Preventie en behandeling van dry socket
Een van de meest gevreesde complicaties na een extractie is de zogeheten ‘dry socket’. Een droge, lege, tandkas die door de te geringe nabloeding niet gevuld raakt met een bloedstolsel, daardoor ontsteekt en de patiënt vervolgens veel pijn kan berokkenen. De conclusies van een uitgebreid literatuuronderzoek bieden nuttige aanbevelingen voor tandarts en patiënt.
Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched together with reference lists of identified articles. Topic experts and organisations were also contacted.
Only randomised controlled trials were considered and there were no restrictions regarding language or date of publication. Data abstraction and risk of bias assessment were conducted in duplicate and Cochrane statistical guidelines were followed. The GRADE tool was used to assess the quality of the body of evidence.
Twenty-one trials with 2.570 participants were included. Eighteen trials (2.376 participants) related to prevention and three to treatment (194 participants). Six studies were at high risk of bias, 14 of unclear risk and one study at low risk. There was moderate evidence (4 trials, 750 participants) that chlorhexidine mouthrinses (0.12% and 0.2% concentrations) both before and after extraction(s) prevented approximately 42% of dry socket(s) with a RR of 0.58 (95% CI 0.43 to 0.78; P < 0.001). The number of patients needed to be treated (0.12% and 0.2%) with chlorhexidine rinse to prevent 1 patient having dry socket (NNT) was 232 (95% CI 176 to 417), 47 (95% CI 35 to 84) and 8 (95% CI 6 to 14) at prevalences of dry socket of 1%, 5% and 30% respectively. There was moderate evidence (2 trials, in 133 participants) that placing chlorhexidine gel (0.2%) after extractions prevented approximately 58% of dry socket(s) with a RR of 0.42 (95% CI 0.21 to 0.87; P = 0.02) with NNT of 173 (95% CI 127 to 770), 35 (95% CI 25 to 154) and 6 (95% CI 5 to 26) at prevalences of dry socket of 1%, 5% and 30% respectively. There was insufficient evidence to determine the effects of other intrasocket preventive interventions or interventions to treat dry socket.
There is some evidence that rinsing with chlorhexidine (0.12% and 0.2%) or placing chlorhexidine gel (0.2%) in the sockets of extracted teeth, provides a benefit in preventing dry socket. There was insufficient evidence to determine the effects of the other 10 preventative interventions each evaluated in single studies. There was insufficient evidence to determine the effects of any of the interventions to treat dry socket. The present review found some evidence for the association of minor adverse reactions with use of 0.12%, 0.2% and 2% chlorhexidine mouthrinses, though most studies were not designed to detect the presence of hypersensitivity reactions to mouthwash as part of the study protocol. No adverse events were reported in relation to the use of 0.2% chlorhexidine gel placed directly into a socket (though previous allergy to chlorhexidine was an exclusion criterion in these trials). In view of recent reports in the UK of 2 cases of serious adverse events associated with irrigation of dry socket with chlorhexidine mouthrinse, it is recommended that all members of the dental team prescribing chlorhexidine products are aware of the potential for both minor and serious adverse side effects
Dodson T. Prevention and treatment of dry socket. Evid Based Dent 2013; 14: 13-14. doi: 10.1038/sj.ebd.6400913.