What is a blood clot after tooth extraction. What does a blood clot look like and why does it form after tooth extraction? Recovery after tooth extraction

Tooth extraction is a serious surgical procedure, especially if a wisdom tooth is being removed. In order for the operated site to heal correctly and without complications, it is necessary to strictly follow the recommendations of the dentist and respond in a timely manner to deviations from the norm.

The blood clot after tooth extraction fills the socket immediately after the procedure and plays an important role in healing. What is it for, how long does it last, how to keep it in the hole and what to do if it falls out - read our article.

How is a blood clot formed in the hole and why is it needed?

Tooth extraction can be summarized in four stages:

treatment of the cavity around the tooth: cleaning, disinfection;
local anesthesia or general anesthesia;
direct tooth extraction;
wound treatment, suturing is possible.

After a tooth is removed from the wound, blood inevitably begins to flow, and the patient is asked to bite on a swab or gauze napkin (see also: what does the gum usually look like after tooth extraction?). Profuse bleeding lasts 20-30 minutes, in rare cases - about an hour. Until the blood stops, the tampon must be changed periodically so as not to provoke the development of harmful bacteria. It will not be possible to completely stop the bleeding: the wound will continue to secrete a small amount of blood and ichor for about a day.

Important! If a large dose of anesthesia has been administered, then due to vasoconstriction, bleeding may begin only after a few hours - this is normal, but slows down the entire healing process as a whole.

After the bleeding stops, a dark red or burgundy thrombus begins to form at the site of the extracted tooth. It takes 1-2 days to fully form.

The absence of a blood clot in the wound is called dry socket syndrome, which leads to a serious inflammatory process - alveolitis. You can distinguish the usual consequences of an extracted tooth from the symptoms of alveolitis by comparing the appearance of the hole in a photo or the following signs:

Pain and swelling in the operated area usually lasts 1-2 days, is aching in nature and gradually subsides. With alveolitis, the pain becomes acute, increases and moves to neighboring areas, and swelling can capture a large part of the oral cavity, making it difficult to move.
After tooth extraction, the temperature may rise slightly (more in the article: what to do if the temperature rises after the removal of a wisdom tooth?). With alveolitis, the fever rises above 38 degrees, and other symptoms of intoxication also appear: weakness, aching limbs, dizziness.
The first days, the hole may smell unpleasant due to the accumulated blood. With alveolitis, the smell becomes stronger and gives off rot.

Normal healing of the hole: description of the process, photo

Under normal conditions, the hole heals completely within 4-6 months. The stages of healing are approximately determined, since the duration of the process depends on many factors: the condition of the teeth and gums, the experience and qualifications of the doctor, the characteristics of the body and the patient's actions after the operation. The healing process can be seen in the photo.

First day: a blood clot forms at the site of the extracted tooth. It serves as a kind of barrier against bacteria and mechanical influences. Further healing of the hole depends on the formation of a clot.
First week: Formation of granulation tissue begins. Within two days, the thrombus is covered with a whitish film, which may alert the patient, but this plaque does not need to be removed. If the film acquires a green or yellow tint and smells strongly of rot, you should consult a dentist.
First month: the formation of the epithelium and bone structures begins. The blood clot dissolves, and the wound is covered with new tissue. Bone cells become visible, which completely fill the hole within 1-2 months.
After 4-6 months, the bone tissue is completely formed, compacted and finally merges with the jaw. The healing process is much more complicated and slows down if at the first stages the blood clot has shifted or washed out of the hole.

How to keep a clot in the hole and what to do if it falls out?

Alveolitis occurs on average in only 3-5% of cases, however, when wisdom teeth are removed, the probability of complications reaches 30% (we recommend reading: how many days does gum pain persist after wisdom tooth removal?). The place of the extracted tooth becomes inflamed and festering, because of which the patient experiences acute pain and symptoms of intoxication of the body: weakness, dizziness, fever.

To prevent the clot from falling out, you must adhere to the following rules:

Do not rinse your mouth for the first 2-3 days (see also: Should I rinse my mouth with anything after a tooth extraction?). On the recommendation of a doctor, it is permissible to make antiseptic baths, holding a slightly warm liquid in your mouth and spitting gently.
Do not touch the site of the extracted tooth. Avoid touching the clot with a fork, toothpick, or tongue. On the first day, it is recommended not to even brush this area with a toothbrush.
Avoid active physical activity. It is also recommended to limit your facial expressions and move your mouth muscles with extreme caution. If stitches are applied, they can disperse from sudden movements.
Avoid exposure to heat. Do not visit the sauna and bath, do not consume hot drinks and food.
Refrain from alcohol and smoking for at least 1-2 days.
Follow a diet. For the first 2-3 hours after surgery, do not eat at all, after which you should only eat soft, warm foods.
Observe hygiene. Use a soft brush in the morning, evening and after every meal. Near the blood clot, clean especially carefully.
Do not drink through a straw. It is widely believed that food and liquids are best consumed through a straw after tooth extraction, but suction may dislodge the clot.

If a blood clot still fell out, then you need to contact your dentist. The doctor will clean the hole from the remnants of the clot and food, treat it with an antiseptic and fill it with a special agent - iodoform turunda, which will need to be changed every 4-5 days. There is also a secondary clot method: if the inflammatory process has not yet begun in the hole, then it is processed (scraped out) so that bleeding begins and a new clot forms.

Blood clot after tooth extraction: what the patient needs to know

A blood clot after tooth extraction appears on the first day and plays an important role in the wound healing process. What does the hole look like after extraction, what is necessary and what is not recommended to do in the postoperative period?

Briefly about the procedure

Tooth extraction is a serious full-fledged operation that takes place in several stages:

treatment of the area to be operated on,
administration of an anesthetic drug.

Modern anesthetics are in carpules - these are special ampoules in which, along with an anesthetic drug, there is a vasoconstrictor. This combination of drugs helps to reduce the amount of blood that is released from the wound after surgery.

After the anesthetic begins to take effect, the surgeon proceeds to extract the tooth from the socket. To do this, it is necessary to loosen the ligament that fixes the tooth. Sometimes a scalpel is used for this.

The final stage is the treatment of the wound. The lacerated wounds are sutured. If the wound does not need to be sewn up, the doctor applies a swab dipped in a hemostatic drug over it. It must be clamped with teeth for 20 minutes.

What happens after the operation?

3-4 hours after the operation, the anesthetic continues to act, the patient either does not feel pain at all, or feels it weakly. Blood is released from the wound for several hours, and then exudate with blood. After removing the eights, exudate may be released throughout the day, since the operated area during the removal of wisdom teeth is more extensive than the others.

Do not worry if in the first few days after the operation you have an unpleasant smell from the wound, this is normal. Blood accumulates in the hole, it is impossible to rinse the wound, so bacteria accumulate in it. This is what causes the odor. You should not worry about this if the general condition is normal, the body temperature is not elevated and there are no other alarming symptoms.

You can talk about an uncomplicated course of healing of the hole if:

no exudate is released from the hole, if you press it,
the pain is aching in nature and gradually disappears,
general condition and body temperature are normal,
puffiness of the cheek does not increase,
after 2-3 days, the bleeding from the wound stops.

How does the wound heal?

After extraction of the tooth, the hole heals for a long time even without complications. This is a lengthy process that can take from several weeks to several months:

on the second day after the operation, a blood clot appears in the wound, which protects tissues from infection and damage,
if the recovery process goes without complications, granulation tissue is formed on the 3-4th day,
the next week - the active formation of layers of the epithelium in the hole, the blood clot is displaced by granulation tissue. Primary bone formation occurs
after 2-3 weeks, the clot is completely replaced by the epithelium, bone tissue is clearly visible along the edges of the wound,
the formation of young tissue takes 30-45 days,
approximately two months later, the hole is completely overgrown with bone (osteoid) tissue saturated with calcium,
by the end of the 4th month after extraction, the young bone tissue “grows up”, its structure becomes porous,
after the completion of bone formation, the wound resolves by 1/3 of the root length.

After the operation, the gum sags (atrophies), this process lasts from 6 months to a year.

What influences the rate of healing?

The above terms are relative and individual, since the rate of tissue repair is affected by many factors. factors:

surgeon qualification,
the state of the root system,
hygiene quality,
condition of periodontal tissues.

After the extraction of a diseased tooth (in the stage of exacerbation of dental diseases), the restoration is delayed. The healing process is also delayed after lacerations, which often happens when removing eights.

It is important that the surgeon carefully treats the wound after surgery and cleans it of tooth fragments. Otherwise, fragments of enamel will prevent the formation of a blood clot, which will eventually cause inflammation and significantly delay the healing of the wound.

Some patients may develop alveolar bleeding. This is due to problems with blood clotting, as well as arterial hypertension. In this case, it is necessary to normalize blood pressure in order to stop the bleeding.

Alveolitis

All of the above adverse factors lead to the development of complications - alveolitis. This is an inflammatory process in the hole, which develops due to the penetration of infection into it. Most often, alveolitis occurs after a blood clot is washed out of the wound. In some cases, a clot does not form at all.

Usually, inflammation begins 1-3 days after surgery, if the patient rinses his mouth. Under the pressure of the liquid, the clot is washed out of the wound, leaving it unprotected. In this case, inflammation occurs almost always. Symptoms alveolitis:

increasing pain that gradually spreads to nearby tissues,
as the inflammatory process progresses, symptoms of general intoxication of the body appear: body aches, weakness, temperature may rise,
swelling from the gums extends to neighboring tissues,
the gum mucosa turns red, after which it may acquire a bluish tint due to stagnation of blood,
due to the ingress of food debris into the wound, an unpleasant putrefactive odor from the mouth often occurs.

How to care for the hole after surgery?

The main condition for normal healing is the formation of a full-fledged blood clot in it, which protects the hole from infection and damage. The main task of the patient is to keep the blood clot in place. For this you need:

don't blow your nose
very carefully brush your teeth near the operated area,
refrain from smoking
instead of rinsing, do oral baths,
follow a diet
avoid contact with the wound (do not touch it with your tongue, brush, toothpicks),
refrain from brushing your teeth on the day of extraction.

Other complications

In most cases, all complications after extraction develop due to an infection that has entered the well for various reasons. It can be:

A blood clot does not form in the hole, which delays the healing time and can cause alveolitis. In most cases, such a complication develops due to the fact that the patient actively rinses his mouth after surgery and simply flushes the blood clot from the wound. If you find yourself with a dry socket, see your doctor as soon as possible.

This is a serious complication of alveolitis, when the inflammatory process passes to the jaw bone. Treatment is carried out in a hospital.

You can damage the nerve when removing teeth with a large root system. In this case, the area of the cheek, palate, tongue, which are adjacent to the site of the extracted tooth, become numb and lose sensitivity.

Treatment involves taking B vitamins and drugs that stimulate the transmission of signals from the nerves to the muscles.

Complications rarely develop, treatment involves excision of the neoplasm.

After tooth extraction, do not delay with the choice of prosthetics method, since the absence of even one tooth negatively affects the condition of the entire dentition.

Blood clot after tooth extraction: features of the healing of the hole

Tooth extraction is a surgical intervention with the formation of a wound after extraction, therefore, as after any intervention, the wound formed in place of the tooth must also undergo a healing process, and its tissues must recover and fill the voids. This process takes 4 months. The stages of healing of the tooth socket are as follows:

immediately after removal, a blood clot forms;
2-3 day - the epithelialization of the hole begins;
3-4 day - the first signs of the formation of granulation tissue appear;
Day 7-8 - a part of the blood clot is replaced by granulations, gum cells begin to form an epithelial layer; the process of bone formation begins;
14-18 days - granulation tissue completely fills the hole, and the hole itself is completely covered with new epithelium. On the walls of the hole, new bone cells are actively formed;
1-2 months - active process of bone tissue formation;
2-3 - filling the hole with bone tissue; tissue saturation with calcium;
4 month - bone formation ends, the structure becomes spongy.

