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1987: 16:279-284
(Key words: anaesthesia, local," alveolitis; extraction, teeth; surgery, oral and maxillofacial)
Department of Oral Surgery, The Dental School, The University of Newcastle upon Tyne, UK
Table 6. Dry socket incidence in relation to repeat injections for molar extractions
No. No. Incidence
Tooth type extractions dry sockets (%) Significance
Single injection mandibular molars 325 10 3.1
0.01 > p > 0.001
Repeat injections mandibular molars 223 18 8.1
Single injection maxillary molars 375 2 0.5
0.02 > p > 0.01
Repeat injection maxillary molars 118 4 3.4
A patient was considered to have a dry socket likelihood of dry socket production after
if he returned to the dental hospital complaining repeat anaesthesia for mandibular and
of pain from the extraction site and the socket
maxillary molar teeth (Table 6). The major
was either empty or contained necrotic material.
Statistical analysis was performed using the Z2 factor which suggests caution in inter-
test. preting the results after repeated injections,
is that significantly more difficult extrac-
tions were present in this group when com-
Results pared to that group where initial conven-
The results are presented in Tables 1-9. Ta- tional anaesthesia was successful (Table 7).
ble 1 shows that the overall incidence o f dry As far as those teeth most likely to pro-
socket in this study was 3.2% and that, as in duce dry sockets are concerned, there were
other published results, the most c o m m o n proportionately less mandibular and maxil-
sockets affected were those of the lower mo- lary molar teeth in the intraligamental
lars. Table 2 shows that dry socket pro- group; however, there were more mandibu-
duction differed significantly between the
anaesthetic regimes.
Tables 3, 4 show that the variation be- Table 7. Extraction difficulty
tween Citanest and Xylocaine cannot be ex- No. single No. repeat
injection injection
plained by the fact that there were any sig- Classification extractions extractions
nificant differences in the distribution of
Easy 815 339
tooth type between the 2 groups; neither Difficult 183 115
was the spread of easy and difficult extrac- X2= 11.6565; 0,001 >p
tions dissimilar. 12 repeat injection extractions not classified.
A comparison of the results after single
and repeat conventional local anaesthetic Table 8. Tooth distribution
injections is more complex. The tooth distri- No. single No. intra-
bution was such that the spread of tooth injection ligamental
types significantly differed between the Tooth type extractions extractions
groups (Table 5). This difference was such Mandibular molars 325 17
that there were proportionately more o f Maxillary molars 375 13
those teeth more likely to give rise to dry Mandibular premolars 87 11
Maxillary premolars 140 7
sockets, namely mandibular molars and Mandibular incisors and
premolars, in the repeat injection group. canines 20 4
However, when dry socket incidence for the Maxillary incisors and
individual tooth groups is analysed, it is canines 65 3
seen that there is still a significantly greater ;(2__16.6940; 0.01 > p > 0.001
282 MEECHAN ET AL.
Their study, however, had fewer numbers GRUNDY l° that after-pain is irrelevant when
and included females in whom other factors intraligamentary anaesthesia is used for
may play an important rrle 29. KREKMANOVt6 exodontia.
reported that the amount of Xylocaine did It is not possible to determine from the
not affect the frequency of dry socket after present investigation whether periodontal
the surgical removal of mandibular third ligament anaesthesia produced more dry
molars. sockets due to the localised presence of ad-
As mentioned in the results section, the renaline or to the fact that the injection is
distribution of easy and difficult extractions traumatic to the periodontium 3.
differed between the single and repeat injec- In conclusion, the results of this study
tion groups; thus these results must be inter- show that more dry sockets occurred fol-
preted with caution. It has been shown that lowing single dental extractions in males
the more traumatic the extraction, the more after the use of Xylocaine compared to Ci-
likely a dry socket is to occur 1~,~7.~9. How- tanest. Repeat injections are an indication
ever, it is interesting to speculate on which of greater likelihood of dry socket than sin-
of the two factors, viz., the trauma or the gle injections and it appears that the use of
repeated injections, is the more important, periodontal ligament anaesthesia results in
as many previous workers did not take the more dry sockets than conventional tech-
amount of anaesthetic administered into ac- niques.
count. Another factor to consider here is
that patients who require repeat injections
may have a reduced pain threshold and are
therefore more likely to return complaining
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