Department of Oral and Maxillofacial Surgery, Hull Royal Infirmary, Hull, United Kingdom of Great Britain and Northern Ireland.
Department of Academic Oral Surgery & Oral Medicine, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland.
J Oral Rehabil. 2022 Jan;49(1):103-113. doi: 10.1111/joor.13268. Epub 2021 Oct 22.
Alveolar osteitis (AO) is a poorly understood, common, painful complication following exodontia. It is sometimes managed by inappropriate prescription of antibiotics which contributes to the global threat of antimicrobial resistance. Use of intra-alveolar chlorhexidine also presents a serious risk of anaphylaxis to the patient.
This scoping review aims to investigate the aetiology, prevention and management of AO and highlight the extent of inappropriate prescribing and intra-alveolar chlorhexidine use.
A scoping review was undertaken using the PRISMA guidelines. Medline, Ovid and Pubmed were searched between 2010 and 2020, from which 63 studies were selected for review that related to the aetiology, prevention or management of AO. Data were analysed for frequency of studies reporting information on risk factors for aetiology, prevention strategies and management including inappropriate management using antibiotic prescribing and intra-alveolar chlorhexidine.
Impaired immune response, surgical technique and age were identified as significant factors in the development of AO, while there is conflicting evidence regarding the effects of smoking and gender. With regard to prevention, the use of prophylactic antibiotics is not supported within the literature. Saline irrigation and eugenol pastes used preventively have been shown to be cheap and effective alternatives to chlorhexidine with no adverse effects. Hyaluronic acid and low-level laser therapies showed a significant reduction in pain and soft-tissue inflammation in the management of AO compared to Alveogyl.
Further understanding of the pathophysiology of AO is needed, in addition to large high-quality RCTs or long-term observational studies into the aetiology, prevention, and management of AO to produce up-to-date evidence-based clinical guidelines. Clinicians should also be mindful of their contribution to growing antimicrobial resistance and avoid inappropriate prescribing of antibiotics. Saline should replace chlorhexidine as the intra-alveolar irrigant of choice.
牙槽炎（AO）是拔牙后一种常见的、疼痛的、发病机制尚不完全清楚的并发症。有时会不合理地开具抗生素处方来治疗，这导致了全球范围内抗生素耐药性的威胁。使用牙槽内氯己定也会给患者带来严重的过敏反应风险。
本综述旨在研究牙槽炎的病因、预防和管理，并强调不合理处方和牙槽内氯己定使用的程度。
采用 PRISMA 指南进行综述。在 2010 年至 2020 年期间，在 Medline、Ovid 和 Pubmed 上进行了检索，共选择了 63 项与牙槽炎病因、预防或管理相关的研究进行综述。分析了研究报告病因、预防策略和管理中包括抗生素处方和牙槽内氯己定不合理使用等风险因素的数据频率。
免疫反应受损、手术技术和年龄被确定为 AO 发展的重要因素，而吸烟和性别对其的影响则存在争议。在预防方面，文献中不支持预防性使用抗生素。预防性使用生理盐水冲洗和丁香酚糊剂已被证明是氯己定的廉价有效替代品，且无不良反应。与 Alveogyl 相比，透明质酸和低水平激光疗法在治疗牙槽炎时能显著减轻疼痛和软组织炎症。
需要进一步了解 AO 的病理生理学，此外还需要进行更多的高质量 RCT 或长期观察性研究，以制定最新的循证临床指南，包括病因、预防和管理。临床医生还应注意到他们对抗生素耐药性的贡献，避免不合理使用抗生素。生理盐水应取代氯己定成为牙槽内冲洗剂的首选。
