Dry socket is considered as the most common complication following tooth extraction. It is mainly manifested by severe irradiating pain that starts 1 to 4 days after dental extraction with a denuded socket. Although many risk factors are associated with it, no clear and direct cause has been described to explain its etiopathogenesis. Here, we suggest a new pathogenesis and management of Dry socket based on new microbiological and clinical findings. We present a series of Dry socket cases resistant to local management where alveolar swabs were taken for bacterial culture and antibiogram, and results showed the presence of Pseudomonas aeruginosa and sensitivity to ciprofloxacin. Then, these serial cases were treated by ciprofloxacin at 500 mg 3 times per day for 5 days. All patients experienced complete relief within 12 to 24 hours. Laboratory findings and clinical outcomes lend greater credence to the idea that an infectious process is behind the incidence of Dry socket.  This fact may help the practitioner in preventing Dry socket incidence before and during extraction by controlling local infection, and in case of Dry socket occurrence, the management should focus on targeting involved bacteria by selecting the appropriate antibacterial agent.

Wael Khalil is a chief of clinical services at Lebanese University, oral and maxillofacial surgery department. He completed his Phd in biomedical sciences(microbiology) at the American University of Beirut.