Why plaque forms after tooth extraction and how to treat it. Local complications that arise after tooth extraction What pathologies may be

The process of tooth extraction is quite unpleasant, as it always causes severe pain and discomfort. But the torment does not end there, because in the place of the extracted tooth there remains a hole, which can hurt and even bleed for several days after the procedure. But this does not cause any concern until a white coating appears in the hole. What should be the treatment after tooth extraction? What is normal and what should you be wary of? All the details of the processes occurring after tooth extraction are described in this article.

Reasons for the formation of white plaque in the hole

If there is something white in the socket of an extracted tooth, do not immediately panic, because this may be a simple protective reaction of the body. Quite often, white plaque in the gum area is created from a protein of the blood coagulation system and is a natural dressing that blocks the access of various harmful microorganisms and protects the area affected after tooth extraction from injury.

But this does not always happen, and white plaque may form in the socket of an extracted tooth as a result of disruption of the healing process. In the first and second cases, the plaques, although white, are quite different from each other. Unfortunately, it will be quite difficult for an ordinary person to identify this difference. Therefore, basic knowledge about the healing process will help to promptly identify pathology if it is present.

As a result, it can be noted that the formation of white plaque in the hole can be caused by the following factors:

normal healing process;
alveolitis - inflammatory process;
the presence of sharp edges near the hole itself;
defective tooth extraction.

Features of proper healing of the hole

The retention of the tooth root in the socket occurs due to the periodontal ligament, and through the apical opening blood vessels and nerve penetrate into the dental cavity. After a tooth is removed, blood clots form in its place, which protect the bone walls from various types of infections and are sources for the formation of new bone.

Around the dental neck at this time there is a circular ligament, in the process of contraction of which the entrance hole in the socket narrows.

In this case, saliva plays an important role, since it contains such a stabilizing element as fibrin. It is a protein that is formed during the process of blood clotting. When a blood clot occurs, fibrin is partially released onto the surface, so a white plaque forms at the mouth of the hole after the tooth extraction procedure. In other words, this plaque is a natural dressing that prevents the blood clot from coming into contact with the infected mouth. About a week after the tooth extraction procedure, an epithelial barrier is formed, and the white plaque gradually dissolves.

Many people believe that after the formation of the epithelial barrier, the process of full healing has already occurred, but this is not entirely correct. The erroneous opinion is due to the fact that in addition to the appearance of the epithelial barrier, regenerative processes must end, and they last from three to six months. You can see the photo after tooth extraction in the article. As you can understand, the healing took place without any complications.

Normal appearance of the hole

How long does it take for a tooth to heal after extraction? On the first day, the hole may swell a little; dots from the needle with which the anesthetic drug was injected are visible on its surface. The blood clot is dark burgundy in color and has a jelly-like consistency. The clot is completely located in the hole or even rises slightly above it.

After a day, a white coating forms on the hole, and its mouth narrows slightly. Swelling, as a rule, persists or even increases slightly.

How does the tooth heal after removal? In the period from three to seven days after the procedure, there is still a white coating on the hole, while the swelling decreases, and the oral mucosa returns to its normal color. Due to the release of fibrin from saliva and the formation of new epithelial tissue, the hole is practically invisible. And after ten to fourteen days, complete healing occurs after tooth extraction.

Features of the development of alveolitis

Have you had a tooth removed, is there something white in the hole? This may be a signal that alveolitis is progressing. The development of the inflammatory process in the socket can be triggered by the following reasons:

In case of poor oral hygiene or in the presence of an inflammatory process in the oral cavity or ENT organs.
If a tooth was removed during an acute periodontitis, harmful microorganisms may arise from the periodontal lesion.
Due to the lack of bleeding from the socket during the use of anesthetics containing adrenaline. As a result, the formation of a blood clot does not occur, and the hole remains open for the penetration of bacteria.
Flushing or breaking off a blood clot while eating.

As a rule, the development of the inflammation process begins on the third or fourth day after the tooth extraction procedure. Manifestations of inflammation begin with swelling of the gums, and painful sensations are present when touching it. It is worth noting that the pain does not disappear anywhere, it is constantly present, and during eating it can even intensify. Plaque forms; its color, unlike plaque during normal healing of the hole, is not so white; it can rather be called yellow or grayish. An unpleasant aroma appears, a person may feel a taste

If a blood clot is washed out or falls off, then everything looks a little different. Painful sensations appear on the third or fourth day, there is swelling and redness in the gum area. The hole looks like a depression in a circle with white gums. Inside the hole you can see the remaining particles of a blood clot and a gray coating.

Treatment of alveolitis

If the above symptoms appear, you should immediately contact a dentist; it is preferable that this is the doctor who performed the tooth extraction, since he already knows the clinical picture.

