(9) Exploring Prevalance and Risk Factors Associated with Alveolar Osteitis Following Dental Extractions Performed at Rutgers School of Dental Medicine

Abstract: With the advancement of dentoalveolar surgery, teeth extraction remains one of the most routine procedures performed by oral and maxillofacial surgeons, as well as other specialists and even dental students. Regardless of being an everyday procedure, extraction of teeth can result in various complications including post-operative bleeding, pain, infection, swelling, and alveolar osteitis (AO, dry socket). Among all post-operative complications, dry socket is one of the least desired outcomes due to its poorly understood pathophysiology which makes it difficult to prevent. Despite the ongoing effort to minimize the incidence of AO, current interventions to prevent the occurrence of this complication continue to be ineffective. Dry socket usually presents as severe pain accompanied with a disintegrated blood clot at the site of the extraction. Several risk factors such as age, gender, smoking, and tooth location have been identified to have profound effects on the rate of AO development. Nonetheless, the contribution of other risk factors including the degree of tooth impaction and the operator’s experience remains uncertain. This study aims to investigate the incidence of dry socket development in patients undergoing tooth extractions by comparing the results between oral surgery residents and dental students. The findings of this study could help better understand the factors that contribute to the development of AO which eventually improve managing this postoperative complication. In this retrospective study, the 2013-2017 electronic records of 27,848 patients at Rutgers School of Dental Medicine (RSDM) were queried to identify patients who underwent extractions. Data on the type of extraction; whether simple or surgical, degree of tooth impaction, and operator’s experience conducting the procedure was examined to provide insight on the incidence of AO. Results of this study show that out of the total sample of patients, oral surgery residents treated 6959/27848 patients, while dental students treated 20889/27848 patients. Simple extractions compromised, 73.86% and 77.11% of the total number of extractions conducted by oral surgery residents and dental students respectively; the rest were surgical extractions. Furthermore, oral surgery residents treated noticeably higher degrees of soft tissue impaction (3.15%), partial bony impaction (0.79%), and full bony impaction (7.50%) compared to dental students who only treated 0.12%, 0.16%, and 0.08% of impactions respectively. Dental students showed a significantly higher incidence of post-operative infection and AO, with 20 cases of infections and 138 cases of AO, compared to 3 cases of post-operative infections and 2 cases of AO in oral surgery residents. In conclusion, oral surgery residents and dental students conducted an approximately similar number of simple extractions. However, oral surgery residents were able to manage a greater number of soft tissue and bony impactions, with fewer post-operative complications including infections and AO. This suggests a possible correlation between the experience of the operator, and the development of AO. These results highlight the emphasis of adequate training for operators in order to reduce post-operative complications and improve patients’ overall quality of life.

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