Read also: Extraction of 8 tooth from above: uncomplicated cases and impacted wisdom teeth

If, when a tooth is removed, a blood clot does not form in the hole, the healing process of the hole occurs due to its walls - it is they that contribute to the development of granulation tissue. Otherwise, the further stages of healing are the same as described above.

Healing after extraction of an inflamed tooth

We have described a 4-month tissue repair process, however, tissue regenerates so quickly only if there has been no trauma, inflammation, or infection in the tooth and its surrounding tissues. If these processes take place, tissue regeneration does not proceed so quickly. As a rule, it is prevented by the formation and course of the inflammatory process, the terms increase and the stages of healing look like this:

epithelialization and formation of granulation tissue occur after 10-15 days instead of 3-5 days;
the formation of bone tissue begins only on the 15th-16th day instead of the 7th-8th.
the closure of the hole by the epithelium is 2 times slower and ends only on the 30th or 50th day;
only for 2 months, the hole is completely filled with osteoid cells, which then become a full-fledged bone;

The process of formation of the epithelium and bone can be even longer if the walls of the socket and / or gum tissue were severely damaged during the extraction of the tooth.

Since tooth extraction is a surgical intervention, after its implementation, unpleasant consequences can occur - complications of various kinds. At the same time, the causes of such complications can be both the patient's negligence in hygiene after the operation, and the incorrect actions of the surgeon. Another category of etiology of adverse effects is the complex course of the operation (with increased bone strength, non-standard shape or size of the tooth root).

Alveolitis often formed when, after removal, a blood clot does not form in the well for some reason. Without a clot, the socket is devoid of a protective barrier from external influences and is therefore susceptible to the appearance of an inflammatory process. The first and main symptom of this disease is pain immediately after removal or after 2 days. There is swelling of the gums, inflammation of the edges of the hole, due to the fact that a blood clot has not formed, the cavity is filled with food, which further contributes to the development of the inflammatory process. Other characteristic signs: temperature, unpleasant odor from the hole, feeling unwell, pain and swelling of the mucosa at the site of extraction.

The etiology of the development of alveolitis is considered to be an infection caused by the entry of oral microbes into the hole. The body is not able to form a protective barrier in the hole, so inflammation develops rapidly in it.

There are such causes of alveolitis:

chronic course of inflammation in the tissues of the oral cavity, its exacerbation;
a high degree of tissue trauma due to complex tooth extraction;
the blood clot did not form during or after the operation (for example, due to the patient's violation of the doctor's recommendations);
disorders in the immune system, chronic fatigue, chronic diseases;
long removal process (longer than 40 minutes).

Depending on the severity of the course of alveolitis, both local and general treatment can be prescribed. Topical methods are usually applied using antiseptic rinsing and treating the well with an antimicrobial agent. In addition to such treatment, vitamins and antibiotics may be prescribed.

In the case of general treatment, physiotherapy is also added, and the total period of treatment and healing of the hole is increased.

Bleeding can occur both immediately after the operation, and some time after the operation: from 1 hour to 24 hours or more. The period of manifestation of alveolar bleeding varies from the causes that cause it. An earlier manifestation may be caused by vasodilation, later due to injury to the well by the patient after the operation. However, the etiology of the complication may also include trauma during removal (gums, alveoli, blood vessels) and diseases of the body (sepsis, hypertension, leukemia, the first 2 days of the menstrual cycle in women, taking aspirin and its analogues, diabetes).

The process of preventing bleeding depends on what causes it: local causes are eliminated by suturing the gaps or applying cold, using a tampon. If bleeding is caused by low blood clotting, medications are used to increase clotting.

Sometimes after the extraction of a tooth, the patient complains of numbness in the oral cavity. Symptoms can be expressed in the period from 1 to 30 days or even more. The cause of paresthesia lies in nerve damage. Dentists can speed up the recovery of damaged tissues by prescribing vitamins B and C to the patient in combination with injections of galantamine and dibazol.

Adjacent teeth change position, Popov-Gordon effect

The body does not tolerate emptiness, therefore, after the extraction of a tooth and a long absence of an analogue in its place, neighboring teeth (and a tooth on the opposite jaw) tend to fill the resulting space, leaning towards the hole. Obviously, in such a situation, the dentition changes, which leads to curvature, a change in chewing load and bite.

The problem can be solved by replacing the missing tooth with an analog after the hole has healed and tissues have been restored: an implant, a prosthesis.

Communication of the oral and nasal cavities

When extracting maxillary molars and premolars, the floor of the maxillary sinus can be traumatized, resulting in a connection between the oral cavity and the nasal cavity.

It is noteworthy that this complication occurs even if all actions were performed correctly on the part of the dentist. Its causes are usually:

lack of a bony septum or close adherence of the roots to the sinus;
bone destruction due to chronic inflammation in the area of the apex of the tooth root;

The complication requires surgical intervention by a specialist, since food and drink entering the nose through the oral cavity usually leads to inflammation in the sinus (sinusitis), which in itself is a very unfavorable consequence and requires a long and complicated treatment.

Intervention is not carried out only if acute purulent sinusitis of the upper jaw has developed.

Other complications lead to: incorrect actions of the doctor and the characteristics of the patient's body.

improper use of forceps and, as a result, damage to the crest of the alveolar tissue;
erroneous extraction of the tooth germ due to the ignorance of the doctor during the extraction of the milk;
injuries of adjacent teeth due to the careless work of a dental surgeon;

weak or defective adjacent teeth may break during surgery on the causative tooth;
low strength of the causative tooth, which is the reason for its fracture and the need to remove parts;
weak jaw tissues, which increases the risk of fracture and complications;
individual features of the structure of the roots, jaw and location of the nerves.

To prevent the occurrence of complications due to the fault of the patient, it is very important to follow all the instructions of the dentist, namely:

The first day after the operation: keep the installed tampon in the mouth for 30 minutes, do not eat for 2 hours; do not load food and do not touch the area of \u200b\u200bthe hole with the tongue and toothbrush;
2-3 days after the operation, minimize the load on the teeth located in the extraction zone, limit the intake of hard and hot food, giving preference to soft and liquid;
Refrain from smoking (to prevent a vacuum in the hole) and try not to take alcoholic beverages;
Buy a soft toothbrush for gentle cleaning of the area of the extracted tooth a few days after the operation, in the first days it is better not to clean the injured area at all;
The next day after the operation, make oral baths for the hole (in no case rinse) from warm salted water (but not with special rinses).
Do not exercise for 2-3 days;
Do not take a hot bath on the first day after removal;
Do not take aspirin or its analogues.

Alveolitis after tooth extraction: treatment

From this article you will learn:

why does the hole hurt after tooth extraction,
what is alveolitis: photo and video,
How is alveolitis treated?

The article was written by a dental surgeon with more than 19 years of experience.

Alveolitis is a classic complication that occurs after tooth extraction, and consists in the development of inflammation of the socket of the extracted tooth. Often, alveolitis is also called the term "dry socket" (this is due to the fact that the alveolar bone is exposed in the depth of the hole, due to the loss of a blood clot).

On average, alveolitis after tooth extraction develops in 3-5% of cases, but this applies to teeth of any localization, with the exception of wisdom teeth. When the latter are removed, alveolitis occurs already in 25-30% of cases, which is associated with the greater complexity and trauma of the removal process.

Dry socket after tooth extraction: photo

About how the normal healing of the hole should look like (at different times from the moment of removal) - you can see in the photo in the article:
→ "What should the hole look like after tooth extraction"

Alveolitis after tooth extraction: symptoms

As for the general symptoms, since alveolitis is not an acute inflammatory process, it usually does not cause fever or inflammation of the submandibular lymph nodes. However, with its prolonged course, patients often feel weak, fatigued, and the temperature may rise (but not higher than 37.5 degrees).

With the development of alveolitis, pain usually occurs 2-4 days after removal, and can last from 10 to 40 days - in the absence of qualified treatment. Sometimes the pain is so severe that even very strong analgesics do not save. In addition, almost all patients report bad breath, bad taste in the mouth.

By the way, if the alveolar bone is exposed, then it is usually extremely painful when touched, as well as when in contact with cold or hot water. In some cases, the edges of the mucous membrane converge so closely to each other above the hole that it is completely invisible what is happening in its depth. But when washing such a well from a syringe with an antiseptic, the liquid will be cloudy, with a large amount of food residue.

Dry socket after wisdom tooth extraction

Alveolitis after the removal of a wisdom tooth may, in addition, have several more symptoms (in addition to those listed above). We are talking about difficulty opening the mouth or painful swallowing. Also due to the fact that the hole of the 8th tooth is usually located deep in the soft tissues - suppuration from the hole develops there more often (see video 2).

Alveolitis: video

In video 1 below, you can see that there is no blood clot in the hole, the bone is exposed there, and also in the depth of the hole is filled with food debris. And in video 2 - alveolitis of the lower wisdom teeth, when the patient presses his finger on the gum in the region of 7-8 teeth, and copious purulent discharge comes from the holes.

Dry socket after tooth extraction: causes

There are many reasons why alveolitis develops. It can occur due to the fault of the doctor, and the fault of the patient, and for reasons beyond anyone's control. If we talk about the responsibility of the patient, then alveolitis can occur when -

poor oral hygiene,
the presence of untreated carious teeth,
due to smoking after removal,
when ignoring the recommendations of a doctor,
if you rinsed your mouth strongly and simply rinsed out the blood clot from the hole.

Also, alveolitis can occur in women due to the increased content of estrogen in the blood during the menstrual cycle or as a result of taking oral contraceptives (birth control pills). A high concentration of estrogen leads to fibrinolysis of the blood clot in the hole, i.e. to degradation and destruction of the clot.

It is precisely because of fibrinolysis that the blood clot is destroyed both with poor oral hygiene and in the presence of carious teeth. The fact is that pathogenic bacteria that live in large numbers in the composition of dental deposits and in carious defects secrete toxins, which, like estrogens, lead to fibrinolysis of the blood clot in the hole.

When alveolitis occurs due to the fault of the doctor –

If the doctor left a tooth fragment, bone fragments, inactive fragments of bone tissue in the hole, which lead to injury to the blood clot and its destruction.

Large dose of vasoconstrictor in anesthetic
Alveolitis can occur if a doctor injects a large volume of an anesthetic with a high content of a vasoconstrictor (such as adrenaline) during anesthesia. Too much of the latter will cause the hole to simply not fill with blood after the extraction of the tooth. If this happens, the surgeon must scrape the bone walls with an instrument and cause alveolar bleeding.

Due to a large bone injury during removal -
As a rule, this happens in two cases: firstly, when the doctor cuts out the bone with a drill, without using water cooling of the bone at all (or with insufficient cooling). Overheating of the bone leads to its necrosis and the start of the process of destruction of the clot.
Secondly, many doctors try to remove a tooth for 1-2 hours (using only forceps and elevators), which cause such bone injury with these tools that alveolitis simply must develop. An experienced doctor, seeing a complex tooth, sometimes immediately cuts the crown into several parts and removes the tooth fragment by fragment (taking only 15-25 minutes for this), and thereby reduces the injury caused to the bone.

If, after a complex removal or removal against the background of purulent inflammation, the doctor did not prescribe antibiotics, which in these cases are considered mandatory.

Conclusions: thus, the main causes of the destruction (fibrinolysis) of the blood clot are pathogenic bacteria, excessive mechanical trauma to the bone, and estrogens. Reasons of a different nature: smoking, a clot falling out while rinsing the mouth, and the fact that the hole did not fill with blood after the extraction of the tooth. There are also reasons that do not depend on the patient or the doctor, for example, if a tooth is removed against the background of acute purulent inflammation - in this case it is foolish to blame the doctor for the development of alveolitis.

Treatment of alveolitis -

If alveolitis develops in the hole after tooth extraction, treatment at the first stage should be carried out only by a dental surgeon. This is due to the fact that the hole can be filled with necrotic disintegration of a blood clot, there may be inactive fragments and fragments of a bone or tooth. Therefore, the main task of the doctor at this stage is to scrape it all out of the hole. It is clear that no patient can do it on his own - it will not work.