After examining the hole, the dentist will select one of the following treatment methods:

Conservative type. It consists of treating the hole with an antiseptic and applying therapeutic bandages to the affected area. For oral administration, drugs that suppress the process of inflammation and antibiotics are prescribed. As a local therapy, treatment of the hole with a mixture of potassium permanganate and hydrogen peroxide is often used. When these agents are combined, a chemical reaction occurs, during which foam is formed, which removes the remaining particles of infected tissue from the hole.
Surgical type. All infected tissue is removed from the hole mechanically, then this area is treated with an antiseptic, and a new blood clot is formed in its place. In addition, the use of antibiotics is an integral point.

The presence of sharp edges at the hole

Have you had a tooth removed, is there something white in the socket for quite a long time? During the healing of the hole, the following processes occur - bone formation and the appearance of a mucous membrane. In this case, from the very beginning, the bone must be protected by a blood clot or gums. If a situation develops in which one of the walls of the hole rises above the others or has a sharp edge, it cuts through the developing mucous membrane and protrudes into the oral cavity. This makes her unprotected.

In turn, unprotected walls of the socket can provoke the appearance of a sharp edge or alveolitis.

Such a pathology can be identified several weeks after the tooth extraction procedure; if at the end of this period a white, dense and sharp-to-the-touch point is still visible in the socket, then this is not normal.

How to get rid of the sharp edge of the hole?

If the section of the socket wall that stands out in the oral cavity is small in size, then you can try to remove it with your own efforts. In other situations, a fairly simple operation will be required.

Having injected the patient with local anesthesia, the doctor will move the gums in the area of the protruding fragment of the wall and remove it using forceps or a drill, possibly applying a suture.

Manifestations of incomplete tooth extraction

Incomplete tooth extraction quite often provokes the occurrence of alveolitis, but in the case of a strong immune system and high-quality oral care, the inflammatory process may not occur.

It is worth noting that you can see the remainder of the tooth only 2-4 days after the procedure to remove it, since the gums recede only after the formation of white plaque.

What to do in case of defective tooth extraction?

First of all, you need to visit a dentist to complete the tooth extraction procedure. To be completely confident in the success of the procedure, it is recommended to ask the doctor for a referral for an x-ray, where it will be finally clear whether the tooth has been completely removed or not.

Features of behavior after the tooth extraction procedure

It is worth understanding that if you follow all the rules of behavior after tooth extraction, something white in the socket will be the norm for just a few days and the likelihood of developing an inflammatory process is significantly reduced.

Among the basic rules of conduct after tooth extraction are the following:

If, at the end of the procedure, the doctor gives a tampon soaked in an anesthetic or antiseptic, then it should be kept in the mouth for about half an hour.
One day after tooth extraction, you should not try to remove the blood clot in any way.
You should not try to feel the hole with your tongue.
During the day after the procedure, it is forbidden to drink any liquids, for example, a drink through a straw.
It is advisable not to eat for 2-3 hours after tooth extraction.

These basic rules are the key to a normal healing process if you have a tooth removed. Something white in the hole won't bother you!

Often during or after the tooth extraction procedure, various types of complications may arise.

Complications during removal:

Complications after removal:

Fracture of the tooth being removed at the level of the crown or root

This complication occurs quite often. The main reasons are:

The crown part of the tooth is severely damaged, as a result of which it is not possible to fix it tightly with forceps.
Wrong choice of removal tool.
Anatomical features of the tooth (teeth with severely divergent roots, curved apices, hypercementosis).
Dense bone tissue around the tooth and between the roots (interradicular septum).

If a tooth fracture occurs during extraction, it is imperative to completely remove the tooth and remove all broken fragments. Sometimes the doctor sends the patient for an x-ray in order to determine the location and size of the root remaining in the socket.

Mucosal injury

It is impossible to remove a tooth without injuring the surrounding gums, however, if the removal technique is violated, significant trauma to the mucous membrane can be caused. This occurs when forceps are applied to the gingival margin (if the circular ligament of the tooth has been poorly detached), careless movements by the doctor, or the instrument slips.

If crushed areas of the gum remain after removal, they are cut off with a scalpel or scissors. When a wound is formed, its edges are brought together and sutures are placed.

Damage to other teeth

A fracture or dislocation of an adjacent tooth most often occurs as a result of incorrectly selected support when working with an elevator, when mobile or carious damaged teeth are used. A very rare complication is damage to the tooth of the opposite jaw, mainly when the doctor violates the removal technique - uses excessive force, dislocates the tooth to the side in the vertical plane.

When a tooth is dislocated, the degree of its mobility is assessed. The excitability of the pulp is dynamically examined; if it is dead, endodontic treatment is carried out and the tooth is splinted.

When a crown or root is fractured, it is necessary to determine the depth of the lesion. If possible, carry out orthopedic treatment (crown with inlay).

