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Alveolar osteitis is a painful phenomenon that most commonly occurs a few days following the removal of mandibular wisdom teeth. It is commonly believed that it occurs because the blood clot within the healing tooth extraction site is disrupted. More likely, alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible. Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris.
Wound Healing is a complex process and can be positively and negatively affected by Alveolar osteitis. Suppurative osteitis results when the disturbance of extraction socket wound healing occurs later, during the 3rd stage of healing from day 14-16 after extraction, and is a manifestation of the disruption of connective tissue development. This form usually results from an infection and exhibits a purulent discharge from the extraction socket. This during an even later stage of healing might result in necrotizing osteitis in which encapsulated shards of bone will be noted alongside inflammatory cells.
True alveolar osteitis, as opposed to simple postoperative pain, occurs in only about 1-3% of extractions . No one knows for certain how or why dry sockets develop following dental extraction but certain factors are associated with increased risk. One of these factors is the complexity of the extraction. Smoking may be a contributing factor, possibly due to the decreased amount of oxygen available in the healing tissues. It is advisable to avoid smoking for at least 48 hours following tooth extraction to reduce the risk of developing dry socket. Women are generally at higher risk than men of developing alveolar osteitis, because estrogen slows down healing. Dentists recommend that their female patients have extractions performed during the last week of their menstrual cycle, when estrogen levels are lowest, to minimize chances of developing alveolar osteitis.