Antiseptic rinses and antibiotics (without cleaning the socket) - can only temporarily alleviate the symptoms of inflammation, but do not lead to healing of the socket. But at a later stage, when the inflammation in the hole subsides, patients will already be able to independently treat the hole with special epithelial agents to speed up its healing.

Thus, the main method of treatment will be curettage of the hole, but there is also a second technique - by creating a secondary blood clot in the hole of the extracted tooth. Learn more about these methods...

1. Curettage of the tooth socket with alveolitis -

Under anesthesia, a festering blood clot, food residues, and necrotic plaque are removed from the walls of the hole. Without removal of necrotic plaque and disintegration of the blood clot (containing a huge amount of infection) - any treatment will be useless.
The well is washed with antiseptics, dried, after which it is filled with an antiseptic (iodoform turunda). Usually every 4-5 days the turunda needs to be changed, i.e. you will have to go to the doctor at least 3 times.
The doctor will prescribe you antibiotics, antiseptic baths, and painkillers - if necessary.

Doctor's appointments after curettage of the tooth socket –

NSAID-based analgesics (for pain),
0.05% Chlorhexidine solution for antiseptic rinses (2-3 times a day for 1 minute),
Antibiotics: either Amoxiclav 625 mg tablets (2 times a day for 5-7 days) or Unidox-solutab 100 mg (2 times a day for 5-7 days) are usually prescribed. These antibiotics are better, but not cheap. Of the inexpensive ones, Lincomycin 0.25 capsules (2 capsules 3 times a day), but keep in mind that after this antibiotic, problems with the stomach and intestines develop more often.

2. Method for creating a secondary blood clot -

However, there are 2 situations in which a different treatment method can be used. This method involves the creation of a secondary blood clot in the hole and, accordingly, if successful, the hole will heal much sooner than after the constant laying of iodoform turundas in it for 2-3 weeks. It is preferable to use this method only in the following two situations...

Firstly, when you went to the doctor immediately after, for example, you rinsed out the clot from the hole or it fell out by itself (i.e. when the hole is not yet filled with infection and food debris, and there is no necrotic clot decay in it or suppuration). Secondly, when the patient has a sluggish alveolitis for an already long period of time, and the hole is filled with inflammatory granulations.

How this technique is carried out
if the hole is empty, then under anesthesia, the bone walls of the hole are scraped with a curettage spoon to create bleeding and the hole is filled with blood (video 3). If the well is filled with granulations, then they are carefully scraped out, i.e. do the same curettage (video 4). Further, in both cases, after the hole is filled with blood, an anti-inflammatory drug (Alvogel) is placed deep into the hole, and several sutures are applied to the mucous membrane to bring the edges of the wound closer together. Antibiotics are prescribed immediately.

Curettage to create a secondary blood clot: video 3-4

Summary: those. both in the first and in the second methods, curettage of the well is carried out in the same way, but in the first case, the well heals slowly under iodoform turundas, and in the second case, a blood clot forms in the well for the second time, and the well heals, as it should do under normal conditions .

What can be done at home -

After the acute symptoms of inflammation subside, there is no need for antiseptic turundas inside the hole, because. they do not help the wound heal faster (epithelialize). At this stage, the best method of treatment will be to fill the hole with a special Dental Adhesive Paste (Solcoseryl). This drug has just an excellent analgesic effect (after 2-3 hours the pain will practically stop, and after 1-2 days it will disappear completely), and it also accelerates healing many times over.

Usage scheme -
in the hole washed with an antiseptic and slightly dried with a dry gauze swab, this paste is introduced (completely filling the hole). The paste is perfectly fixed in the hole, does not fall out of it. It is not necessary to remove the paste from the hole, because. it slowly dissolves itself, giving way to growing gum tissue. The only thing that may be required is to periodically report it to the hole.

How to rinse the well from food debris -

In some situations (when the turunda has fallen out of the hole, and there is no way to immediately consult a doctor), it may be necessary to wash the hole. After all, after each meal, the hole will become clogged with food residues that will cause new inflammation. Rinsing will not help here, but you can easily rinse the well with a syringe.

Important: at the syringe from the very beginning it is necessary to bite the sharp edge of the needle! Next, bend the needle a little, and fill a 5.0 ml syringe with a 0.05% Chlorhexidine solution (it is sold ready-made in every pharmacy for 20-30 rubles). Screw the needle tightly so that it does not fly off when you press the syringe plunger! Place the blunt end of the beveled needle at the top of the well (do not insert too deep to avoid tissue injury) and flush the well with pressure. If necessary, do this after every meal.

In principle, after that, the well can be dried with a gauze swab and treated with Solcoseryl. We hope that our article on the topic: Alveolitis after tooth extraction, symptoms, treatment - turned out to be useful to you!

Sources:

1. Higher prof. the author's education in surgical dentistry,
2. Based on personal experience as a dental surgeon,
3. National Library of Medicine (USA),
4. "Outpatient surgical dentistry" (Bezrukov V.),
5. "Propaedeutics of surgical dentistry" (Soloviev M.).

Hemostasis and care of the socket after tooth extraction

A successful operation to remove a tooth or root is not enough for a successful outcome of the operation. Many complications develop with improper care of the hole and the oral cavity in the postoperative period. The dentist is obliged to give recommendations to the patient and, if there is a lack of information, to teach the patient some elements of self-care, as well as to warn about possible complications if the doctor's recommendations are not followed.

The extracted tooth or root should be carefully inspected to ensure that it is completely extracted. Therefore, everything removed from the hole should be put on a separate napkin or in a tray, and not thrown into a spittoon. The hole is then inspected. With a small surgical spoon, the bottom and walls of the hole are very carefully examined without injuring the tissues. Freely lying fragments of the alveoli or fragments of the tooth are removed.

If softening is found at the bottom of the alveoli, which indicates the growth of granulations, they are scraped off the walls with very careful movements and removed from the hole. The sharp edges of the alveoli and the edges of the bone hole protruding above the gum are bitten with wire cutters, as they will interfere with healing and bring pain to the patient.

The use of adrenaline in a larger amount than necessary can lead to spasm of the periodontal vessels. In such a situation, bleeding in the hole is practically absent and a blood clot does not form. In this case, you can carry out a light curettage of the walls of the hole or pour a little penicillin powder into the hole, which will provoke bleeding.

After the revision of the hole, the gum is examined in the area of surgical intervention. In case of rough removal, if the removal technique is not followed, if the instrument accidentally slips, damage to the gums may occur. The detached tissues are carefully placed in place and, if necessary, reinforced with a simple interrupted suture. It is expedient to excise strongly crushed tissues.

After examining the well, the edges of it are brought together with little effort and a sterile gauze ball is applied over the well. The patient is offered to bite the ball and hold it for 10-15 minutes. You should not hold the ball more than this, since, having been saturated with saliva and discharge from the hole, it interferes with the formation of a blood clot and is a source of infection. If there are no signs of bleeding after removal of the ball, the patient can be released, giving him recommendations for oral care and scheduling a second visit after 3 days.

In the first 24 hours:

if there is bleeding:
- take a clean, damp piece of gauze, roll it up, put it on top of the hole, bite for 45 minutes;
- do not touch, move, or remove the blood clot from the socket. Otherwise, a "dry socket" may form;
- do not rinse your mouth and do not spit;
if after that within 2 hours the bleeding does not stop, then you should again consult a doctor;
do not rinse the wound, even if the taste of blood in the mouth is unpleasant, unless the doctor himself recommends doing it;
avoid hot soups and coffee;
do not smoke, do not take alcohol and do not expose yourself to heavy physical exertion for 48 hours;
with moderate pain, take painkillers - analgin, ketorol, nice, etc .;
before going to bed, add an extra pillow under your head to keep your head elevated;
take mostly semi-liquid, pureed food. Chew with the other side of your mouth. Avoid hot liquids - can cause the blood clot to dissolve;
do not brush your teeth near the hole. On the second day, resume proper hygiene, but very carefully. Do not use mouthwash;
if a tumor is present, alternately apply cold and warm gauze pads for 20 minutes;
If on the third day after surgery, pain suddenly reappears or swelling appears, you should immediately consult a dentist.

In the following days:

after eating and at night, rinse the mouth with a warm solution of antiseptics (dilute with boiled water): 1-2% sodium bicarbonate (1 tsp per glass of water); potassium permanganate (1:1000); furatsilina (2 tablets per glass of water), etc.;
if there are seams - do not touch! Some sutures are self-absorbing, others will be removed by the dentist after 7 days;
over time, the shape of the hole will round out and fill with bone tissue. It will take several months for complete healing, but you will no longer feel uncomfortable in your mouth after 1-2 weeks.

The patient must be warned about some complications!

"Dry Hole" is the most common complication. A "dry socket" appears when a blood clot failed to form in it or was washed out. Since the formation of a blood clot is an important part of the healing process, tightening of the socket is delayed. Usually the patient experiences a dull pain that disappears on the 3rd-4th day after removal. The intensity of the pain varies from moderate to severe. There is often a repulsive odor. In the case of a "dry socket", a visit to the dentist is mandatory. The doctor will place the medicine-soaked gauze on the wound to help relieve pain. The gauze pad will need to be changed every 24 hours until symptoms improve. This complication occurs more often in people over 30 and in heavy smokers.

Paresthesia. Nerves may be damaged during the removal process. As a result, there is numbness of the tongue and chin (paresthesia), cheeks and lips. The perception of paresthesia is similar to the sensation that occurs when the dentist gives you anesthesia, with the only difference being that it will not disappear in a few hours. Paresthesia is a temporary phenomenon, lasting from 1-2 days to several weeks. However, if the nerve has been severely damaged, the paresthesia may become permanent.

Bleeding. Currently, the problem of hemostasis after tooth extraction has not lost its relevance, despite the sufficient amount of hemostatic agents.

The cause of alveolar bleeding is more often a trauma to the bone tissue due to complex extraction of teeth or the removal of atypical tooth roots.

With alveolar bleeding, thrombin, a hemostatic sponge, caprofen, gelevin, chonsuride, iodoform turunda tamponade and other means are used. Gelevin and chonsuride are used according to the following method: after tooth extraction, revision of the hole and filling it with blood, 0.3-0.5 g of gelevin or 0.1 g of chonsuride are added to the hole with a spatula. Then the edges of the hole are squeezed with a gauze ball. With the ineffectiveness of gelevin or chonsuride, or in the presence of severe hole bleeding, it is advisable to introduce an oxycelodex prepared according to the instructions, or a Traumacel dental pin into the bleeding hole; one or two sutures can be applied to bring the soft tissues closer together at the edge of the hole. This allows you to stop alveolar bleeding in 100% of cases.

Healing of the hole after tooth extraction. Normally, after removal, the hole is filled with blood. As a result of vasospasm and thrombosis, bleeding stops after 3-7 minutes, and then a blood clot is formed. More observations of the great Russian surgeon N.I. Pirogov showed that the presence of a blood clot has a positive effect on the healing of a bone wound (the pain quickly subsides and completely disappears on the 2nd-3rd day, inflammatory complications rarely occur), and in the absence of a clot, healing proceeds more slowly and a number of complications occur.

The blood clot acts as a biological bandage, protecting the walls of the hole from infected saliva.

Research by A.E. Verlotsky showed that the healing of the surgical wound after removal proceeds as follows. From the side of the bottom and edges of the hole and the subepithelial layer of the gums, granulation tissue is formed, which grows into the blood clot and replaces it. On the 7-8th day, the granulation tissue completely fills the hole and ends with epithelialization. At the same time, the formation of bone tissue and resorption of the damaged bone begins. By the end of the 3rd week, the epithelium has a normal thickness. By the end of the 4th week, a wide-loop network of bone trabeculae is visible on the radiograph in the area of the extracted tooth. By the end of the 2nd month, the border between the wall of the hole and the bone regenerate is barely visible, the space between the bone trabeculae is filled with red bone marrow. After 6 months, the hole of the extracted tooth is no different from the surrounding tissue. But there is a decrease in the height and thickness of the alveolar edge of the jaw by approximately 1/3 of the original value.