Fracture of the alveolar process

During removal, very often small fragments of the alveolar process break off when the cheeks of the forceps are applied not only to the root, but also to the alveolus. As a rule, this does not interfere with complete healing.

However, in some cases, the root may be tightly fused to the surrounding bone, resulting in a large fragment of the alveolar process being removed when it is removed. Often, large sections of the alveoli are broken when lower or upper wisdom teeth are removed.

If movable fragments of bone walls remain in the socket, they must be bitten off.

Fracture of the lower jaw

This complication during removal can only occur if there are pathological lesions in the jaw, when the bone resolves and becomes thinner. And if the doctor applies a lot of force when removing first, second or third molars, this can lead to fracture.

Treatment consists of fixation and immobilization of jaw fragments using splinting or osteosynthesis.

Dislocation of the lower jaw

Occurs when the mouth is wide open, when the doctor puts strong pressure on the lower jaw (more often when working with an elevator). To prevent this complication, it is necessary to hold the patient’s jaw with your left hand.

A dislocated lower jaw must be realigned.

Perforation of the floor of the maxillary sinus

This complication occurs most often during the removal of upper molars and second premolars. The main reason for this complication is the close location of the roots of the upper chewing teeth to the sinus. Often, perforation is facilitated by traumatic removal with forceps or an elevator, or inaccurate curettage with a sharp spoon.

In case of perforation, everything possible must be done to ensure that a clot forms in the alveolus and does not fall out within several weeks. To do this, the hole is covered with iodoform turunda and sewn to the gingival margin on both sides; you can also use a special mouth guard. Thus, the clot does not fall out of the socket, which guarantees rapid healing.

Pushing the root into the maxillary sinus

Occurs during traumatic removal when the doctor carelessly uses an elevator in an attempt to reach the broken root tip.

To confirm fears that a tooth fragment has fallen into the sinus, it is necessary to conduct an x-ray examination - panoramic x-ray. If the image shows a root in the sinus, it must be removed. Such an intervention should be carried out in a hospital.

The root is removed through a hole made in the anterior wall of the sinus (usually endoscopically); in some cases, the perforation in the area of the socket of the extracted tooth is plastically closed. If some time has passed after removal and sinusitis has developed, radical surgery is performed on the maxillary sinus.

Bleeding

Prolonged bleeding should be considered a complication after tooth extraction.

The causes of severe bleeding can be many factors, both local and general:

Disturbance of the blood coagulation system.
High blood pressure.
Taking blood thinning medications.
Local inflammatory process.
Severe injury to blood vessels.

All methods of stopping bleeding can be divided into local (pressing with a bandage tampon, placing hemostatic drugs in the hole, suturing the wound) and general (taking drugs that enhance blood clotting).

Read more about bleeding as a complication after tooth extraction.

Sharp edges of holes

After tooth extraction, sharp edges of the alveoli often remain, which injure the gums and cause pain in the patient. Doctors try, if possible, to preserve as much bone as possible in the place of the extracted tooth, so such walls do not always bite (only if they protrude above the gum).

To reduce inflammation and pain, treat the hole with antiseptics (carefully, without rinsing out the clot) and anti-inflammatory ointments.

Alveolitis

This is an inflammatory reaction in the socket, the main cause of which is the loss of a blood clot. The patient is bothered by aching pain of varying intensity in the area of the extracted tooth.

Read more about this pathology in the article about alveolitis.

It is believed that the occurrence of a “dry socket”, and therefore alveolitis, can be contributed to by traumatic tooth extraction, insufficient detachment of the dentogingival ligament, incorrect choice of instrument for the operation, anomaly in the location of the teeth, etc.

It should be remembered that infection of the socket plays a significant role in the occurrence of alveolitis. Microorganisms can penetrate into a post-extraction wound from odontogenic and non-odontogenic foci of chronic infection, which are located in the form of a granuloma or granulation tissue on the mucous membrane of the oral cavity, nose, nasopharynx, as well as in the hole itself (A.E. Verlotsky, 1950; A.I. . Evdokimov, G. Vasiliev, 1965; Yu. I. Zhabin, 1982).

According to Yu.V. Dyachenko (1982), the main place of accumulation of staphylococci in the human body is the nasal cavity. According to the author, its high contamination with staphylococci is a stable indicator of the development of alveolitis, independent of the age and gender of patients, as well as the season of the year.

