Khalil Wael
Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, LBN.
Cureus. 2023 Jul 4;15(7):e41347. doi: 10.7759/cureus.41347. eCollection 2023 Jul.
Objective Dry socket, a common complication following a tooth extraction, is characterized by severe and radiating pain that typically begins one to four days after the extraction. Despite several risk factors, the exact cause and underlying mechanisms of dry sockets remain unclear. This study aims to propose a novel pathogenesis and management approach for dry sockets based on an infectious process. Methods The study was conducted by reviewing medical records, at a private dental clinic, of patients who fit the inclusion criteria; these patients appeared to have come between April 2022 and April 2023. The study included all patients with age ≥17 years diagnosed with dry socket that was resistant to conventional topical treatment, and who received treatment with ciprofloxacin 500 mg three times per day during the study period. Results Out of 15 patients who received treatment with ciprofloxacin 500 mg three times per day during the study period, 11 patients (73.3%) were completely relieved of symptoms within 24 hours, with no need for additional painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, two patients (13.3%) had a partial response after 48 hours, where their pain was ameliorated from severe to moderate with the use of conventional painkillers (including paracetamol and NSAIDs) and steroidal anti-inflammatory drugs such as dexamethasone (8 mg IM daily) to have total relief. On the other hand, the other two patients (13.3%) had a negative response to the treatment and were out of reach for follow-up. Conclusion These clinical outcomes, coupled with previous laboratory data, could explain all clinical aspects of dry sockets and provide substantial support for the hypothesis that an infectious mechanism plays the principal role in the pathophysiology of dry sockets.
目的 干槽症是拔牙后常见的并发症，其特征为严重的放射性疼痛，通常在拔牙后1至4天开始。尽管存在多种风险因素，但干槽症的确切病因和潜在机制仍不清楚。本研究旨在基于感染过程提出一种新的干槽症发病机制和治疗方法。方法 通过回顾一家私人牙科诊所符合纳入标准患者的病历进行研究；这些患者就诊时间在2022年4月至2023年4月之间。该研究纳入了所有年龄≥17岁、被诊断为对传统局部治疗有抵抗性的干槽症患者，且这些患者在研究期间每天接受3次500毫克环丙沙星治疗。结果 在研究期间每天接受3次500毫克环丙沙星治疗的15例患者中，11例患者（73.3%）在24小时内症状完全缓解，无需额外使用止痛药或非甾体抗炎药（NSAIDs）。此外，2例患者（13.3%）在48小时后有部分反应，通过使用传统止痛药（包括对乙酰氨基酚和NSAIDs）以及甾体抗炎药如地塞米松（每日8毫克肌肉注射），其疼痛从重度减轻至中度，最终完全缓解。另一方面，另外2例患者（13.3%）对治疗反应不佳且无法进行随访。结论 这些临床结果，再加上之前的实验室数据，可以解释干槽症的所有临床方面，并为感染机制在干槽症病理生理学中起主要作用这一假说提供有力支持。