This circumstance must be taken into account in the further replacement of the defect of the dentition with prostheses.

With a complicated course of a postoperative wound, the period increases significantly.

“Practical Guide to Surgical Dentistry”
A.V. Vyazmitina

Healing of the hole after tooth extraction

Tooth extraction may seem like a simple procedure, for which it is enough to pull out the diseased crown with forceps. In fact, this requires careful preparation and adherence to a certain algorithm of actions. The quality of tooth extraction is affected by the force applied by the dentist and the general condition of the patient's oral cavity.

After removal, a bleeding wound remains on the gum - a gum hole, which at first hurts and swells.

Pain and bleeding on the first day after the procedure is a normal reaction, but when the hole after tooth extraction does not heal for a long time, plaque forms and inflammation occurs, this is defined as alveolitis, which requires medical treatment. Normally, the hole heals completely after tooth extraction in a few days. But there are a number of reasons that can disrupt this process, causing complications in the area of the extracted tooth.

Recovery after tooth extraction

For normal healing of the tooth socket after extraction, certain rules of postoperative care should be followed. The list of recommendations for all patients is standard, only the names of the drugs that should be prescribed exclusively by the attending physician may differ. To eliminate toothache after a tooth has been pulled out, the use of folk recipes is allowed, unless they can cause allergies or irritation of the mucous membrane.

Normally, after the extraction of the tooth, a blood clot should form, which protects the socket from pathogens and prevents bleeding. But this process can be disrupted for various reasons, and a dry socket after tooth extraction increases the risk of infection entering the deep layers of the periodontium and bone tissue.

What to do for normal gum healing after tooth extraction:

stop smoking for at least a few hours after the operation;
take antihistamines and pain medications prescribed by your doctor;
while brushing your teeth, bypass the hole so as not to damage the blood clot;
for a few days to refuse too hot food;
try to chew on the healthy side;
wash the gums with antiseptic solutions;
do not rinse your mouth strongly so as not to wash the clot.

Why does the hole hurt

The healing of the hole after tooth extraction is accompanied by pain for some time. In dentistry, good painkillers are used, therefore, during the operation, the patient does not feel anything, but after a few hours, moderate aching pain appears. The duration of this symptom will depend on the degree of gum trauma during tooth extraction.

With difficult removal, the mucosa can be significantly damaged, therefore, during the recovery period, it is necessary to use anesthetic dental gels and take anti-inflammatory pills. This also applies to the removal of a wisdom tooth, which is difficult to reach, because the removal takes place in several stages with significant damage to the soft tissues.

Pain for 1-3 days after treatment is normal. If the symptom persists for a week or longer, an urgent need to go to the doctor for treatment.

The main cause of pain will be the development of alveolitis - inflammation of the socket of the extracted tooth. This complication can occur with a mild degree of severity of symptoms, less often there is abundant formation and discharge of pus from the wound, the cheek swells strongly and signs of general intoxication appear.

Alveolitis

After the removal of a molar tooth, you may encounter such a problem as alveolitis. The condition is characterized by inflammation of the gums, absence of a blood clot, swelling, and pain. The violation is accompanied by infection of the tissues, the color of the hole changes, the body temperature rises less often and bleeding from the wound occurs.

Why, after tooth extraction, there is no clot in the hole and inflammation begins:

trauma to the walls of the hole, which often occurs when wisdom teeth are removed;
thermal effect on the gum immediately after surgery;
active rinsing of the mouth, washing out the clot;
brushing your teeth too hard on the first day;
weakened immune defense, acute infection at the time of surgery;
blood clotting disorder;
ignoring the rules for caring for the well after treatment.

The first manifestations of alveolitis are more often observed 2-3 days after tooth extraction. The resulting wound may begin to bleed, but not always. More often, the main symptoms are severe pain, swelling of the gums and general weakness due to intoxication of the body.

How else alveolitis appears:

serous form. Constant aching pain in the area of the removed crown, fever to subfebrile. General well-being does not suffer much. On examination, the doctor sees the absence of a blood clot, tissue hyperemia, food debris in the hole. This stage proceeds within 2-3 days, then becomes complicated.
Purulent form. Severe pain, putrid breath, fever to febrile. Weakness, malaise, lack of appetite accompany for 1-3 days, then the process becomes chronic.
Chronic form. The general condition is normalized, but there is weakness and body temperature of 37-37.5 degrees. The tissues are swollen, there is aching pain and a feeling of pulsation of the gums. There is a release of pus from a partially overgrown hole. The color of the hole becomes cyanotic. There is pain when chewing and opening the mouth.

For the treatment of alveolitis, the doctor will prescribe anti-inflammatory drugs, analgesics, antibacterial agents and antiseptics to wash the inflamed hole. When there are pains of a neurological nature, Finlepsin is indicated, with long-term treatment with antibacterial agents, Omez or Omeprazole is additionally prescribed. A surgical operation may be required when the pus that has accumulated in the hole does not come out, but compresses the surrounding tissues. This threatens its exit inside, infection of periodontal tissues and bones.

Other complications

Alveolitis may be accompanied by bleeding, hematoma, tissue infection, cyst formation, and flux. Each condition is dangerous in its own way and requires a separate approach to treatment. Their self-treatment at home is permissible, but only after the examination of the dentist and the prescription of drug therapy by the doctor. The risk of developing consequences increases when the tooth was pulled out urgently against the background of acute inflammation and a purulent focus.

Features of various complications after extirpation:

cyst- is formed due to chronic inflammation without treatment, at the initial stage it is eliminated with medication, later surgical removal may be required;
flux- occurs due to infection of tissues during or after extraction, first soft tissues are affected, and then the periosteum;
hematoma- occurs when the vessel is injured during the operation, the tissues become cyanotic, swell, there is a feeling of bursting;
bleeding- also the result of a vessel injury and problems with blood clotting, the condition is not dangerous, it occurs immediately after treatment and the doctor quickly fixes the problem.

Normal gums can heal for about a week, after extraction of the figure eight - up to 14 days, with complex removal of molars - 10-14 days.

The state of the immune system will also affect how long the gum heals after surgery. A weakened body does not respond well to any surgical intervention, and may not be able to cope with the infection.

What to do with a dry hole

The first thing to do after accidentally removing a blood clot is to see a doctor. This will ensure that there are no serious complications that require immediate surgery. After that, you need to follow the treatment prescribed by the doctor, additionally resorting to traditional medicine recipes that will help improve overall well-being and anesthetize the gums.

When the serous stage has passed, and the dentist is already observing a purulent process, curettage of the hole will be performed.

Under local anesthesia, the gums are incised, the purulent contents are removed and the wound is washed. The doctor leaves an antiseptic in the hole, so you will need to go to an appointment to change the turunda every 3-5 days. After the procedure, the dentist will prescribe medications to be taken at home.

To create a blood clot, the doctor provokes bleeding by scraping the hole. If it is filled with granulation, curettage is performed. In each case, bleeding will occur and a clot will form. The doctor may then apply several stitches to bring the edges of the wound closer together. After that, the gums will still hurt for some time, but not as much as with purulent inflammation.

After curettage, the doctor prescribes painkillers based on anti-inflammatory drugs and an antiseptic solution for washing the mouth 3 times a day after meals.

How to eliminate the consequences of the operation at home:

apply a dental anesthetic gel to the gum;
after the inflammation subsides, stop rinsing your mouth;
take an anesthetic during a period of severe pain;
avoid eating dry food (crackers, chips);
rinse your mouth with soda-salt solution after eating;
apply a cotton swab dipped in clove oil to the gum.

How to remove inflammation and pain

The best option for eliminating inflammation with swelling of the gums is the use of dental gels. They contain anti-inflammatory and analgesic components, and also disinfect the wound. Gels will also help when an ulcerative lesion has formed as a result of infection or injury to the mucosa.

Which gel is suitable for gum treatment after dental treatment:

Holisal- anesthetizes, relieves inflammation, destroys bacteria, begins to act in a few minutes, cooling diseased gums;
Metrogil Denta- one of the safest, acts superficially, is absorbed in small quantities, therefore it is used in pediatric dentistry;
Kamistad- not the most powerful analgesic, contains chamomile extract and lidocaine hydrochloride;
Asepta- is not a drug, has an anti-inflammatory and antimicrobial effect, contains propolis and is significantly inferior in effectiveness to other gels.

In addition to dental gels, other effective remedies can be used - Forest Gum Balm, Malavit.

It is not recommended to use gels and tablets of your choice if they have already been prescribed by a dentist. They differ in action and composition, and some may be completely useless in alveolitis or other complication of extirpation.

When everything goes fine after removal, there is no inflammation and a blood clot is formed, you don’t need to constantly think about how to speed up healing and fanatically rinse your mouth with an antiseptic and lubricate the gums with gel. This will not help, but will contribute to the violation of the microflora, which will then lead to gingivitis or stomatitis.

The dentist should be aware of the presence of health problems before any procedure, even if they seem insignificant. Extraction of teeth, like any other surgical intervention in the oral cavity, has contraindications.

in the first few days after the operation, refuse heavy physical work;
avoid overheating of the face from the side of the hole of the extracted tooth;
try not to smoke for the first 24 hours;
give up alcohol so as not to provoke bleeding;
during the day to exclude visiting the bath.

The risk group for the appearance of alveolitis or dry socket includes smokers, women taking oral contraceptives, patients with diabetes mellitus. People with bleeding disorders are susceptible to bleeding. Inflammation occurs in patients who ignore the rules of hygiene in the postoperative period.

Dry socket syndrome (alveolitis) is the definition of a disorder where a blood clot does not form after tooth extraction.

This is dangerous because it is accompanied by bleeding and the risk of infection. A complication is possible for two reasons, when a clot does not form at all, and when it falls out after a while.

What does it look like?

The hole may be partially or completely filled with food particles and necrotic tissues from the collapse of a blood clot.

On visual inspection, the alveolitis looks like an empty hole.

It can be partially or completely filled with food particles and necrotic tissues from the collapse of a blood clot.

Pain is felt when touched, especially if the alveolar bone is exposed.

Often the edges of the hole converge so that you can not see its contents. When washed, a cloudy liquid with food residues comes out of it.

What does it mean?

Alveolitis occurs in 4-5% of cases, and after the removal of wisdom teeth in 25-30%. Such a violation indicates either a doctor's mistake, or systemic diseases, or non-compliance with the rules for caring for the well after extraction.

A large concentration of estrogen and toxins released by bacteria in the presence of carious cavities lead to the destruction of the clot (fibrinolysis).

What should be normal?

After tooth extraction, a blood clot forms in 2-3 hours. It prevents bleeding and protects tissues from infection.

It gradually dissipates. On day 3, granulation begins, followed by the growth of new epithelium. A week later, bone tissue begins to form. After a few months, it calcifies, and then there is a complete recovery.

The mechanism of formation of a blood bubble on the oral mucosa

Blood blisters in the mouth in most cases are not life-threatening. They are formed as a result of mechanical damage to the mucosa. When a microtrauma occurs, an attack of harmful microorganisms occurs on the damaged area.
See also: gum pain and swelling

After that, a number of response reactions are activated in the human body:

The immune system is activated. Monocytes and leukocytes, as well as macrophages, instantly arrive at the damaged site, attacking the harmful pathogen and quickly destroying it.
Immune cells are dying. This is a signal to other cells and substances are released in the affected area that are mediators of inflammation of the mucous membrane - serotonin, histamine and bradykinin.
These substances cause a strong spasm of the circulatory system and the outflow of blood is difficult. After the spasm is relieved, all the accumulated blood immediately flows to the site of inflammation. It moves at high speed and under pressure. In the mouth, the mucosal detachment occurs, and a bubble appears with bloody filling.