In my opinion, Yu.V. Dyachenko underestimates the role of odontogenic foci of chronic infection in the development of alveolitis. With this disease, in most patients we found identical microorganisms in the socket, in odontogenic foci and in the pharynx. We believe that the intensity of contamination of the oral cavity with microorganisms is influenced by a number of factors, including the age and gender of patients, the type of disease, and the season of the year. It is also necessary to take into account the degree of infection by staphylococci in the nasal cavity.(A.A. Timofeev, 1982). It is assumed that most of the microorganisms that colonize the oral cavity entered it from the nasal cavity. The recommendation of Yu.V. deserves attention. Dyachenko (1982) and GA. Zhitkova (1984), indicating the need for sanitation of the nasal cavity in patients before surgery. GA. Zhitkova (1984) established a relationship between the species composition of staphylococcal microflora isolated from the post-extraction socket, as well as the mucous membrane of the nasal cavity, and the severity of the disease. In purulent and purulent-necrotic forms of alveolitis, Staphylococcus aureus was often cultured in association with other microorganisms. Based on microbiological and immunological studies, as well as clinical observations, a certain relationship was revealed between the clinical picture of this disease and indicators of phagocytic activity of neutrophil granulocytes in the blood, the nature of the microflora of the post-extraction hole and the mucous membrane of the nasal cavity.

It is known that the constant persistence of microorganisms in chronic foci of infection causes sensitization of the patient’s body, leading to a change in the immunological reactivity of the body. The waste products of microorganisms, penetrating through the system of lymphatic vessels into regional lymph nodes, are subsequently fixed by immunocompetent cells, which is accompanied by the production of antibodies and sensitization of the body (Rosengren, 1962). Sensitization leads to a weakening of protective reactions (L.N. Rebreeva, 1969). Using skin tests with microbial allergens, as well as laboratory tests, we identified the presence of sensitization of the body to pathogenic microflora in patients with alveolitis (A.A. Timofeev, 1981; A.M. Solntsev, A.A. Timofeev, A.N. Likhota 1985 ).

According to L.M., Tsepov (1982), in patients with inflammatory complications there is a decrease in the function of the physiological system of connective tissue, which is determined using the R.E. test. Kavetsky. The dermal coefficient decreased from 8.3 (normal) to 5.6-6.1 (inflammatory process).

In patients with alveolitis, with varying severity of the pathological process, a decrease in the phagocytic activity of neutrophil granulocytes in the blood, lysozyme activity in the blood serum and saliva, as well as a weakening of the bactericidal properties of the skin were recorded (G. A. Zhitkova, 1984).

In the clinical picture of acute alveolitis, which occurs in the form of a “dry socket,” three forms of inflammation are distinguished: serous, purulent and purulent-necrotic (N.M. Gordiyuk, 1979). Each clinical form of the disease is characterized by characteristics of the clinical manifestation and cytological changes in the contents of the wells. T.G. Gapanenko et al. (1980) recommend highlighting only two clinical forms of inflammation:serous and purulent.

At serous alveolitis patients complain of constant aching pain, which intensifies during meals (probably caused by neuritis of the alveolar nerve). The socket of the extracted tooth usually gapes, the mucous membrane is hyperemic, swollen and painful. In some cases, the tooth socket may be filled with the remains of a blood clot, on the surface of which there are food debris. In other cases, the hole may contain a disintegrated blood clot, food debris, or saliva. The patient's body temperature, as a rule, does not increase. Regional lymph nodes do not become inflamed. Serous alveolitis develops on the 2nd-3rd day after tooth extraction and lasts about 1 week.

At purulent alveolitis Patients develop intense constant pain radiating along the branches of the trigeminal nerve, putrid breath, weakness, and malaise. Body temperature rises to 37.5-38.0° C. The skin of the face is pale, there is facial asymmetry, which occurs due to swelling of the soft tissues on the side of the extracted tooth. Regional lymph nodes are enlarged and painful on palpation. Opening the mouth causes pain. The mucous membrane around the tooth socket is hyperemic, swollen, painful, the alveolar process is thickened. The postoperative wound is filled with necrotic masses and covered with a dirty gray coating with a pungent, unpleasant odor. This form of inflammation of the socket develops, as a rule, on the 3rd and 4th days after tooth extraction. A purulent-necrotic process occurs. I believe that it makes sense to divide acute alveolitis into two forms -serous and purulent-necrotic. The latter form was introduced instead of the purulent one, as it more fully reflects the processes that occur in the hole.

We can agree with G.A. Zhitkova (1984), who proposes to highlight chronic form of the disease -chronic hypertrophic alveolitis. Just a word "hypertrophic" should be replaced with the word "purulent". Chronic alveolitis is characterized by an abundant proliferation of granulation tissue, which begins from the bottom of the socket. The mucous membrane of the alveolar process is bluish, swollen, and hyperemic. During an instrumental examination, a slit-like space, as well as small sequestra (usually by the end of the 3rd week, they are mobile) can be detected between the bone wall of the alveoli and hypertrophic growths. Pus comes out of the wound. Flow chronic form of purulent alveolitis is characterized by a gradual subsidence of pain in the alveolar process, a decrease in regional lymph nodes, normalization of body temperature and an improvement in the general condition of the patient. The pathological process stops by the end of the 3rd week, and if the patient has not been operated on, then the bone sequesters can recede on their own within the 4th week, after which recovery occurs. "

Thus, acute alveolitis is divided into serous and purulent-necrotic, and chronic - hypertrophic (purulent).

