Infected Socket

Clinical Description

A post extraction complication due to infection of the clot due to contamination (infected socket). The condition is painful and if not managed well could lead to osteomyelitis.

Signs and Symptoms

• Severe painful socket 2-4 days after tooth extraction
• Fever
• Necrotic blood clot in the socket
• Swollen gingiva around the socket
• Sometimes there may be lymphadenopathy and trismus (Inability to open the mouth)

Investigations

• Intraoral X-rays

Treatment

• Under local anesthesia with Lignocaine 2% socket debridement and irrigation with 3% Hydrogen peroxide. The procedure of irrigation is repeated the 2nd and 3rd day and where necessary can be extended to 4th day if pain persists. On follow-up visits local anesthesia is avoided unless necessary.
• Patient is instructed to rinse with warm saline (5ml spoonful salt in 200 mls cup of warm water) or 3% hydrogen peroxide 8 hourly or 6 hourly in a day.
• Antibiotics prescribed to prevent progression to osteomyelitis: Amoxicillin 500 mg

PO 6 hourly for 5 days.

PLUS

• Metronidazole 400 mg 8 hourly for 5 days.
• X-Ray: Periapical X-ray of the socket may be necessary when there is poor progression apart from the above treatment, aim is to check whether there is no root remnant, foreign body or any local bone pathology