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.
True alveolar osteitis 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. Smoking may be a contributing factor, possibly due to the decreased amount of oxygen available in the healing tissues. 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.
The pain from alveolar osteitis usually lasts for 24-72 hours. There is no real treatment for alveolar osteitis; it is a self-limiting condition that will improve and disappear with time, but certain interventions can significantly decrease pain during an episode of alveolar osteitis. These interventions usually consist of a gentle rinsing of the inflamed socket followed by the direct placement within the socket of some type of sedative dressing, which soothes the inflamed bone for a period of time and promotes tissue growth. This is usually done without anesthesia. The active ingredients in dressings include substances like, zinc oxide, eugenol, and oil of cloves. This is generally done for two or three consecutive days, although occasionally it can take longer.