In patients with diabetes mellitus, alveolitis occurs with a more pronounced local inflammatory reaction and is characterized by “inhibition” of reparative processes in the area of complicated wounds. Alveolitis causes a deterioration in the clinical picture of diabetes mellitus, which is primarily expressed in an increase in blood sugar against the background of existing hyperglycemia (P.P. Guseinova, 1977).

There is no consensus on the treatment of acute alveolitis. Some authors advocate curettage of the tooth socket in the acute stage of inflammation (A.E. Verlotsky, 1960; Yu.I. Vernadsky, 1970, 1984; I.M. Starobinsky, 1972; V.E. Zhabin, 1975, etc.) . I do not recommend repeated scraping of the tooth socket, since in case of alveolitis, the pain syndrome is based on post-traumatic neuritis of the alveolar nerve and curettage of the socket will only lead to increased trauma as a result of postoperative edema.

To treat alveolitis, it was proposed to carry out coagulation of the walls and bottom of the socket, followed by filling it with iodoform gauze (B.Sh. Brenman, 1965). This method is not widely used due to its traumatic nature. We believe that its implementation has an extremely adverse effect on the disease.

It is known that the clinical course of alveolitis of the lower jaw has a beneficial effect regional novocaine blockade of the mandibular nerve. The effect of novocaine blockade is manifested in two ways: in the stage of serous inflammation, the process can be stopped, and in the presence of suppuration, rapid delimitation and reduction of inflammation occurs (M.P. Zhakov, 1969).

K.I. Berdygan and T.F. For the treatment of alveolitis, Okolot (1963) proposed injecting turunda soaked in 10-20% camphor oil with an anesthetic (novocaine or anesthesin) into the tooth socket. In case of severe pain, the tooth socket is washed with a 2% novocaine solution, after which a tampon moistened with a 5% novocaine solution is left in it (for 5-10 minutes).

I.N. Vavilov and A.I. In order to treat this pathological process, Protasevich (1969) recommends use proteolytic enzymes- trypsin, chymotrypsin, chymopsin. The solvents used are isotonic sodium chloride solution or 0.25% novocaine solution (10 mg of enzyme in 5-10 ml of solvent). Enzyme therapy helps clean the tooth socket of necrotic tissue, but it does not shorten the wound healing time.

Based on the biochemical studies carried out by L.F. Korczak (1971) determined the possibility of combined use of hydrogen peroxide, microcide, rivanol, furatsilin with chymopsin. It has been proven that these substances do not have an inactivating effect on the enzyme, as previously thought. N.F. Danilevsky and L.A. Khomenko (1972) indicate that the use of enzymes in combination with potent antiseptics, alcohol, and tincture of iodine causes inactivation of the latter.

In the treatment of acute alveolitis G.K. Sidorchuk (1974) recommends washing the tooth sockets with a warm solution of furatsilin and trypsin (chymotrypsin) and then filling them with antibacterial enzyme anesthetic paste, prepared in a 0.25% solution of novocaine or isotonic sodium chloride solution. The paste is prepared before use. It consists of 1.25 parts of one or two antibiotics (300,000 units), 0.5 parts of sulfonamides, 5 mg of trypsin (chymotrypsin) and 0.25 parts of anesthesin. According to the author's observations, the use of this paste stimulates the growth of granulations. They appear about two days earlier.

Used for the treatment of alveolitis antistaphylococcal plasma(A.G. Katz et al., 1973; Ya.M. Biberman, 1975). After washing the hole with a warm antiseptic solution and removing food debris and disintegrated blood clots from it, a gauze strip soaked in anti-staphylococcal plasma is placed in its cavity. Treatment procedures are carried out daily until the inflammation is eliminated. The use of this drug neutralizes the toxin released by staphylococci, which creates favorable conditions for healing of the hole.

V.A. Petrov (1963) uses bee venom preparation(venapiolin-1), which has analgesic and anti-inflammatory effects. The author recommends injecting it into the submucous membrane of the transitional fold, in the area of the extracted tooth, on the 1st day in the amount of 0.3 ml, on the 2nd - 0.5 ml, on the 3rd - 0.8 ml. The effect of using the drug occurs on the 2nd-3rd day from the start of treatment, and the hole is not tamponed.

To reduce antibiotic resistance of microorganisms, according to M.M. Solovyov et al. (1975), can be used surfactants (surfactants). Thus, surfactants enhance the effect of penicillin on antibiotic-resistant staphylococci (which is associated with blockade of the beta-lactomase enzyme) and directly interact with microbial cells (G.E. Afinogenov, 1970).

