British Dental Journal 205, 168 (2008)
Published online: 23 August 2008 | doi:10.1038/sj.bdj.2008.703

Dry socket secrets

J. A. Speechley1

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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!



  1. Heng C H, Badner V M et al. Relationship of cigarette smoking to post operative complications from dental extractions among female inmates. Oral Surg 2007; 104: 757–762
  2. Alvéo-Penga – Pierre Rolland France.
  1. Warrington


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