Symptoms

Dry socket symptoms after tooth extraction:

With alveolitis, the gum is inflamed, the hole is red, at the bottom you can see the exposed bone
2 days after extraction, inflammation of the gums occurs, pain increases;
there is an unpleasant smell and taste;
pain extends to the neck;
reversible hearing loss may occur.

With alveolitis, the gum is inflamed, the hole is red, and a bare bone is visible at the bottom. There may be a release of pus when pressed.

A few words about the procedure

Tooth extraction is a serious full-fledged operation that takes place in several stages:

treatment of the area to be operated on,
administration of an anesthetic drug.

Tooth extraction is a complete surgical procedure. The operation consists of four stages.

Treatment of the area around the tooth to be removed.
Anesthetic injections - ampoules in carpules, where the anesthetic is combined with drugs to narrow the vessels. Usually, local anesthesia is used in the exit zone of the nerve that innervates the problem tooth, if this is not enough, anesthetics are added without additional effect. When the drug is injected into the inflamed gum with an acidic environment, part of it is inactivated, so additional anesthesia is used.
Extraction of the tooth after the anesthesia has worked (the gums become numb, the vessels narrow). To cut off the ligaments that fix the tooth, use a scalpel. The choice of instruments and the duration of the procedure depend on the condition of the tooth.
Treatment of the oral cavity after removal: suturing (if the wound is torn or its edges are far apart) and a gauze swab soaked in a hemostatic agent (it must be kept in the teeth for 20 minutes, since the effectiveness of the hemostatic drug increases the compression of the wound). Do not rush to remove the tampon.

The bleeding itself from the hole does not carry a mortal danger. In medical practice, only one case of death was recorded when blood from the wound entered the respiratory tract, because the patient was intoxicated. Bleeding was complicated due to cirrhosis of the liver, which disrupts coagulation, in addition, the woman had three teeth removed at once.

Causes

Causes of dry socket can be:

blood clotting disorder;
improperly selected anesthesia;
severe tissue injury during extraction;
active rinsing of the mouth in the first days;
smoking immediately after the procedure;
a fragment of a tooth remaining in the hole;
poor washing of tissues, which leads to infection.

Important! If at the time of tooth extraction there are foci of infection in the oral cavity, this will become a factor in alveolitis. Before extraction, professional hygiene is mandatory and inflammatory processes are eliminated.

Characteristics of a blood bubble on the oral mucosa

The mucous membrane protects the entire body from the negative effects of the environment, from harmful microorganisms, various kinds of pollution, and also has a fairly high level of regeneration. If blood bubbles regularly appear on the oral mucosa, then this signal should be taken seriously and action taken.
A bloody ball in the mouth is a hematoma (bruise), which is characterized by the accumulation of blood in a certain place in the oral cavity. The appearance of bloody vesicles is a kind of hemorrhage that occurs as a result of trauma to the capillaries and thin vessels of the mucosa.

A bubble on the mucous membrane may be with a clear serous fluid without the presence of blood. This means that the vessels were not damaged, and the resulting wound is superficial. Such bubbles on the mucous membrane heal much faster. The presence of blood in the bladder indicates a deep injury and a longer period of its healing, blood resorption.

Possible shapes

The table shows the forms of alveolitis:

Associated symptoms

Dry socket may be accompanied by such manifestations as:

Heat- accompanies acute and purulent inflammation, a dangerous symptom that requires immediate dental care.
cheek swelling- speaks of the accumulation of pus, the development of a dangerous purulent form of the disease.
severe pain- an obligatory companion of alveolitis, increases with bone exposure and purulent inflammation.

Etiology of periodontal suppuration

The main source of the origin of the abscess include inflammation of the gums or periodontal disease. Swollen and bleeding gums are seen in the early stages of periodontal disease called gingivitis. The disease is also characterized by hypersensitivity of the teeth and the absence of pain.

Photo: external signs of an abscess on the gum with periodontitis

If the inflammatory process is ignored, the disease progresses, periodontal pockets form, inside which food residues, plaque, and calculus accumulate. These deposits provoke an increase in the activity of gram-negative and anaerobic bacteria, the gum begins to fester.

The accumulation of pus in periodontitis is limited to the area of one or two teeth within the infected periodontium. The gum breaks strictly at the top of the tooth root. With progressive periodontitis, pain symptoms are typical during palpation of the tooth and biting food, loss of appetite, fever.

The sources of an abscess at the root of the tooth can be:

caries;
pulpitis;
illiterately performed dental operations, including implantation of teeth;
tooth damage.

Treatment

Treatment methods will depend on the severity of the alveolitis:

Light- rinsing with antiseptics and anti-inflammatory agents.
Medium- taking antibacterial agents, filling the hole with medicine.
heavy- hospitalization, therapy, depending on the complications, recovery includes physiotherapy, ultraviolet irradiation.

Important! Antiseptic rinses and antibiotics only temporarily eliminate the symptoms of inflammation, so curettage (cleaning the hole) will be the only effective treatment.

Treatment at home

Treatment at home is carried out with a mild form of inflammation

Treatment at home is carried out with a mild form of inflammation.

For this, drugs Chlorhexidine, Miramistin, a solution of potassium permanganate are used.

Means the mouth is washed after each meal.

Additionally, you can use decoctions of chamomile, sage, calendula, oak bark.

The doctor may prescribe Solcoseryl dental paste. It has an analgesic effect and promotes the healing of damaged tissues.

It is introduced into the hole pre-washed with an antiseptic. The paste gradually dissolves, so it is not necessary to remove it. Periodically, it must be reported to the hole.

dental care

Stages of treatment of dry socket at the dentist:

Anesthesia.
Removal of food particles and necrosis from the well.
Washing with antiseptic.
Drying and filling the hole with iodoform turunda.

Important! Without removal of necrosis, any other therapeutic measures will be useless.

After curettage, the dentist prescribes medications and makes recommendations about caring for the hole. The medicine in the well should be changed every 3-5 days. You will have to visit the dentist at least 3 times.

Secondary Clot Treatment

When the cavity fills with blood, the dentist puts an anti-inflammatory agent and puts in a few stitches.

Treatment by creating a secondary clot involves scraping the hole to induce bleeding.

When the cavity fills with blood, the dentist puts an anti-inflammatory agent and puts in a few stitches. After the procedure, you need to take antibiotics.

This method of treatment is possible only in 2 cases: when the patient seeks help immediately after the clot has fallen out, and with sluggish alveolitis without severe symptoms, provided that the well is filled with granulation.

Medical assistance

After cleaning the hole, the following medications are prescribed:

painkillers based on NSAIDs - Ibuprofen, Nise, Diclofenac;
antibiotics - Amoxiclav, Lincomycin, Unidox-solutab;
Chlorhexidine solution 0.05% for rinsing.

Possible consequences

A cyst at the root of the tooth is dangerous primarily asymptomatic onset of the disease. And at the first signs of a neoplasm, most people do not rush to the dental clinic. But such a negligent attitude can lead to serious consequences:

the ingress of pus from a ruptured cyst into the periosteum and the development of phlegmon;

the formation of a bag with pus in the periodontal space - flux;

inflammation in the jawbone with the threat of spread to other elements of the skeleton;

development of periodontitis with the subsequent formation of a fistulous tube;

bone marrow damage - osteomyelitis;

destruction of the roots, interruption of communication with the periosteum and tooth loss;

the development of a cystic formation into a malignant tumor;

chronic diseases of various organs (throat, nose, liver).

Diseases that occur as a result of a timely untreated cyst cause much more pain and require a longer and more complex treatment than the primary disease.

Therefore, if a formation occurs on the gum, it is necessary to visit a doctor as soon as possible.

Treatment of dry socket in severe form

Symptomatic agents are used to lower the temperature, anesthetize, and relieve swelling.

In severe cases, hospitalization is required. The patient is assigned a number of measures, depending on the manifestations.

Treatment will be aimed at eliminating complications - abscess, phlegmon, cysts.

Physiotherapy is prescribed - electrophoresis, UHF, UFO. Patients are on bed rest.

Symptomatic agents are used to lower the temperature, anesthetize, relieve swelling.

With fibrosing alveolitis, glucocorticoid drugs are prescribed. If they are ineffective, the doctor prescribes immunosuppressants and penicillamine. Without treatment, the rapid replacement of epithelial tissue threatens with respiratory failure.

In toxic and allergic inflammation, glucocorticoids are also indicated. To speed up recovery, the doctor recommends special breathing exercises, physical exercises, and taking vitamin complexes.

Preventive measures

To prevent alveolitis, follow these recommendations after tooth extraction:

for the first 3 days, do not rinse your mouth, but easily rinse the well with decoctions and prescribed antiseptics, putting them in your mouth for 10-20 seconds;
after each meal, inspect the hole so that food does not get stuck in it, rinse it if necessary, but very carefully;
do not apply hot to the cheek and gum, it is strictly forbidden to warm the hole;
give up smoking and alcohol until complete healing;
do not self-medicate, and take only those remedies prescribed by the doctor, and be sure to coordinate the recipes of traditional medicine with him;
if pain and other symptoms do not go away within 3-5 days, contact your dentist.

How to define a disease?

A cyst is a rather insidious disease. At the initial stage of development, even when examining a dentist, it is very difficult to identify it. Initially, her growth does not differ in absolutely any symptoms, she does not manifest herself at all.

During this period, a neoplasm can be detected only by resorting to x-rays of the teeth. In the picture, the dentist will be able to clearly see the nascent cyst.

But according to a number of symptoms, it is quite possible to notice the development of this disease, although not at the very initial, but still at an early stage:

the occurrence of unpleasant sensations in the gums when biting food or in the process of chewing it;
feeling of heaviness in the area of the root of the tooth;
periodic development of uncomfortable sensations into pain, especially during meals;
difficulty opening the mouth;
gradual development of periodic aching pain into a constant acute;
the appearance of a small tubercle on the gum in the root region of the tooth, which increases in size over time and fills with liquid;
feeling of weakness, slight malaise, causeless fever, swollen lymph nodes;
the appearance of a flux or fistula.

Having found one of these symptoms, and even more so several, you should immediately visit a specialist to prescribe the necessary treatment. It is impossible to delay this, since a neglected cyst can lead to the loss of a problem tooth and other, more serious consequences.

Extraction is accompanied by tissue damage and profuse bleeding. Normally, it stops after 30 to 90 minutes. And in the hole, a blood clot forms after the extraction of the tooth. It fills the wound by 2/3, promotes healing and prevents infection.

clot formation mechanism

Immediately after the extraction of the tooth, severe bleeding opens. To stop it, the patient is asked to bite on a gauze pad. This manipulation helps and accelerates the formation of a blood clot.

After half an hour, a blood clot begins to form in the wound.

A blood clot begins to form in about 15 to 30 minutes. But its full formation lasts about a day. At this time, it is important to prevent a blood clot from falling out of the alveoli - a recess in the jaw in which the roots of the tooth are located.

Important! Sometimes bleeding opens after a few hours. Accordingly, the appearance of a blood clot is delayed. This is due to the introduction of large doses of anesthesia - adrenaline in its composition temporarily constricts blood vessels.

The function of a thrombus is to protect tissues from infection and accelerate healing. If it does not appear, they talk about the "dry hole" syndrome. In this case, it is impossible to avoid inflammation and suppuration of the wound - alveolitis.

If the operation was difficult, a large area was damaged, the edges of the gums were severely cut, the doctor puts stitches. They will help keep the clot in the alveolus.

Stages of healing of the hole

After extraction, the healing process (reparation) begins. The hole after tooth extraction looks like a deep wound with torn edges. Direct restoration of blood vessels, nerve endings and soft tissues lasts 2-3 days. The formation of a new epithelium takes 14-21 days. It takes 4-6 months for the complete restoration of bone structures.

Important! The duration of repair depends on the type of extraction (simple, complex), the degree and volume of damaged tissues. So, healing occurs faster if the canine, incisor was removed, the wound heals longer after extraction of chewing, impacted teeth.