At treatment of alveolitis in patients with diabetes mellitus P.P. Guseinov (1977) recommends introducing turunda moistened with a solution consisting of 20 units of insulin, 5 ml of furatsilin 1:1000 and 1 ml of 5% vitamin B1 solution into the cavity of the tooth socket.

R.N. Chekhovsky et al. (1978) used the drug deflagin, which contains concentrated solutions sodium thiosulfate, urea and 10% oil solution of anesthesin. The drug is non-toxic, has anti-inflammatory, anti-edematous, non-political, bacteriostatic and desensitizing effects.

Used for baking alveolites alcohol solution of calamus. First, the tooth socket is washed tincture of calamus in 70° alcohol, then gauze turunda soaked in an alcohol solution of calamus is inserted into it for 20-30 minutes. The top of the wound is covered with a gauze swab soaked in the same solution (B.N. Pankin, 1978).

L.I. Kolomiets (1981) suggests that in patients with alveolitis, after anesthesia, revise the tooth socket and then fill it with turunda moistened ectericide or 50% solution of dimexide with oxacillin sodium salt(40% dimexide liniment). It has been established that the ectericide has activity against mono- and polyresistant strains of microorganisms that were isolated from infected post-extraction wells (V.F. Chistyakova et al., 1981).

I believe that dental cavity inspection should be carried out only in patients with a chronic form of the disease; in acute cases, this cannot be done.

Antibacterial drugs are used in the treatment of inflammatory complications that occur after tooth extraction dioxidin and hydrophilic ointments:levosin, levomekol, levonorsin. Our clinic has obtained encouraging results from the use of these drugs.

A new dosage form has been developed - 5% chloroacetophos ointment, made on a castor-lanolin base, which allows it to be inserted on the turunda into the tooth socket (F.S. Khamitov, T.T. Faizov, 1981).

For the treatment of alveolitis, a composition prepared from bactericidal liquid Gorgiev and 0.1% lysozyme solution in a 1:1 ratio. Gorgiev's bactericidal liquid contains more than 90% water, 0.5-0.9% sodium chloride solution, 4-6% fish oil and its oxidation products (G.A. Zhitkova, 1984). There is still no information about the existence of strains of microorganisms resistant to this drug. According to the author, the liquid has biostimulating activity.

Physiotherapeutic methods are used in the treatment of alveolitis. Use fluctuarization, which has an analgesic effect, accelerates the course of reparative processes, and stimulates regeneration. Laser therapy is also used to treat this disease. Helium-neon laser radiation has an anti-inflammatory effect, normalizes microcirculation, reduces vascular permeability, has a pronounced analgesic effect, stimulates tissue regeneration, etc. Irradiation parameters: power density 100-200 2 mW/cm, exposure - 2 min.

G.S. Mironenko (1976) recommends using it for the treatment of alveolitis tape recorders, being a source of constant magnetic field. They are made from elastic medical rubber with the addition of magnetic powder, in particular barium ferrite. They can be boiled or sterilized in an autoclave.

Physiotherapy as a method of treating alveolitis has found application in complex therapy, which has shortened the healing time of infected tooth sockets.

In recent years, it has become increasingly widespread acupuncture, which has an analgesic effect, increases the overall reactivity of the body and creates a peculiar background that promotes a favorable course of the disease and faster recovery (V.P. Goliki et al., 1981; V.G. Burgonsky, 1984).

All manipulations in the treatment of alveolitis, in my opinion, should be carried out under local conduction anesthesia, since the latter, in addition to the analgesic effect, has a beneficial effect on the course of the inflammatory process. We object to surgical interventions on the bones in acute forms of alveolitis, as well as coagulation, curettage and cauterization of the tooth socket with medicinal substances. We recommend rinsing the tooth socket with warm solutions of antiseptics (furacilin, chlorhexidine, etc.). Rinsing must be done under pressure using a syringe, bringing the curved needle to the bottom of the tooth socket and making sure that there are no remnants of a disintegrated blood clot, bone fragments or dental fragments left in it. Then the tooth socket is filled with turunda moistened with an antiseptic solution. The first tampon change is made after 1 day, and then after 3-4 days (until the pain disappears). In the chronic stage of alveolitis, that is, at the end of the 3rd and at the beginning of the 4th week, in the presence of sequesters, sequestrectomy is performed. Typically, after surgery, patients recover.

As can be seen from the above, the treatment of alveolitis still presents significant difficulties. A huge number of treatment methods have been proposed, but none of them is universal.

♦ Sharp bone edges of the socket

Pain in the area of the postoperative wound can be caused by sharp protruding bone edges of the socket, which injure the mucous membrane located above them. Most often, sharp bone edges in the area of a postoperative wound are formed after the removal of several adjacent teeth or during their atypical removal. Patients complain of severe pain of a neuralgic nature, which often appears 3-5 days after tooth extraction, when the approaching gingival edges seem to be pulled onto sharp areas of the alveolar bone. The pain intensifies while eating or when accidentally touching the tooth socket with your tongue.

