The most dreaded thing that most patients ask me during the consultation. Everyone seemingly knows about dry socket. What is dry socket? Well, its really the inflammation of the bone in the extraction site, the bone that used to support the extracted tooth. Typically when a tooth is extracted, a blood clot is formed in the socket, that acts as a “bandaid” to protect the underlying bone. This blood clot will eventually reorganize, mature and turn into bone, if it is not dislodged.
Unfortunately, sometimes this blood clot becomes dislodged and the bone in the extraction site becomes exposed to all things that are typically found in ones mouth…saliva, bacteria, food….This becomes a setup for disaster and a petri dish for bacteria overgrowth, really irritating the bone and leading to severe pain….pain that is not even controlled with narcotic pain medications. This is why everyone dreads this complication after extractions, especially after the extraction of third molars.
So how do we prevent this dreaded side-effect? I always tell my students to “bring the tissue back into harmony” meaning if there is an incision made or if the soft tissue is elevated in order to extract a tooth; then replace the tissue over the extraction site with stitches…to cover the hole, to prevent the dislodgment of the blood clot. Additionally, for years I have been placing resorbable collagen in the sockets, to act as the so called blood clot, to prevent dry sockets. Honestly, I have performed thousands of these procedure and I have had only one dry socket case in 10 years. Why? because I am preventing the dislodgment of the blood clot by closing up the extraction hole. Patient recover faster, they have less pain and they rarely ever get dry socket. It may take us longer to suture the sites and costs us more to place collagen in the extraction sites…but its so much better for the patient.
So is this just some voodoo medicine or is this based on scientific research…..
In the most recent edition of JOMS (Oral Maxillofac Surg 73:1457-1464, 2015), Dr. Cortell-Ballester and their team found that actually the use of resorbable collagen membrane after surgical extraction of mesioangular or horizontally impacted third molars, stimulates bone regeneration, improving the attachment level and bone fill distal to the second molars! Also, it decreased the probing depth and results in faster recovery for the patient.
Amazing….We known this all along based on our clinical findings. Glad to see someone is proving this for us! Thank you.
The next time you have an extraction, wisdom tooth extraction….ask your doctor, are they packing the extraction site with collagen? Trust me, it will only help your body recover faster and prevent the dreaded dry socket.