The quality of evidence is downgraded by study limitations (unclear allocation concealment and incomplete or selective outcome reporting).
A Cochrane review [Abstract] 1 included 21 trials with a total of 2 570 adult participants: 18 trials (2 376 patients) for the prevention of dry socket and 3 trials (194 patients) for the treatment of dry socket. In most studies (n=18) patients underwent extraction of third molars, mostly by oral surgeons. The prevalence of dry socket varied from 1% to 5% in routine dental extractions to upwards of 30% in surgically extracted third molars. Most commonly used intervention was chlorhexidine, either as rinses before and after extraction, or placing chlorhexidine gel in the sockets of extracted teeth. Studies involving immunodeficient or severely ill patients were excluded. Studies which looked at the use of antibiotics to manage dry socket were out of the scope of this review.
Chlorhexidine rinses and gel placed in the socket may reduce the risk of having a dry socket but the benefit depends strongly on the baseline risk. There was insufficient evidence to conclude whether any treatments relieved established dry socket or not.
There were minor adverse reactions observed in the studies with the mouthrinses. In the gel studies there was no adverse events reported. Patients allergic to chlorhexidine had been excluded from the studies and the current studies were not powered to detect new cases of hypersensitivity.
| Outcome | Number of participants (trials) | Control:Placebo | Intervention:Chlorhexidine rinses (0.12 and 0.2%) | NNT (95 % CI) | Effect size (95 % CI) |
|---|---|---|---|---|---|
| Presence of dry socket | 750(4) | 1% 5% 30% | 0.6% 3% 16% | 232 (176 to 417) 47 (35 to 84) 8 (6 to 14) | RR 0.58 (0.43 to 0.78) |
| Outcome | Number of participants (trials) | Control:Placebo | Intervention:Chlorhexidine gel 0.2% | NNT (95 % CI) | Effect size (95 % CI) |
| Presence of dry socket | 133(2) | 1% 5% 30% | 0.4% 2% 13% | 173 (127 to 770) 35 (25 to 154) 6 (5 to 26) | RR 0.42( 0.21 to 0.87) |
There are recent reports in the UK of cases of serious adverse events associated with irrigation of dry socket with chlorhexidine mouthrinse. The dental teams should be aware of potential serious adverse effects.
Date of latest search: 2012-11-07
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