When examining the area of the postoperative wound, a protruding, uneven edge of the alveoli is visible. There are no signs of inflammation, which distinguishes this complication from alveolitis. When palpating the protruding sharp bone edges, the patient feels a sharp pain, which decreases somewhat as the bone atrophies. However, bone resorption occurs over a long period of time, so the pain does not disappear for a long time and patients should undergo surgery to remove the protruding sharp bone edges of the alveoli. Surgery is performed under local anesthesia. An incision is made over the protruding bone edge, and the mucoperiosteal flap is removed. The sharp bone edges are removed (with nippers) or knocked down with a chisel or cut off with a milling cutter. The flap is placed in place and sutures are applied with catgut.

Prevention of the development of this complication is the removal (resection) of the protruding edges of the alveoli, interdental and interroot septum directly during tooth extraction.

After tooth extraction, it is necessary to carefully monitor the healing process of the hole. The operation requires recovery of the body. In the absence of complications, tissue regeneration occurs quite quickly and without additional interventions, but if there are any unpleasant symptoms, you should consult a specialist. This happens especially often when a wisdom tooth is pulled out.

What does a normal hole look like: photo

The process of complete healing of the gums after tooth extraction reaches 4 months and takes place in several stages (we recommend reading: how long does it take for a wound to heal after tooth extraction?). You can see how the hole looks normally in the photo.

On the first day after surgery, a blood clot forms in the removal area. Without it, the healing process will be difficult, so it does not require removal. The clot contains fibrin protein, which when accumulated looks like a white coating. It performs a protective function and prevents infection and the development of infectious processes.

On the third day, the formation of thin epithelium begins, which indicates the beginning of healing of the wound. Subsequently, the epithelial tissue is replaced by connective tissue, forming granulomas. After a week, these tumors displace the clotted blood.

The wound is actively overgrown with epithelial tissue, while bone tissue is formed in the gum itself. In a month, its quantity will be enough to almost completely fill the hole, and after two, there will be no free space left at all. Gradually, the tissue in the wound becomes the same as on the entire jaw, the edge decreases in size.

Causes of white fibrinous plaque

In most cases, the resulting fibrin white layer in the socket does not pose a threat to health, but on the contrary is necessary for a speedy recovery. In some situations, white formations on the gums are signs of:

In the presence of pathologies, the color and structure of plaque changes. Only an experienced doctor can notice these differences, so it is necessary to consult with a specialist who can accurately determine the nature of the white plaque.

What pathologies can there be?

Removing a problematic tooth entails a violation of the integrity of the mucous membrane, rupture of blood vessels and nerves, especially if a wisdom tooth is pulled out. Ligaments, muscle fibers and soft tissues located in the operation area and holding the root are also injured.

As a result of surgical exposure, inflammatory processes begin to develop. This is an integral part of the recovery period, which is accompanied by the following symptoms:

Gradually, all these symptoms become less intense and disappear. If the discomfort does not go away and intensifies, this may indicate the presence of a bacterial infection or the development of other pathologies.

The socket becomes inflamed

Sometimes the operation to remove a tooth is complicated and takes a long time. Such an intervention causes more trauma to the gums and can negatively affect tissue regeneration.

The appearance of a white formation in the surgical area in some cases indicates the presence of inflammation in the oral cavity. The socket itself becomes inflamed with alveolitis. This disease is characterized by the presence of infections in the wound. The gray color of the plaque indicates that the disease is progressing. Under no circumstances should such a situation be left without attention and medical treatment. Advanced alveolitis turns into osteomyelitis and threatens with serious complications.

Some infections that get into the socket provoke the formation of pus, which is easily confused with fibrin deposits. It must be removed by a doctor using special solutions. Medications will help prevent further development of the disease.

The hole has a sharp edge

During the healing process of the hole, mucous membrane and bone are formed. A prerequisite is the protection of the bone tissue from external influences from a blood clot or gum.

When the wall of the socket is higher than the rest and has a sharp edge, it is able to break through the new mucous membrane and protrude into the oral cavity. The presence of an unprotected bone area increases the risk of developing alveolitis.

If quite a lot of time has passed after the tooth was pulled out, but the fibrous stain does not go away and something white is clearly visible on the gum, most likely this is the sharp edge of the wound. By touching it carefully, you can really feel its sharpness.

Small sharp edges gradually self-destruct. In more complex situations, minor surgery is performed. After anesthesia, the gum is moved back at the site where the sharp edge is formed and a piece of bone is removed, followed by suturing.

