DR.Mhel Dental Aesthetica

20/04/2026

Dry Socket

🔹 Also called alveolar osteitis / alveolitis sicca dolorosa
🔹 Loss/disintegration of extraction socket clot → exposed bone

Pathogenesis
🔹 Due to fibrinolysis of clot
🔹 Plasmin dissolves fibrin clot
🔹 Severe pain + foul odor, but usually no pus

Risk factors
🔹 Traumatic/difficult extraction
🔹 Especially impacted mandibular 3rd molar
🔹 Women, smokers
🔹 Oral contraceptives (estrogen ↑ fibrinolysis)
🔹 Also seen with Paget disease or post-radiotherapy

Clinical features
🔹 Starts day 2–3 after extraction
🔹 Lasts about 7–10 days
🔹 Severe throbbing pain radiating to ear/neck
🔹 Bad odor / bad taste
🔹 Empty dry socket with exposed necrotic bone
🔹 May have low-grade fever and ipsilateral nodes

Management
🔹 Palliative only
🔹 Gentle irrigation
🔹 Obtundent dressing: ZOE or iodoform gauze
🔹 Change dressing until pain subsides

Prevention
🔹 Atraumatic extraction technique is most important
🔹 Routine socket antibiotics not routinely recommended

High-yield pearl
🔹 Post-extraction day 2–3 severe pain + empty socket + foul odor + no pus = dry socket

19/04/2026

Burning Mouth Syndrome (BMS)

Definition
🔹 Chronic burning/stinging oral pain with normal-appearing mucosa
🔹 Most likely neuropathic
🔹 Also called stomatodynia

Types
🔹 Primary (idiopathic): no identifiable local/systemic cause
🔹 Secondary: due to an underlying cause

Secondary causes
🔹 Local: candidiasis, lichen planus, allergy, denture-related irritation/galvanic currents
🔹 Systemic: menopause/hormonal change, diabetes, medications, B12/folate/iron deficiency

Classic patient
🔹 Postmenopausal woman
🔹 Strong female predilection
🔹 Typical onset around 50 years

Common sites
🔹 Anterior 2/3 of tongue most common
🔹 Often also palate, lips, gingiva

Key symptoms
🔹 Burning/hot pain
🔹 Usually worse later in the day
🔹 May be continuous or intermittent
🔹 Often triggered by stress, fatigue, spicy/hot/acidic foods
🔹 Eating/drinking may temporarily relieve
🔹 Usually does not disturb sleep
🔹 Spontaneous remission is rare

Associated findings
🔹 Dysgeusia → metallic/bitter taste
🔹 Subjective xerostomia common
🔹 If true hyposalivation is present, think secondary BMS

Management
🔹 First rule out local and systemic causes
🔹 Often difficult to treat
🔹 Options: antidepressants, topical analgesic rinses/sprays (eg, benzydamine), alpha-lipoic acid/vitamin supplementation
🔹 In postmenopausal women: topical/systemic estrogen may be considered
🔹 Saliva substitutes for dry-mouth symptoms

High-yield pearl
🔹 Burning mouth + normal oral exam + postmenopausal woman = think BMS
🔹 Normal mucosa is the key clue

02/04/2026