Sir, I have read with interest the paper by L. Tolstunov in a recent edition.1 It is important to continue the research related to prevention and management of alveolar osteitis (AO). During my on-calls as a dental foundation trainee in a busy oral & maxillofacial department, I received a lot of referrals from the accident & emergency department, where patients presented with severe post-operative pain or AO following dental extractions. Most patients I saw had already received treatment for AO by their dentist or their local emergency dental clinic. I noticed that a high number of patients who eventually presented to A&E developed an infection of the extraction socket following placement of Alvogyl. In most cases this could be managed with the removal of the dressing, irrigation of the socket and a short course of antibiotics. However, one patient developed severe facial cellulitis as a result of an Alvogyl dressing that was left in situ for over three weeks and caused infection of the socket. She had to be admitted for intravenous antibiotics and underwent extraoral drainage and debridement of the socket under general anaesthesia.

The dressing of a socket with Alvogyl is a very safe and effective management of AO.2 It is an antiseptic and analgesic paste containing butamben, iodoform and eugenol. A recent study carried out by Ryalat et al. showed that Alvogyl reduced postoperative pain at the extraction site, but a higher incidence of both alveolar osteitis and local operative site infection had been encountered.3 According to the manufacturer Alvogyl easily adheres to the alveolus and assisted by the patient's tongue movements, it gradually self-eliminates.4 This is not synonymous with self-dissolving, which is the impression frequently given to patients.

I acknowledge that the lady's case I have described is rare but it is an important reminder that the dressing is to be treated as an undissolvable foreign body and it cannot be assumed that 'self-elimination' takes place in every case. Good practice is to review patients who received treatment for AO to observe the healing process.