Reparation takes place in several stages:

Important! The patient feels severe pain only for 2-3 days. Minor discomfort persists for a couple of weeks until the wound is covered with epithelial tissue. The rest of the processes are asymptomatic.

These stages are typical for normal healing. If the removal was difficult, or the clot fell out at some stage, the repair is delayed.

What do we do when a tooth is pulled out? Even under the office, many examine the traces of the operation, fearing for its consequences. Fear intensifies after the end of the effect of painkillers: how long should the wound hurt, and when will the bleeding stop?

Blood clot after tooth extraction

On the first day, a blood clot appears at the site of the pulled out tooth - an important condition for high-quality wound healing. In order for the recovery to proceed without serious consequences, it is important to know how the wound should look during extraction, what needs to be done and what cannot be done with it during the recovery period.

Preparing for a visit to the dentist

If you prepare for the operation according to all the rules, you can avoid many unpleasant consequences.

A few words about the procedure

Tooth extraction is a complete surgical procedure. The operation consists of four stages.

Treatment of the area around the tooth to be removed.
Anesthetic injections - ampoules in carpules, where the anesthetic is combined with drugs to narrow the vessels. Usually, local anesthesia is used in the exit zone of the nerve that innervates the problem tooth, if this is not enough, anesthetics are added without additional effect. When the drug is injected into the inflamed gum with an acidic environment, part of it is inactivated, so additional anesthesia is used.
Extraction of the tooth after the anesthesia has worked (the gums become numb, the vessels narrow). To cut off the ligaments that fix the tooth, use a scalpel. The choice of instruments and the duration of the procedure depend on the condition of the tooth.
Treatment of the oral cavity after removal: suturing (if the wound is torn or its edges are far apart) and a gauze swab soaked in a hemostatic agent (it must be kept in the teeth for 20 minutes, since the effectiveness of the hemostatic drug increases the compression of the wound). Do not rush to remove the tampon.

gum incision

Preparing for removal

Removal of a tooth

Insertion of a tampon

Suturing

After operation

After three hours, the painkillers still retain their strength, so patients do not feel pain or it manifests itself weakly. Pure blood or ichor can stand out from the hole all this time. If the figure eight was removed, this can last all day, since the area of surgical intervention in the wisdom tooth is larger than in other teeth.

Bleeding from hole

On the second day, the hole has an unattractive appearance: a blood clot with a grayish coating. It looks like pus, but you should not be afraid of it: it is fibrin - a substance that facilitates the recovery of the wound. If everything goes well, the pain will be aching and subside by the end of the day. If the nature of the pain is different - sharp, pulsating, and there is scarlet blood from the wound, you should urgently see a dentist.

At first, the hole may smell bad. There is no need to be afraid of this: blood accumulates there, and since it cannot be rinsed out, bacteria settle in the wound. If you feel normal, there is no fever, there is no reason for concern either.

The rehabilitation process is normal if:

when touching the wound, the ichor does not appear;
aching pain gradually disappears;
health is normal (temperature up to 38 ° is possible only in the first two hours);
puffiness on the cheek decreases (if it was not there before the extraction, it should not appear at all);
after 3 days, the wound no longer bleeds.

2 weeks after removal

To reduce bleeding, you can make a tampon yourself. Positioning it so that the edges do not injure the blood clot, hold the napkin for half an hour. In the pharmacy network, you can buy a hemostatic sponge, which can be used for heavy bleeding, for example, with liver failure.

Hemostatic sponge

The well is closed with a hemostatic sponge.

You can drink one or two tablets of Dicinon or Etamzilat (no more than 8 pieces per day).

Dicynon tablets

You can’t experiment with hydrogen peroxide: it reacts to blood components, destroying a blood clot and increasing blood flow.

How is the healing process

Even if there are no complications, the wound is completely tightened from four to six months.

On the 2nd day, a thrombus appears in the well - a protective gate against mechanical damage and infections.
If healing proceeds normally, on the third day it is already possible to see granulation tissue at the site of the operation.
In the second week, the epithelium actively grows, instead of a clot, granulation tissue appears. There is a primary restoration of bone structures.
In 2-3 weeks, it displaces the thrombus and bone tissue is visible along the perimeter.
Reconstruction of new tissues stretches for 30-45 days.
Approximately 60 days later, the hole is closed by osteoid tissue impregnated with calcium.
After 4 months, the bone becomes "adult", with a porous structure.
When the bone is fully formed, the wound should be resorbed by a third of the length of the root.
After extraction, the gum atrophies, the process of settling continues for 6-12 months.

Stages of tissue healing after tooth extraction

What determines the rate of tissue regeneration

The indicated terms are approximate information, since many factors influence the recovery process:

doctor qualification,
root condition,
hygiene procedures,
gum health.

If a tooth is removed at the time of an exacerbation of the disease, healing slows down. A torn wound also tightens it, especially during operations on eights. Particular attention is paid to high-quality processing after the procedure. If fragments of the tooth remain in the hole, they will interfere with the formation of a protective thrombus, as a result, everything will end with an inflammatory process that lengthens the recovery period.

Healing hole in place of the wisdom tooth

After removal, the surgeon will definitely give advice on proper wound care. If you ignore the advice or follow them irregularly, complications are inevitable.

Since the thrombus closes the vulnerable well, it is important not to disturb it. If you start rinsing immediately after visiting the dental office, you can wash it. An unprotected wound is easily infected.

Rinsing after tooth extraction is prohibited

If there are problems with blood pressure drops, sometimes the wound bleeds for a long time. After normalization of pressure bleeding usually stops.

Complications during extraction

All adverse conditions lead to alveolitis - inflammation that develops after infection of the wound. Most often, problems begin after a blood clot falls out. Sometimes a clot does not form at all.

Alveolitis of the tooth socket

If you rinse your mouth, alveolitis is diagnosed after 1-3 days. The pressure of water washes away protection and inflammation is guaranteed. Its signs:

increasing pain, gradually capturing neighboring areas;
with the spread of inflammation, general signs of intoxication also increase: fever, aching joints, loss of strength;
swelling goes to the nearest areas;
the mucosa turns red-blue due to impaired blood supply;
bad smell from the problem area, in which food remains accumulate.

All other complications also develop after infection of the wound. Their features are conveniently presented in the table.

dry hole	The thrombus has not formed, the recovery time is delayed, there is a threat of alveolitis. Most often happens with active rinsing. A dry socket should be shown to the dentist.
Osteomyelitis	A severe consequence when the alveolitis spreads to the jawbone. Requires inpatient treatment.
Nerve damage	If the tooth has massive roots, there is a possibility of nerve damage. All tissues near the tooth lose sensitivity. For treatment, a vitamin complex and drugs are used that accelerate the transmission of nerve impulses to muscle tissues.
	A serious complication involves surgical methods of elimination.

After restoration, it is not necessary to delay with prosthetics, since the absence of any unit of the dentition has a bad effect on the condition of the entire oral cavity.

Prosthetics

Oral hygiene after extraction

An important condition for the rapid healing of the wound is the formation of a normal blood clot that protects the well from infection and mechanical influences. Therefore, the number one task should be to protect the hole from the external aggressive environment. To prevent unwanted consequences, you must follow simple rules.

Blow your nose carefully.
In the operated area, brush your teeth with special attention; on the first day - do not clean at all.
Try not to smoke, as a blood clot can be pulled out by the negative pressure generated when smoke is swallowed.
Do not smoke after tooth extraction
Replace rinses with salt baths for the oral cavity (1 teaspoon of salt per 1 glass of water). Frequency - 2-3 rubles / day. 1 min. You can use furatsilin, chamomile and sage. Baths are necessary if before removal there was purulent inflammation of the gums, cyst, pulpitis.
Salt solution
Stick to a diet: do not drink alcohol, spicy and hot foods (increase bleeding), as well as solid foods that can provoke mechanical damage and inflammation of the wound.
Avoid contact with the hole (brush, tongue, toothpick). Remains of food are removed using salt baths. The first days try not to chew on the half where there is a wound.
Rules after tooth extraction

To reduce blood flow to the problem area, you need to sleep on high pillows. In the first week, water procedures should be avoided - going to the bathhouse or to the pond. Significant physical activity should be postponed until full recovery.

Within three hours after the extraction, food or water is not allowed so that the blood clot can form normally.

If there were no complications in the recovery phase, the wound was not cleaned with medical instruments, after 4 months it will heal completely, otherwise the process may drag on for six months.

On the video - What to do after tooth extraction

In most cases, complications after a tooth extraction operation have been performed do not arise due to the wrong actions of the doctor, but due to the fact that the patient did not perform oral hygiene correctly, did not follow the doctor's recommendations and did not monitor the state of the patient. located hole after tooth extraction.

Doctor's actions after tooth extraction

After the tooth is extracted, the doctor carefully examines its roots to make sure that there are no fragments left in the hole. After that, a thorough examination is carried out, while the doctor examines the walls and bottom of the hole with a special small surgical spoon, while extracting fragments of the tooth or fragments of the alveoli.

Sometimes it is necessary to scrape the walls of the granulation hole, then inspect the gums, and if there is damage, sutures may be applied. Then the edges of the hole are brought together, and a gauze swab is applied to it, which the patient must bite and hold in this position for fifteen to twenty minutes. It is not recommended to hold a cotton or gauze ball longer, as it is saturated with saliva, prevents the formation of a blood clot, which is necessary for the hole to heal faster after tooth extraction and is a source of infection.

If bleeding develops in the first twenty-four hours after the operation, then you should take a sterile gauze napkin, make a tampon out of it, put it on the hole and bite.

In no case should a blood clot from the hole be touched, washed off or removed, it protects the wound from infection and promotes its speedy healing.

You should try not to spit and rinse your mouth for twenty-four hours.

You should stop drinking hot drinks and food, do not smoke, do not rinse your mouth (unless, of course, the doctor recommended such procedures), even if an unpleasant bloody taste is felt in the mouth.

If pain occurs, you can take analgesics: ketorol, nice, analgin, etc.

At night, it is worth putting an extra pillow under your head so that your head is in an elevated position.

On the first day after surgery, you should not brush your teeth near the socket, then you can resume normal brushing, but at the same time be careful in the area of the socket.

Alternately applying warm and cold wipes will help relieve swelling.

Complications after tooth extraction

If the hole after tooth extraction has lost its clot as a result of rinsing, or the clot has not formed at all, then a complication may occur, which dentists call a “dry socket”. A blood clot is a very important component of the proper healing of the wound, and if it is absent, then the process of tightening the hole can take a long time. The patient often begins to experience dull pain in the area of the extracted tooth, and bad breath may occur. If a dry socket has formed, then a visit to the doctor is mandatory. The dentist places a gauze swab soaked in a special medicine into the wound, which reduces pain and helps to tighten the hole as soon as possible. You need to change your tampon every day. Most often, this complication occurs in smokers, as well as in people over thirty years old.

If nerve endings were damaged during tooth extraction, then paresthesia occurs - numbness of the lips, chin, tongue or cheeks. The sensation that accompanies this disease is similar to that which occurs after the doctor gives you a local anesthesia. However, it does not disappear after a few hours, and can last from two days to several weeks. If the nerve damage was severe, then the paresthesia may be permanent.

The hole after tooth extraction usually bleeds within a few hours. If the bone tissue was injured as a result of complex removal, then hole bleeding can last longer and be very intense. In such cases, you should consult a doctor.

clot formation mechanism

Immediately after the extraction of the tooth, severe bleeding opens. To stop it, the patient is asked to bite on a gauze pad. This manipulation helps to stop bleeding and accelerates the formation of a blood clot.

Important! Sometimes bleeding opens after a few hours. Accordingly, the appearance of a blood clot is delayed. This is due to the introduction of large doses of anesthesia - adrenaline in its composition temporarily constricts blood vessels.

If the operation was difficult, a large area was damaged, the edges of the gums were severely cut, the doctor puts stitches. They will help keep the clot in the alveolus.

