Dental Alveolitis and Root Residues

SCAN PROTOCOL: CBCT Best-Quality – MyRay Scan

EFFECTIVE DOSE: kV: 90, mAs: 21.71

Air Kerma : 4.43 mGy – DAP : 249.05 mGy · cm² – DLP : 11.28 mGy · cm – CTDIw : 1.88 mGy

CLINICAL INFORMATION: CBCT scan exam – Right quadrant, requested by a dentist, for implantological evaluation of edentulous areas 1.7. 1.8, checkup of the new implant and general standard control with required further information.

RADIOLOGICAL ANALYSIS:

•  Examination of a partial CBCT of the upper jaw.
•  Nasopalatine duct of normal Radiomorphology.
•  A slight mucous thickening of the right maxillary sinus is highlighted.
•  Implant present with no signs of periimplantitis.
•  Root residues of site 17 with ongoing alveolar inflammatory process.
• Other dental findings as noted above (AI report)

IN-DEPTH

PATHOLOGY

Dental alveolitis is an acute inflammation of the alveolus, i.e. the bone cavity housing the dental roots. In most cases, this pathology arises after a tooth extraction, or in presence of post-extraction dental residue. It is found most frequently when the removal involves a tooth that is seriously compromised by pathological processes, as is the case with deep caries, pulpits, or granulomas.

After a tooth extraction, the alveolus (or alveolar cavity) refers to the residual bone cavity; this can be single or divided by inter-radicular bone septa, depending on the removed tooth being a single-root or multi-root respectively.

CAUSES

The exact causes of dental alveolitis are still unknown, but several factors which could favor its onset have been identified, including Smoking, due to the fact that nicotine acts as an ischemic agent, i.e. it reduces the availability of oxygen needed by the tissues in order to speed up healing.

The development of Alveolitis may be contributed by factors such as:

• Infections: The likelihood of developing inflammation such as alveolitis may also increase based on the patient’s general health, medication intake and the concomitant presence of other pathologies (e.g. coagulation disorders, diabetes etc.).
• Surgical trauma: The risk of incurring into such complication increases if the surgery proves particularly “difficult”, as with the presence of impacted teeth (i.e. teeth which have failed to erupt through the gum either wholly or partly), misplaced teeth or other situations which may make the execution of operative procedures traumatic for periodontal tissues.
• Early clot fibrinolysis: resulting from bacterial contamination of the clot. In fact, after the tooth’s extraction, local bleeding is followed by the formation of a clot in the socket, which: 
  1. Stops the bleeding.
  2. Protects underlying tissue.
  3. Serves as the basis for the organization of granulation tissue, on which the formation of new bone tissue in the alveolar cavity depends.

• Oral contraceptives.
• Vasoconstrictors.

In most cases, inflammation of a tooth socket occurs after an extraction. However, this complication is infrequent, as it occurs in about 1-2% of cases, usually if the surgery is performed on a tooth or on surrounding tissue which was already infected or seriously damaged.

SYMPTOMATOLOGY

The symptoms of alveolitis typically appear a few days after the extraction:

• During the first days after the extraction, patients report a state of discomfort caused by the surgery, which then tends to progressively decrease.
• After about 3-4 days, the pain intensifies unexpectedly in the area in which the surgery was performed.
• Subsequently, the pain due to alveolitis tends to radiate towards areas adjacent to the affected alveolus, and along the regions innervated by the ramifications of the trigeminal nerve (such as the ear). Peculiarly, this manifestation is resistant to common analgesic drugs.

Thus, in most cases, dental alveolitis involves:

• Intense, throbbing, and persistent pain in the alveolus affected by the inflammation
• Slight redness and swelling of the gum
• Halitosis
• Bad taste in the mouth
• Soreness or pain in the jaw.

In case of alveolitis, one may also experience one or more of the following symptoms:

• Fever
• Enlarged submandibular lymph nodes
• Neck pain
• Ear pain

In severe cases of alveolitis, there could be manifestations of:

• Headache
• Cutaneous hyperesthesia
• Facial swelling (swelling of the face on one side)

Possible complications

In particularly serious cases, dental alveolitis may target the bone tissue, with potential evolvement into Osteitis.

DIAGNOSIS

The diagnosis is obtained through inspection of the oral cavity (direct observation), during which it is possible to detect lysis of the alveolar clot. 

In typical cases, the tooth socket is malodorous and has a grayish color and the patient reports throbbing pain, resistant to common analgesics. 

After aspiration, the alveolar cavity appears empty (hence the name “dry alveolitis”), characteristically devoid of granulation tissue and with shiny bone walls.

On palpation or simple contact, the dentist can evoke intense pain, with redness of the mucous membrane and gum surrounding the affected socket.

In order to confirm the diagnosis or to rule out other conditions, it is possible to initially run an OPG (panoramic scan) and/or a CBCT (cone-beam CT scan) of the dental arches, to discriminate of more serious pathologies or more extensive anatomical interests.

 

Elaborated by Dr. Lucisano Francesco, Lead Radiographer – DentQ Italy