Jurnal Os Get
Jurnal Os Get
Jurnal Os Get
ABSTRACT
The objective of this study was to compare the effect of local application of chlorhexidine
digluconate and combination of Iodoform with Butylparaminobenzoate in the management of dry
socket. A Quasi experimental study was carried out on a total of sixty diagnosed cases of dry socket.
Patients were randomly distributed among two treatment groups (30 patients in each group) i.e.
patients of group A were treated by local application of chlorhexidine digluconate gel and of group B
by local treatment with combination of Iodoform + Butylparaminobenzoate (Alvogyl). Both the
treatment groups were given the same systemic analgesic i.e., Ibuprofen 400mg TDS along with
thorough irrigation of the socket. Patients were followed for five consecutive days by replacing dressing
each day and findings were recorded in the proforma. Out of the sixty patients, forty five were males
and fifteen were females (3:1). In group A there were 22 (73.33%) males and 8 (26.66%) females and
in group B there were 23 (76.66%) males and 7 (23.33%) females. Mean age was 31.68 (11.23+S.D).
There was no significant effect of gender (P=0.766) and age (P=0.668) on both of the treatment groups
respectively. All patients measured their pain subjectively as S3 i.e. severe pain on day 1 on visual
analogue scale. There was a significant difference in pain control of the two treatment groups on 2nd,
3rd and 4th treatment day with P=0.000, P=0.000 and P = 0.02 respectively. Significant difference was
noted for sensitivity on gentle probing the extraction socket between the results of two treatment groups
on 3rd and 4th day i.e. p=0.000 for both days.
Iodoform and Butylparaminobenzoate (Alvogyl) had been the most successful combination in
relieving patients pain.
Key Words: Dry socket, Alvogyl, chlorhexidine.
INTRODUCTION
Dry socket or alveolar osteitis is the post extraction socket in which the patient is having pain due to
loss of blood clot thus exposing bone to air, food and
fluids. Prevention of dry socket remains the best strategy that can be achieved by providing an aseptic
environment, avoiding inadvertent instrumental
1
Correspondence: Dr. Fahimuddin, Junior registrar, Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar. Email: fahim79pk@yahoo.com,
Cell: 0321-9693326
Prof. Head of Deptt. Oral & Maxillofacial Surgery, Ayub Medical
College, Abottabad.
Associate Professor, Oral & Maxillofacial Surgery, Khyber College of Dentistry,
Assistant Professor, Oral & Maxillofacial Surgery, Khyber College of Dentistry
Received for Publication:
March 10, 2013
Revision Received:
March 27, 2013
Revision Accepted:
March 31, 2013
Pakistan Oral & Dental Journal Vol 33, No. 1 (April 2013)
Patients with systemic diseases like diabetes mellitus, hepatic dysfunctions, blood dyscrasias, bleeding disorders, previous
use of systemic antibiotics for dry socket, previous treatment for
dry socket and history of all kinds of tobacco use including snuff
dipping were excluded from the study.
Group A
Group B
Gender
Cases
Cases
Male
Female
Total
22
8
30
73.33%
26.66%
100%
23
7
30
76.66%
23.33%
100%
Group B
Cases
Cases
11
8
5
4
2
36.66
26.66
16.66
13.33
6.66
6
5
7
6
6
20
16.6
23.33
20
20
No. of patients
19
15
12
4
4
3
2
1
31.66
25
20
6.66
6.66
5
3.33
1.66
32
Day 1
Day 2
Day 3
Day 4
Day 5
Group A
Group B
GroupA
GroupB
S3=100
S2= 37
S3= 64
S1= 3
S2= 83
S3= 13
S1= 83
S2= 7
S1= 100
S3= 100
S1= 83
S2= 17
S1= 83
S2= 17
P= 100
P= 100
P= 100
P= 100
P= 100
P= 27
A-73
S1= 100
P= 47
A= 53
A= 100
A=100
S1= 100
A= 100
{VAS=visual analogue scale, 1-4= mild pain (S1), 5-7= moderate pain (S2) and 8-10= severe pain (S3)
P = present; A = absent % patients= total of 60 patients per group considered as 100 %}
DISCUSSION
The pain of Dry socket occurs because of release of
kinins which are immediately available following tissue trauma,2 exposure of nerve endings to air, food and
fluids in bare bone of the extraction socket1 and infectious process which releases tissue activators and pain
mediators.7
Local application of the Alvogyl in the empty
socket can show its effect according to all the possible
causes of pain of dry socket mentioned above. Eugenol
of clove oil (in Alvogyl) depresses sensory receptors
involved in pain perception by inhibition of prostaglandins biosynthesis. Alvogyl pack itself works by
acting as a physical barrier between the exposed bone
along with exposed nerve endings and the oral environment. Iodoform is a powerful antiseptic. Chlorhexidine on the other hand could be considered only for its
antiseptic effect and providing a weak barrier for
covering exposed bone not as strong as Alvogyl. In this
regard, Alvogyl remained superior to Chlorhexidine
i.e. on second, third and fourth day of treatment there
was a tremendous improvement in pain relief of group
B patients (Alvogyl group) with P=0.000, P=0.000 and
P=0.02 respectively and a significant difference of
P=0.000 for sensitivity on gentle probing the extraction socket. Chlorhexidine if used for preoperative
prophylaxis would remain a good remedy in reducing
incidence of dry socket and might have shown good
results.8,9
Male to female ratio was 3:1 with no significant
effect of gender on both of the treatment groups
Pakistan Oral & Dental Journal Vol 33, No. 1 (April 2013)
Miloro M. Petersons principles of oral and maxillofacial surgery. 2nd ed. Canada: BC Decker Inc 2004; 151.
10
11
Howe GL. Minor Oral Surgery. 3rd ed. Eng: Wright 1988: 390-3.
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13
14
15
16
17
18
19
20
21
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REFRENCES
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Pakistan Oral & Dental Journal Vol 33, No. 1 (April 2013)
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