Stages of healing of the hole

Important! The duration of repair depends on the type of extraction (simple, complex), the degree and volume of damaged tissues. So, healing occurs faster if the canine, incisor was removed, the wound heals longer after extraction of chewing, impacted teeth.

Reparation takes place in several stages:

1st day. A blood clot of dark red, sometimes burgundy color is formed in the alveolus.
2 - 3rd day. Whitish films appear - young epithelium. This color is due to the leaching of hemoglobin and the production of fibrin. You should be wary if a gray-green, yellow tint appears, a putrid smell is heard.
3 - 4 days. Connective tissue is formed, granulations appear. Due to the dense white coating, patients are frightened by what the hole looks like, they try to pick off the film. But this is normal, you should not clean the clot.
7 - 8 days. The alveolus is overgrown with epithelium. The clot is almost completely replaced by granulations, they shine through the top layer. The process of bone formation begins.
14 - 18 days. The wound is completely covered with epithelial tissue, and the clot is replaced by granulations.
Month. Young bone tissue is formed in the alveolus.
2 - 3 months. Bone cells completely fill the hole.
4 - 6 month. There is a compaction of the bone tissue, its fusion with the jaw. The height of the alveolar ridge decreases - it is 1/3 lower than the edge of the holes of other teeth.

These stages are typical for normal healing. If the removal was difficult, or the clot fell out at some stage, the repair is delayed.

How to prevent a clot from falling out?

Thrombus formation is essential for normal repair. To prevent it from falling out, observe the following recommendations:

do not rinse your mouth for 2 - 3 days - only baths with antiseptic solutions are allowed;
do not try to feel the hole with your tongue, clean food out of it with toothpicks;
brush their teeth with a soft brush in the morning, in the evening and after each meal, carefully passing it next to the operated area;
do not drink drinks through a straw - this creates a vacuum effect;
exclude heavy physical exertion;
do not eat hot, cold, hard, irritating food;
do not heat the operation site - heat provokes inflammation and reproduction of microorganisms;
it is forbidden to smoke and drink alcohol - the substances in their composition irritate unhealed tissues;
do not take a bath - only a shower is allowed.

After extraction, a blood clot normally forms. If the formation of a thrombus did not occur, complications develop in 100% of cases: dry socket, inflammation, suppuration, alveolitis. Complete reparation lasts up to six months, but the main healing occurs in 2-3 weeks.

Briefly about the procedure

How does the wound heal?

factors:

surgeon qualification,
the state of the root system,
hygiene quality,
condition of periodontal tissues.

Alveolitis

Symptoms alveolitis:

don't blow your nose
refrain from smoking
follow a diet

Other complications

Complications	Peculiarities
dry hole
Osteomyelitis
Nerve damage
Cyst

Alveolitis after tooth extraction: symptoms

Patient complaints -
on aching or throbbing pains in the area of the hole of the extracted tooth (of varying severity - from moderate to severe). Sometimes alveolar pain can also spread to other areas of the head and neck. With the development of alveolitis, pain usually occurs 2-4 days after removal, and can last from 10 to 40 days - in the absence of qualified treatment. Sometimes the pain is so severe that even very strong analgesics do not save. In addition, almost all patients report bad breath, bad taste in the mouth.

When visually inspecting the hole -
you may see an empty socket without a blood clot (in this case, the alveolar bone in the depth of the socket will be exposed). Or the hole can be completely or partially filled with food debris or necrotic disintegration of the blood clot. By the way, if the alveolar bone is exposed, it is usually extremely painful when touched, as well as when in contact with cold or hot water. In some cases, the edges of the mucous membrane converge so closely to each other above the hole that it is completely invisible what is happening in its depth. But when washing such a well from a syringe with an antiseptic, the liquid will be cloudy, with a large amount of food residue.

Dry socket after wisdom tooth extraction

Alveolitis: video

Dry socket after tooth extraction: causes

When alveolitis occurs due to the fault of the doctor –

If the doctor left a tooth fragment, bone fragments, inactive fragments of bone tissue in the hole, which lead to injury to the blood clot and its destruction.

Large dose of vasoconstrictor in anesthetic
Alveolitis can occur if a doctor injects a large volume of an anesthetic with a high content of a vasoconstrictor (such as adrenaline) during anesthesia. Too much of the latter will cause the hole to simply not fill with blood after the extraction of the tooth. If this happens, the surgeon must scrape the bone walls with an instrument and cause alveolar bleeding.

If the doctor left a cyst / granulation in the well -
when removing a tooth with a diagnosis of periodontitis, the doctor must necessarily scrape out a cyst or granulation (Fig. 10), which could not come out with the tooth, but remain in the depth of the hole. If the doctor did not revise the hole after extracting the root of the tooth and left the cyst in the hole, a blood clot will fester.

Due to a large bone injury during removal -
As a rule, this happens in two cases: firstly, when the doctor cuts out the bone with a drill, without using water cooling of the bone at all (or with insufficient cooling). Overheating of the bone leads to its necrosis and the start of the clot destruction process. Secondly, many doctors try to remove a tooth for 1-2 hours (using only forceps and elevators), which cause such bone injury with these tools that alveolitis simply must develop. An experienced doctor, seeing a complex tooth, sometimes immediately cuts the crown into several parts and removes the tooth fragment by fragment (taking only 15-25 minutes for this), and thereby reduces the injury caused to the bone.

If, after a complex removal or removal against the background of purulent inflammation, the doctor did not prescribe antibiotics, which in these cases are considered mandatory.

Treatment of alveolitis -

1. Curettage of the tooth socket with alveolitis -

Under anesthesia, a festering blood clot, food residues, and necrotic plaque are removed from the walls of the hole. Without removal of necrotic plaque and disintegration of the blood clot (containing a huge amount of infection) - any treatment will be useless.
The well is washed with antiseptics, dried, after which it is filled with an antiseptic (iodoform turunda). Usually every 4-5 days the turunda needs to be changed, i.e. you will have to go to the doctor at least 3 times.
The doctor will prescribe you antibiotics, antiseptic baths, and painkillers - if necessary.

Doctor's appointments after curettage of the tooth socket –

What can be done at home -

How to rinse the well from food debris -

First day after removal

Norm indicators

Swelling of the gums.
Swelling of cheeks.
Pain characteristic syndrome.

For reference: Alveolitis

The presence of a blood clot after an operation, such as tooth extraction, is considered normal by experts. After all, a plentiful source of blood from a wound will always be accompanied in such cases by a tightening. This will happen after the release of a certain amount of blood substance. Therefore, the clot is not classified by pathology doctors. However, every surgeon in the field of dentistry is obliged to observe the patient, after a couple of days to examine what the hole looks like after tooth extraction, whether the blood flow has stopped, whether the hole is being tightened at the site of the operation. Special attention is paid to the clot, its condition, preventive procedures, as well as the absence of complications.

First day after removal

Every person who has lost his tooth by removing it in a hospital, in dentistry, is interested in the question of how long, how long does the hole last after tooth extraction? In general, the answer to this question is that it is different for all people. In many ways, everything here depends on the characteristics of blood coagulation, the regenerating functions of tissues that can grow together, the necessary activity of the growth of new cells with the death of old ones, and other features inherent in the body of each person and manifesting themselves in each case in their own way.

But there are also norms adopted at the level of the Healthcare of the Russian Federation or the International level of the WHO (World Health Organization). In general, indicators in practice register that the hole begins to tighten slowly, over a period of several hours to several tens of hours. But if, in addition, the procedure for the rehabilitation of the operated gum area is still competently carried out, then in order for the hole to begin to slowly tighten, several hours are enough. In order for a blood clot to form after tooth extraction in time, without negative consequences and the whole process to be successful, on the first day after the operation, the patient must perform the following procedures, usually prescribed in such cases by a dental surgeon:

A soft gauze pad that is applied to the bleeding hole should be bitten tighter, thus pressing the wound.
You can’t keep a tampon from a bandage for a long time - just hold it for half an hour.
The tampon should be removed very slowly, gradually, and not jerkily, and very carefully.
If the blood is still oozing, then you need to hold the tampon for another half an hour. This is acceptable.
If even after an hour the bleeding does not stop, you should urgently contact your doctor, the same surgeon who tore the tooth.
If the bleeding has stopped, then periodically rinse your mouth with chlorhexidine or another disinfectant. It is especially necessary to keep this solution on the wound for 5 minutes.
For about an hour or two, it is recommended not to eat or drink anything.

Important! You can not apply a cotton swab to an open wound, but you can only use gauze! The fact is that cotton fibers (villi) can get inside the wound and cause suppuration there, or even worse - tissue necrosis, when tissues die due to the presence of a foreign body inside their structure.

Why is clot formation so important?

The presence of a blood clot that looks healthy, without signs of inflammation or the onset of a pustular process, is a necessary formation after a tooth has been pulled out. The blood must eventually clot and form a small clot that covers the entire wound. This is one of the most important stages in the normal biological process of closing an open wound - a blood clot protects the wound from microbes and pathogenic bacteria entering it. If further dental treatment is required, it is best to wait until the wound has healed, at least half (50%) or more (70-85%). And for this, more than one day will pass until the frozen blood-cork itself gradually resolves and disappears from the protracted hole.

Additional information: On average, the wound should be well tightened within 3 days, although the hole does not immediately overgrow, it needs more time. And the blood flow should stop after a few hours with the formation of a corresponding clot.

Restorative therapy after removal

All dentists of surgical specialization agree that before removing a tooth, it would be better for the patient to first drink some antibiotics, antibacterial drugs that the doctor will prescribe for several days. In case of acute pain, then strong painkillers are used, the main thing, when using which, is not to get involved in their use. The doctor may prescribe some painkillers and antibiotics even after tooth extraction. This is done to relieve inflammation, if any is found - you need to follow all the methods that the doctor prescribed.

In the process of recovery after surgery, the patient is examined by the attending physician to determine how the hole looks, whether there is infection, whether there is excessive opening of the wound, and so on. Meetings for such an examination are appointed by the specialist himself, but the patient himself can come for an examination 2-3 days after the extraction of the tooth. If the wound continues to be very painful, or the gum is swollen, then the dental nerve may be damaged, or something else that only an expert in this field can identify.

For reference: The patient himself can also examine what the clot looks like after tooth extraction at home, if the wound is available for viewing. However, it would be better if the doctor does it. Because if you damaged the wound with solid food, then it can be poorly tightened, the clot can move from pieces of food. Therefore, it is recommended to eat something softer on recovery days.

What will help you recover faster?

All medicines that were prescribed by a dental surgeon should be used according to medical instructions.
Teeth cleaning should be carried out with a soft toothbrush in the area of tissue damage. You need to buy a brush with silk bristles.
Hot food is excluded from consumption for a period of several days.
Do not eat dairy products for three days. They cause a large number of bacteria in the mouth.
You should do without physical activity for 30 days, so as not to create once again the intensity of blood flow.
It is impossible to warm up the jaw until the fossa is completely tightened.
It is forbidden to smoke and use intoxicating or alcoholic substances - this sharply weakens the immune system.

For reference: Hot food causes bleeding, so you should eat warm food. To understand how long a blood clot lasts after tooth extraction, one should also remember about solid food, it can scratch the gums and move the saving lump of dried blood to the side, partially opening the wound. We'll have to try to eat soft and warm for about a month.

Norm indicators

And you also need to take into account those indications of the patient's condition that are recorded by doctors as normal. The following indicators should be remembered:

Swelling of the gums.
Swelling of cheeks.
Pain characteristic syndrome.
Aching sensations in the area of the former fossa.
Backlog of small pieces of blood clot after a few days, or a week.
Sleepiness in the first few days.

After the patient comes to the doctor for an examination on the third day to check how the hole looks like after tooth extraction, the cheek may swell, even if this relapse did not occur for the first 2 days. This is not scary, this happens after the complete cessation of the action of anesthetics. It is also believed that pain symptoms should even be mandatory, only they are suppressed by painkillers so that the quality of life of the patient does not decrease during the recovery period. Only if aching or sharp pain does not go away for too long (more than 3-4 days). If you want to sleep on the first day after the operation, it is better to sleep.

