ABSTRACT Aims & Objectives: This study was performed to evaluate the incidence, risk factors (age, sex, infection, radiographic difficulty of the extraction, tobacco use) contributing to the development of dry socket and clinical features following surgical removal of impacted mandibular third molar. Materials and Methods: The study included 63 patients during period of September 2009 to September 2011 in the age group of 18 to 53 years with impacted mandibular third molars all of which were surgically removed under local anesthesia by the same operator. Following surgery all patients received a single dose of 4 mg corticosteroid intravenously and similar prescriptions for analgesics, antibiotics and postoperative instructions. All patients were reviewed at 3rd and 7th day postoperatively. Results: In this study incidence of dry socket was 6.3%. We also noticed onset of symptom mostly appeared within 48 hours. Postoperatively pain, bare bone and halitosis were the most significant clinical feature at 3rd postoperative day and pain, empty socket and bare bone were most significant clinical feature at 7th postoperative day. Variables like right 3rd molar impaction, patients mean age between 19 - 32 years, female, preoperative infection, radiographically difficult impaction and habitual tobacco users showed a higher incidence of dry socket formation. Conclusion: Incidence of dry socket formation is multifactorial and therefore, there is need to evaluate all factors, with special attentions in handling these patients to reduce the incidence of dry socket formation.
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Kumar, V. , Chaudhary, M. , Singh, S. and  , G. (2012) Post-surgical evaluation of dry socket formation after surgical removal of impacted mandibular third molar—A prospective study. Open Journal of Stomatology, 2, 292-298. doi: 10.4236/ojst.2012.24051.
 Al-Saffar, M.T., Al-Sandook, T.A. and Suleiman M.S. (2008) Protective effect of topical ibuprofen against dry socket. Al-Rafidain Dentak Journal, 8, 136-143.
 Fridrich, K.L. and Olson, R.A.J. (1990) Alveolar osteitis following surgical removal of mandibular third molars. Anesthesia Progress, 37, 32-41.
 Schow, S.R. (1974) Evaluation of postoperative localized osteitis in mandibular third molar surgery. Oral Sur- gery, Oral Medicine, Oral Pathology, 38, 352-358.
 Birn, H. (1973) Etiology and pathogenesis of fibrinolytic alveolitis (“dry socket”). International Journal of Oral Surgery, 2, 211-263.
 Goldman, D.R., Kilgore, D.S., Panzer, J.D. and Atkinson, W.H. (1973) Prevention of dry socket by local application of lincomycin in Gelfoam. Oral Surgery, Oral Medicine, Oral Pathology, 35, 472-474.
 Larsen, P.E. (1992) Alveolar osteitis after surgical removal of impacted mandibular third molars: Identification of the patient at risk. Oral Surgery, Oral Medicine, Oral Pathology, 73, 393-397.
 Pitekova, L., Satko, I. and Novotnakova, D. (2010) Complications after third molar surgery. Bratislavské Lekárske Listy, 111, 296-298.
 Wong, J.D. (1993) Alveolar osteitis: A review. Dentistry Library University of Sydney, Sydney.
 Blum, I.R. (2002) Contemporary views on dry socket (alveolar osteitis): A clinical appraisal of standardization, aetiopathogenesis and management: A critical review. International Journal of Oral and Maxillofacial Surgery, 31, 309-317. doi:10.1054/ijom.2002.0263
 Bouloux, G.F., Steed, M.B. and Perciaccante, V.J. (2007) Complication of third molar surgery. Oral & Maxillofacial Surgery Clinics of North America, 19, 117-128.
 Mercier, P. and Precious, D. (1992) Risks and benefits of removal of impacted third molars: A critical review of the literature. International Journal of Oral and Maxillofacial Surgery, 21, 17-27.
 Susarla, S.M. Blaeser, B.F. and Magalnick, D. (2003) Third molar surgery and associated complications. Oral & Maxillofacial Surgery Clinics of North America, 15, 177-186.
 Younis, M.H.A. and AbuHantash, R.O. (2011) Dry socket: Frequency, clinical picture, and risk factors in a Palesinian Dental Teaching Center. The Open Dentistry Journal, 5, 7-12. doi:10.2174/1874210601105010007
 Cardoso, C.L., Rodrigues, M.T.V., Ferreira Junior, O., Garlet, G.P. and De-Carvalho, P.S.P. (2010) Clinical concepts of dry socket. Journal of Oral and Maxillofacial Surgery, 68, 1922-1932. doi:10.1016/j.joms.2009.09.085
 Sheikh, M.A., Kiyani, A., Mehdi, A. and Musharaf, Q. (2010) Pathogenesis and management of dry socket (alveolar osteitis). Pakistan Oral & Dental Journal, 30, 323- 326.
 Krogh, H.W. (1948) Prevention of dry sockets. Journal of Dental Research, 27, 3-8.
