Sir, an interesting paper published as an abstract in the BDJ (204: 559)1 discusses the relationship of cigarette smoking to post-operative complications from dental extractions among female prison inmates. The authors report that dry socket is increased following third molar extractions and surgical extractions but not specifically in smokers. I can concur with this finding.

My colleagues and I operate a dental service at Styal Women's Prison, where the majority of the women require several extractions and over 95% smoke.

From 1 April 2007 – 31 March 2008 out of 481 routine extractions and minor surgical procedures (364 by the author) there were seven post-operative complications, which could be classified as alveolar osteitis. Since the majority of women smoke post-operatively, diligently ignoring the written and verbal instructions given, we feel that this complication rate of 1.45% is lower than most published reports.

I feel that the major contributing factor to the development of dry socket is a traumatic extraction and any patient factors post-operatively have relatively little bearing on this complication. The extractions, although grossly carious and frequently infected, are relatively 'easy'. Interestingly despite 70% of the women being infected with Hepatitis C, with potential liver damage, no cases of post-extraction haemorrhage occurred during the year. We do, however, routinely place Alvéo-Penga2 in all sockets, as recommended by the manufacturers; maybe this is the secret!