If someone does not know how the hole overgrows after tooth extraction, then we can also draw his attention to the fact that saliva will have a glandular taste and a pinkish tint for some time. This also should not be frightened, gradually the blood substrates will come out with saliva, which can be gently spit out. But even swallowing such saliva, you do not harm yourself very much. An unpleasant slight nausea can simply make itself felt - the reaction of the stomach to an unusual inclusion in saliva. Now that the reader already knows how much the hole overgrows after tooth extraction, you can focus on these data and, in case of any deviations from the norm, consult a doctor in a timely manner.

Acute complications after tooth extraction

One type of complication that can happen to a patient who has lost a tooth is alveolitis. It is he who can provoke swelling of the cheeks, swelling and inflammation of the gums. And such processes are usually always accompanied by a severe headache, high body temperature, nausea, weakness and a severe general condition of a person. Of course, all this happens when the inflammation that has begun has not been eliminated by the doctor. Or the patient himself, after visiting the dentist-surgeon, neglected his recommendation, did not rinse his mouth for several days in a row.

For reference: Alveolitis- this is a local suppuration that forms in the hole after tooth extraction due to insufficient disinfection of the oral cavity or its treatment with antiseptic materials.

Other complications, when a blood clot acquires non-standard characteristics after tooth extraction, can be in the following manifestations:

Copious amounts of scarlet (clear) blood for 12 consecutive hours without stopping.
Sharp pain that may signal that the trigeminal nerve has been affected.
The exit from the wound is some dark brown and even black "threads", "pieces".
Active numbness of the jaws for 4-5 days, which also indicates a violation of the nerve endings.
High body temperature - from 38 degrees.
Swelling when touched is extremely painful and prevents you from opening your mouth or eating normally.

In all of the above cases and with such symptoms, you must either call the attending dentist at home, or go yourself urgently to the surgeon who removed the tooth. A blood clot is a natural defense against microbes entering an open wound while it is being healed, as well as a natural “tampon” to stop blood flow. If one of the patients finds that the hole after tooth extraction has not been overgrown for a long time, and the blood is flowing and flowing, then you should immediately contact the doctor for help.

Useful video: oral care after tooth extraction

Briefly about the procedure

Tooth extraction is a serious full-fledged operation that takes place in several stages:

treatment of the area to be operated on,
administration of an anesthetic drug.

What happens after the operation?

What does the hole look like after tooth extraction? On day 2-3, the wound does not look very attractive, as white or grayish spots form on top of the blood clot. This is not pus, as many people think, but fibrin, which helps the wound heal.
If the wound healing process proceeds without complications, the pain is aching or pulling in nature and gradually subsides. If you are worried about shooting, throbbing pain, this is an alarming symptom, which is better to see a doctor.

You can talk about an uncomplicated course of healing of the hole if:

no exudate is released from the hole, if you press it,
the pain is aching in nature and gradually disappears,
general condition and body temperature are normal,
puffiness of the cheek does not increase,
after 2-3 days, the bleeding from the wound stops.

How does the wound heal?

After extraction of the tooth, the hole heals for a long time even without complications. This is a lengthy process that can take from several weeks to several months:

on the second day after the operation, a blood clot appears in the wound, which protects tissues from infection and damage,
if the recovery process goes without complications, granulation tissue is formed on the 3-4th day,
the next week - the active formation of layers of the epithelium in the hole, the blood clot is displaced by granulation tissue. Primary bone formation occurs
after 2-3 weeks, the clot is completely replaced by the epithelium, bone tissue is clearly visible along the edges of the wound,
the formation of young tissue takes 30-45 days,
approximately two months later, the hole is completely overgrown with bone (osteoid) tissue saturated with calcium,
by the end of the 4th month after extraction, the young bone tissue “grows up”, its structure becomes porous,
after the completion of bone formation, the wound resolves by 1/3 of the root length.

After the operation, the gum sags (atrophies), this process lasts from 6 months to a year.

What influences the rate of healing?

The above terms are relative and individual, since the rate of tissue repair is affected by many factors. factors:

surgeon qualification,
the state of the root system,
hygiene quality,
condition of periodontal tissues.

Non-compliance by the patient with advice and recommendations for caring for the oral cavity after surgery inevitably leads to complications. Since the blood clot protects the socket, care should be taken to keep it in place. For this reason, it is strictly forbidden to rinse your mouth after tooth extraction, as such procedures lead to washing out the blood clot from the wound. The wound remains unprotected and the risk of infection increases.

Alveolitis

increasing pain that gradually spreads to nearby tissues,
as the inflammatory process progresses, symptoms of general intoxication of the body appear: body aches, weakness, temperature may rise,
swelling from the gums extends to neighboring tissues,
the gum mucosa turns red, after which it may acquire a bluish tint due to stagnation of blood,
due to the ingress of food debris into the wound, an unpleasant putrefactive odor from the mouth often occurs.

How to care for the hole after surgery?

don't blow your nose
very carefully brush your teeth near the operated area,
refrain from smoking
instead of rinsing, do oral baths,
follow a diet
avoid contact with the wound (do not touch it with your tongue, brush, toothpicks),
refrain from brushing your teeth on the day of extraction.

Doctors recommend sleeping on a high pillow to reduce blood flow to the site of removal. Exclude in the first few days a hot bath, sauna, bath, swimming pool and open water. For 3 hours after removal, it is contraindicated to eat and drink to allow the blood clot to fully form.

Other complications

In most cases, all complications after extraction develop due to an infection that has entered the well for various reasons. It can be:

Complications	Peculiarities
dry hole	A blood clot does not form in the hole, which delays the healing time and can cause alveolitis. In most cases, such a complication develops due to the fact that the patient actively rinses his mouth after surgery and simply flushes the blood clot from the wound. If you find yourself with a dry socket, see your doctor as soon as possible.
Osteomyelitis	This is a serious complication of alveolitis, when the inflammatory process passes to the jaw bone. Treatment is carried out in a hospital.
Nerve damage	You can damage the nerve when removing teeth with a large root system. In this case, the area of the cheek, palate, tongue, which are adjacent to the site of the extracted tooth, become numb and lose sensitivity. Treatment involves taking B vitamins and drugs that stimulate the transmission of signals from the nerves to the muscles.
Cyst	Complications rarely develop, treatment involves excision of the neoplasm.

After tooth extraction, do not delay with the choice of prosthetics method, since the absence of even one tooth negatively affects the condition of the entire dentition.

Reading 21 min. Published on 11.12.2019

Dry socket, alveolitis: symptoms

Patient complaints -
on aching or throbbing pains in the area of the hole of the extracted tooth (of varying severity - from moderate to severe). Sometimes alveolar pain can also spread to other areas of the head and neck.
With the development of alveolitis, pain usually occurs 2-4 days after removal, and can last from 10 to 40 days - in the absence of qualified treatment. Sometimes the pain is so severe that even very strong analgesics do not save. In addition, almost all patients report bad breath, bad taste in the mouth.

When visually inspecting the hole -
you may see an empty socket without a blood clot (in this case, the alveolar bone in the depth of the socket will be exposed). Or the socket may be completely or partially filled with food debris or necrotic disintegration of the blood clot.
By the way, if the alveolar bone is exposed, then it is usually extremely painful when touched, as well as when in contact with cold or hot water. In some cases, the edges of the mucous membrane converge so closely to each other above the hole that it is completely invisible what is happening in its depth. But when washing such a well from a syringe with an antiseptic, the liquid will be cloudy, with a large amount of food residue.

Alveolitis after tooth extraction is quite easily diagnosed based on symptoms and visual inspection of the socket of the extracted tooth. Below we list the main symptoms that will allow you to calculate inflammation.

Lune pain with alveolitis -
they can be both acute and mild. There may also be associated headaches.

Bad smell -
suppuration of a blood clot or inflammation of an empty hole always proceeds with the appearance of an unpleasant smell of decay. Suppuration of the clot also leads to intoxication of the body, which can be expressed by poor health, fatigue, fever.

Swelling of the cheeks, gums -
in most cases, alveolitis occurs without swelling of the soft tissues of the face, tk. pus and infection have an outflow through a gaping empty hole. However, in some cases, suppuration of a blood clot can be acute, with a sharp swelling of the gums and soft tissues of the face, high fever, and acute pain.

First day after removal

But there are also norms adopted at the level of the Healthcare of the Russian Federation or the International level of the WHO (World Health Organization). In general, indicators in practice register that the hole begins to tighten slowly, over a period of several hours to several tens of hours. But if, in addition, the procedure for the rehabilitation of the operated gum area is still competently carried out, then in order for the hole to begin to slowly tighten, several hours are enough.

A soft gauze pad that is applied to the bleeding hole should be bitten tighter, thus pressing the wound.
You can’t keep a tampon from a bandage for a long time - just hold it for half an hour.
The tampon should be removed very slowly, gradually, and not jerkily, and very carefully.
If the blood is still oozing, then you need to hold the tampon for another half an hour. This is acceptable.
If even after an hour the bleeding does not stop, you should urgently contact your doctor, the same surgeon who tore the tooth.
If the bleeding has stopped, then periodically rinse your mouth with chlorhexidine or another disinfectant. It is especially necessary to keep this solution on the wound for 5 minutes.
For about an hour or two, it is recommended not to eat or drink anything.

Alveolitis after tooth extraction: symptoms

When alveolitis occurs due to the fault of the doctor -

If the doctor left a tooth fragment, bone fragments, inactive fragments of bone tissue in the hole, which lead to injury to the blood clot and its destruction.

Large dose of vasoconstrictor in anesthetic
Alveolitis can occur if a doctor injects a large volume of an anesthetic with a high content of a vasoconstrictor (such as adrenaline) during anesthesia. Too much of the latter will cause the hole to simply not fill with blood after the extraction of the tooth. If this happens, the surgeon must scrape the bone walls with an instrument and cause alveolar bleeding.

Due to a large bone injury during removal -
As a rule, this happens in two cases: firstly, when the doctor cuts out the bone with a drill, without using water cooling of the bone at all (or with insufficient cooling). Overheating of the bone leads to its necrosis and the start of the process of destruction of the clot.
Secondly, many doctors try to remove a tooth for 1-2 hours (using only forceps and elevators), which cause such bone injury with these tools that alveolitis simply must develop. An experienced doctor, seeing a complex tooth, sometimes immediately cuts the crown into several parts and removes the tooth fragment by fragment (taking only 15-25 minutes for this), and thereby reduces the injury caused to the bone.

If, after a complex removal or removal against the background of purulent inflammation, the doctor did not prescribe antibiotics, which in these cases are considered mandatory.

Conclusions: Thus, the main causes of the destruction (fibrinolysis) of the blood clot are pathogenic bacteria, excessive mechanical trauma to the bone, and estrogens. Reasons of a different nature: smoking, a clot falling out while rinsing the mouth, and the fact that the hole did not fill with blood after the extraction of the tooth.

Cases in which the doctor is to blame -

The tooth was completely removed, but a granuloma / cyst remained in the depth of the hole, which infects the blood clot. In Fig. 8 - You can see the x-ray taken before the tooth was removed. The black arrows on the image mark the area filled with the cyst. After extracting the tooth from the hole (Fig. 9), it is also necessary to remove the cyst (Fig. 10), otherwise the blood clot will fester.

A fragment of a tooth or its root remains in the hole, which can infect a blood clot,

A mobile fragment of the surrounding bone tissue remained in the hole, which was formed during the dislocation of the tooth with forceps, which injures the blood clot,

There was a difficult extraction, or the tooth was removed against the background of purulent inflammation, but the doctor did not prescribe antibiotics and antiseptic baths,

After the extraction of the tooth, the tooth socket did not fill with blood (due to the action of adrenaline, which is part of the anesthesia), and the doctor let the patient go home with an empty socket, simply covering it with a swab.