 Killey, H.C. and Key, L.W. (1975) The impacted wisdom tooth.
 Ministry of health Malaysia, (2005) Clinical practice guide line. Management of unerupted and impacted third molar teeth.
 Conaty, S., Hoang, H., Kirshen, D., Kwong, C., Schroeder, E. and Stromme, A. (2010) Pre and postoperative antibiotic prophylaxis in the prevention of complications following third molar surgery. University of Toronto, Faculty of Dentistry, March.
 Krekmanov, L. and Hallander, H.O. (1979) Relationship between bacterial contamination and alveolitis after third molar surgery. International Journal of Oral Surgery, 9, 274-280. doi:10.1016/S0300-9785(80)80034-2
 TiigimaeSaar, J., Leibur, E. and Tamme, T. (2010) The effect of prednisolone on reduction of complaints after impacted third molar removal. Stomatologija, Baltic Dental and Maxillofacial Journal, 12, 17-22.
 Tiwana, P.S., Foy, S.P., Shugars, D.A., Marciani, R.D., Phillips, C. and White, R.P. (2005) The impact of intravenous corticosteroids with third molar surgery in patients at high risk for delayed health-related quality of life and clinical recovery. Journal of Oral and Maxillofacial Surgery, 63, 55-62. doi:10.1016/j.joms.2004.01.029
 Noroozi, A.R. and Philbert, R.F. (2009) Modern concepts in understanding and management of the “dry socket” syndrome: Comprehensive review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 107, 30-35.
 Benediktsdottir, I.S., Wenzel, A., Petersen, J.K. and Hintze, H. (2004) Mandibular third molar removal: Risk indicators for extended operation time, postoperative pain, and complica-tions. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 97, 438-446.
 Rood, J.P., Murgatroyd J. (1979-80) Metronidazole in the prevention of ‘dry socket. British Journal of oral surgery; 17, 62-70. doi:10.1016/0007-117X(79)90009-X
 Al Jadid, O.G. (2003) An investigation in the incidence of dry socket and the factors affecting the incidence. JRMS, 10, 33-39.
 Bortoluzzi, M.C., Manfro, R., De-Oliveira, K.C., Colombo, C. and Petry, I.C. (2007) Prevalence of fibrinolitic alveolitis and infection in dental surgery. Revista de Clínica e Pesquisa Odontológica, 3, 115-122.
 Ahmed, A., Mohamed, F., Hattab, K. (2009) Surgical extraction of impacted mandibular third molars: Postoperative complications and their risk factors. Jamahiriya Medical Journal, 9, 272-275.
 Cohen, M.E and Simecek, J.W (1995) Effect of gender-related factors on the incidence of localized alveolar osteitis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 79, 416-422.
 Krekmanov, L. (1981) Alveolitis after operative removal of third molars in the mandible. International Journal of Oral Surgery, 10, 173-179.
 Knoedler, D. and Stanmeyer, W. (1958) Dental observations made while wintering in Antarctica, 1956-1957. Journal of Dental Research, 37, 614-622.
 Khorasani, M. (2006) The prevalence and risk factors of dry socket in dental surgery clients following tooth extraction at Qazvin faculty of dentistry. Qazvin University of Medical Sciences, 10, 29-35.
 Chuang, S.K., Perrott, D.H., Susarla, S.M. and Dodson, T.B. (2008) Risk factors for inflammatory complications following third molar surgery in adults. Journal of Oral and Maxillofacial Surgery, 66, 2213-2218.
 Yuasa, H., Kawai, T., Sugiura, M. (2002) Classification of surgical difficulty in extracting impacted third molars. British Journal of Oral and Maxillofacial Surgery, 40, 26-31.
 Biesbrock, A.R., Hamlin, J.C., Baker, R.A., Gerlach, R.W., Mc-Clanahan, S.F. and Hilton, T.J. et al. (1997) Risk factors for alveolar osteitis following the extraction of impacted mandibular molars. Research presented at the 75th General Session of the IADR, 19-23.
 Al-Belasy, F.A. (2004) The relationship of “shisha” (water pipe) smoking to postextraction dry socket. Journal of Oral and Maxillofacial Surgery, 62, 10-14.
 Balaji, S.M. (2008) Tobacco smoking and surgical healing of oral tissues: A review. Indian Journal of Dental Research, 19, 344-348. doi:10.4103/0970-9290.44540
 Ritzau, M. and Therkildsen, P. (1978) Antifibrinolytic prevention of alveolitis sicca dolorosa. International Journal of Oral Surgery, 7, 534-540.
 Ruvo, A.T., Shugars, D.A., White, R.P. and Phillips, C. (2005) The impact of delayed clinical healing after third molar surgery on health-related quality-of-life outcomes. Journal of Oral and Maxillofacial Surgery, 63, 929-935.