clotting process at the site of tooth extraction does not develop properly, or when the clot dissolves before the wound has healed, perhaps due to bacterial contamination or trauma.

After the extraction surgery, a coagulation process is triggered, as in any wound, with the function of protecting the underlying structures, bones, nerve endings, among others. If something in this phase does not happen as expected, the tissues are exposed to the accumulation of food debris, oral microorganisms and other materials, the tissue becomes inflamed and the symptoms of alveolitisappear.

This condition is the most common complication of dental extractions. Several factors have been identified that contribute to its development :

• Trauma and difficulty during tooth extraction can increase the inflammatory response.
• Third molar: the increase in bone density together with the reduction of vascularizationmakes it the most susceptible to develop this disease.
• Systemic diseases: immunocompromised patients, such as diabetics, for example, are at higher risk.
• Oral contraceptives: the estrogen contained in the drug seems to be able to increase clot lysis.
• Smoking: there is a strong correlation between smoking and dental alveolitis. A dose-dependent relationship has also been reported between smoking and the appearance of the disease. This could be due to the presence of substances contained in cigarettes, such as nicotine, which decrease the availability of oxygen, altering the surgical area and favoring the development of the disease.
• Insufficient oral hygiene: numerous studies support this hypothesis, based on the fact that these patients often have pre-existing bacterial infections, such as pericoronitis or advanced periodontal disease. Several responsible microorganisms have been isolated and identified, such as Actinomyces viscosus, Streptococcus mutans and Treponema denticola, which slow down the healing process.
• Patient age: The specialized literature states that the older the patient, the greater the risk of developing alveolitis. One study states that mandibular third molars should be removed before the age of 24, especially in female patients, since the risk of postoperative complications increases significantly with age.
• Previous alveolitis: there is an increased risk if there have been similar episodes in the past.
• Radiation therapy to the maxillary and mandibular bones causes numerous tissue changes, resulting in reduced blood flow and an increased risk of subsequently developing dental alveolitis.

Symptoms

The symptoms of alveolitis usually appear a few days after the extraction of a dental piece, after the partial or total loss of the clot.

The pain is intense and persistent, especially at night; if initially localized, it tends to radiate to the ear, temple where the trigeminal nerve passes, eye and neck.

Sometimes the alveolar cavity is hollow and dry, hence the name dry alveolitis, with the bone clearly visible. The surrounding areas will be reddened and swollen or edematous.

Associated with this, the patient may also complain of halitosis and an unpleasant sensation in the mouth.

Although in fewer cases, fever and laterocervical lymphadenopathy, i.e. an increase in locoregional lymph nodes, may also develop.

Treatment

Alveolitis is not a particularly serious condition, but it is quite uncomfortable for sufferers and the exposure of the cavity delays healing.

To obtain a specific guidance on the treatment of alveolitis and allow for the best possible cure, it is advisable to consult to the dentist. Since the exact causal factors of the disease are unknown, there is currently no specific etiological therapy. Therefore, treatment is symptomatic and is directed primarily to the pain control and to a better resumption of repair and healing processes.

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Dental alveolitis: what treatment should be applied?

Depending on the specific clinical case, strategies to reduce the symptoms of this condition are different and may involve thedaily use of antiseptics (e.g. mouthwashes or 0.2% chlorhexidine gels) and analgesics (e.g. ibuprofen). These topical medications can be used in combination with anti-inflammatory drugs and antibiotics that should be taken at doses and times recommended by the primary care physician or dentist.

At the same time, it is advisable to pay special attention to daily oral hygiene, using a soft-bristled toothbrush.

Washing with physiological saline solution allows the removal of food residues and foreign bodies. The pain associated with alveolitis subsides rapidly after topical application of eugenol (essence derived from cloves with analgesic action) or zinc oxide, which should be used only after the dentist's recommendation.

In the most severe cases, the dentist may clean the dental alveolus (curettage, lavage and application of an intralveolar analgesic dressing) or, in rare cases, proceed to the ablation of a bone fragment involved in the pathological process.

Prevention of alveolitis

Since dental alveolitis appears to be the most common postoperative complication following extraction, applying the following recommendations will decrease the risk of its occurrence:

• In the days prior to surgery, it is of great importance to maintain proper oral hygiene by rinsing with mouthwashes or chlorhexidine gels. This procedure should also continue in the postoperative period.
• People taking anticoagulant drugs are advised to suspend them in the days before and after surgery, always under medical supervision and possible substitution by another treatment.
• In the postoperative period, it is recommended to avoid smoking, since tobacco reduces blood flow, leading to tissue ischemia, reduced perfusion and an increased risk of dental alveolitis.
• Avoid hot fluid intake in the next 24-48 hours after surgery, as it may increase local blood flow and interfere with clot formation; instead, cold drinks and foods are recommended.
• Avoid straining, such as drinking through a straw, spitting or gargling, as this can create negative pressure in the oral cavity, making the clot more fragile.
• Chew on the opposite side of the cure.
• Use soft bristle toothbrushes for hygiene of the area.

Although simple in essence, these are steps that can make a difference and drastically reduce the risk of developing dental alveolitis, a rare and non-serious condition that can resolve, if treated correctly, within a few days to a few weeks.