For the last 25 years I’ve always placed a collagen plug plus resorbable sutures. After doing this, I have had not a single dry socket - except for one patient who actually pulled the collagen plug out! The days of letting people walk out with bleeding holes should have been over several decades ago. For the lower 3rds, definitely allow the sutures to fall out (PGA will be in 3 to 4 weeks on average). Also, tissue loves to grow over those plugs. For the lower 3rds, I always tell the patient that the goal is no hole. None. So I also never ever give them a syringe to rinse with. That’s the opposite of what I want. It is very easy to prevent dry sockets altogether. And also prevent these lower 3rd holes that take so long to resolve. But it does require a plug and sutures which means extra time and money.
Interesting. I had an infected bottom molar, and in hindsight, the dentist said it must have been quite infected for quite some time. A root canal became an extraction. Seemed like she was stressed during a lengthy attempt to pull it out, and she put in a number of stitches (guessing 5-7?). After, on day 8 it was too much discomfort, poor sleep, etc., and a noticeable taste of puss. She numbed it, said it was infected, cleaned it and packed it. The packing came out within a couple of hours. Painful again. Poor sleep, etc. Two days later, again freezing, irrigation, and this time packing with stitches. And now 'Jamp Ketorolac and Ketoroiac Tromethamine'. The packing for the most part has stayed put so far, and I am noticeably more comfortable. See them again in 3 days. My most traumatic dental experience yet in my 66 years.
Thanks for this episode. Did you try surgical-grade hyaluronic acid gel? Helps preserve socket (stabilize blood clot), bacteriostatic, while reducing swelling and pain.
Thanks for the episode. In patient's who are already on stronger painkillers such as zapain or co-codamol would you still recommend that they follow the ibuprofen + paracetamol regimen?
I usually stick a curved end if Mitchell's inside the anaesthetised socket and and agigitate/scrape - usually by the time I have curreted a socket to remove debris, bleeding will be promoted. Hope that helps!
I work just like Jaz has described. I’d use a Mitchell’s, a Lucas curette or even a dental excavator, trying to agitate the side of the sockets to remove any debris and promote some bleeding. I know some implant colleagues who go as far as to use a rose head in a handpiece to promote some bleeding (although I wouldn’t routinely).
Just a quick pharmaceutical tip more the. 400mg ibuprofen is useless for pain you only need 200 or 400 or pain reliever more than that is not needed , and thanks for this great podcast ❤
In 20 years of practice I basically only place Alvogyl gently into the socket and obviously only antibiotics if there is a post op infection which is rare. I have had only one patient get no relief from Alvogyl and they had multiple comorbidities. Otherwise Alvogyl gives relief within 30 minutes. Also let your patient know that they have had a surgical procedure and have an open wound that needs time to heal so some post op pain should be expected.
I really enjoyed watching this and I am a patient! Keep up the good work.
Glad you enjoyed it! 🙌
For the last 25 years I’ve always placed a collagen plug plus resorbable sutures. After doing this, I have had not a single dry socket - except for one patient who actually pulled the collagen plug out! The days of letting people walk out with bleeding holes should have been over several decades ago. For the lower 3rds, definitely allow the sutures to fall out (PGA will be in 3 to 4 weeks on average). Also, tissue loves to grow over those plugs. For the lower 3rds, I always tell the patient that the goal is no hole. None. So I also never ever give them a syringe to rinse with. That’s the opposite of what I want. It is very easy to prevent dry sockets altogether. And also prevent these lower 3rd holes that take so long to resolve. But it does require a plug and sutures which means extra time and money.
appreciate you sharing this experience- it has certainly helped to validate for me
I wish my dentist did this, these holes are so annoying and a nonsense and pain
Interesting. I had an infected bottom molar, and in hindsight, the dentist said it must have been quite infected for quite some time. A root canal became an extraction. Seemed like she was stressed during a lengthy attempt to pull it out, and she put in a number of stitches (guessing 5-7?). After, on day 8 it was too much discomfort, poor sleep, etc., and a noticeable taste of puss. She numbed it, said it was infected, cleaned it and packed it. The packing came out within a couple of hours. Painful again. Poor sleep, etc. Two days later, again freezing, irrigation, and this time packing with stitches. And now 'Jamp Ketorolac and Ketoroiac Tromethamine'. The packing for the most part has stayed put so far, and I am noticeably more comfortable. See them again in 3 days. My most traumatic dental experience yet in my 66 years.
I really didn’t liked getting staining from chlorxecidine how does it help before extraction
reduce bacterial load and reduce chance of dry sockey
Thanks for this episode. Did you try surgical-grade hyaluronic acid gel? Helps preserve socket (stabilize blood clot), bacteriostatic, while reducing swelling and pain.
Thanks! Will take a look in to this - have not used it before :)
Thanks for the episode. In patient's who are already on stronger painkillers such as zapain or co-codamol would you still recommend that they follow the ibuprofen + paracetamol regimen?
Any tips on how to stimulate bleeding in the socket if it doesn't happen naturally after the extraction?
I usually stick a curved end if Mitchell's inside the anaesthetised socket and and agigitate/scrape - usually by the time I have curreted a socket to remove debris, bleeding will be promoted. Hope that helps!
I work just like Jaz has described. I’d use a Mitchell’s, a Lucas curette or even a dental excavator, trying to agitate the side of the sockets to remove any debris and promote some bleeding. I know some implant colleagues who go as far as to use a rose head in a handpiece to promote some bleeding (although I wouldn’t routinely).
Just a quick pharmaceutical tip more the. 400mg ibuprofen is useless for pain you only need 200 or 400 or pain reliever more than that is not needed , and thanks for this great podcast ❤
thank you!
Best advice i have heard. Thank you so much to Dr gorgeous-but-ugly french bulldog.
@bbyng7316 well for a moment I thought you were being rude to our guesr, Chris, then I remembered there LITERALLY WAS a French bulldog in this ep! 😂
In 20 years of practice I basically only place Alvogyl gently into the socket and obviously only antibiotics if there is a post op infection which is rare.
I have had only one patient get no relief from Alvogyl and they had multiple comorbidities.
Otherwise Alvogyl gives relief within 30 minutes.
Also let your patient know that they have had a surgical procedure and have an open wound that needs time to heal so some post op pain should be expected.
agreed - unfortunately in the UK (unsure of rest of world) alvogyl no longer exists: www.nature.com/articles/s41415-020-2073-x
Jaz u should recive a nobel prize