Removal was incomplete

It is not always possible to remove a tooth completely and notice it immediately. Dental residue with reduced immunity and neglect of hygiene will provoke alveolitis and thus reveal itself. In other cases, inspection will help to detect the forgotten root. After the formation of a white fibrinous film, it will become noticeable that the gums in this area are receding a little.

A dental surgeon will help remove the remaining fragments. It would be a good idea to undergo an additional X-ray examination. The image will show the remains of the extracted tooth, if any, or help verify their absence.

What to do: how to get rid of fibrin plaque?

To remove fibrin plaque, a toothbrush and toothpaste are not enough. Proven methods will help you clean off a white spot on your gums:

using tooth powder instead of paste, but not daily, but once a week;
Rubbing your teeth with lemon peel will help cope not only with plaque, but also with hard deposits;
applying a paste of baking soda and hydrogen peroxide once a week;
adding crushed activated carbon to toothpaste removes plaque and helps whiten teeth.

If a light plaque appears at the site of an extracted tooth, it does not pose a threat in most cases. Following hygiene rules will easily get rid of it.

Preventive measures

Following certain rules in the postoperative period will help restore tissue faster and heal the wound. The duration of their implementation depends on the complexity of each specific case and ranges from one to two weeks.

The main thing is that soft tissues are regenerated. After this, the bone tissue will be reliably protected and nothing will interfere with bone formation. Measures for speedy healing include the following points:

after a tooth has been pulled out, it is necessary to hold a cotton swab soaked in a special solution on the wound for about half an hour;
do not remove a blood clot formed on the wound;
do not check the degree of healing of the hole with your tongue;
Do not use straws for drinking for 2 hours after surgery, because at the same time, a vacuum environment is formed in the mouth and a blood clot can break, causing bleeding;
step away from training and physical activity for a couple of days;
do not overheat for 2 hours in the sun, in a hot bath or shower, and also do not go to the bathhouse;
do not warm up the surgical area;
do not eat for 2-3 hours;
until the wound begins to heal, you should avoid hot or cold foods and drinks;
Give up cigarettes and alcoholic beverages for a week.

Toothache not only deprives you of the joys of life, but is also dangerous to your health. That is why dentists do not advise ignoring it, muffling it with painkillers and postponing treatment until tomorrow. With the capabilities of modern dentistry, tooth extraction is a last resort. However, in advanced cases this procedure cannot be avoided.

Tooth extraction means implantation or prosthetics in the future, for which it is important to be financially prepared. However, first there will be an operation in the office of a dental surgeon. The manipulations are performed under local anesthesia and sometimes bring significant relief. For this, you will have to be patient and carefully care for your oral cavity after removal. Wound healing has its own nuances, and serious complications can occur if hygiene rules are not followed.

How long should a hole heal?

After tooth extraction, a hole remains, which is a source of increased attention. During the operation, the surgeon violates the integrity of blood vessels and nerves and damages adjacent soft tissues. As a result, the injury site may become inflamed and bleed. Its healing is usually accompanied by the following symptoms:

pain in the area of the extracted tooth;
pain can radiate to the ear, eye, neighboring tissues;
rise in body temperature;
difficulty swallowing, swelling, other dysfunctions of the jaw.

All these consequences are considered normal, but they should gradually fade away and not progress. Successful healing of the gums is influenced by many factors, the main ones being proper oral care, the condition of the body, and the rate of blood clotting. Until a blood clot appears and closes the wound (this takes up to three hours), there is a risk of infection entering it.

Stages of healing with photos

A complete recovery will take much longer, since healing after removal occurs both in the tooth socket and in the gum. They behave differently:

When a wisdom tooth is removed, the formation of new tissue will end by the end of the first month (we recommend reading: How long does it take for a socket to heal after a wisdom tooth is removed?). When looking for photographs of a tooth socket at different times, you should take this point into account so as not to get upset that the process is going wrong. Excessive stress will not benefit your health and will prolong the healing period.

3 days after removal

Normally, the wound does not bleed on day 3. The clot, which was burgundy on the first day, becomes lighter and acquires a yellowish tint. Its color is determined by natural physiological processes. Hemoglobin (the red component) is gradually washed out by saliva, but the fibrin framework remains. It forms the basis of a blood clot that prevents bleeding from the wound.

There is no need to reach into the problem area with your hands or injure it with toothpicks and a brush. The wound heals according to the principle of secondary intention, from the edges to the center. If these conditions are not met and there is a lack of hygiene, suppuration at the removal site is possible after 1-3 days. This is alveolitis - a dangerous complication with a complex of unpleasant symptoms. The gum becomes inflamed, the pain intensifies, the socket is filled with food or saliva, or is empty, the blood clot is injured or missing. If treatment is not started in time, the disease can lead to phlegmon, abscess, and sepsis.

5 day

By 4-5 days, the color of the tooth socket normally becomes even lighter, the wound heals, as can be seen in the photo. The extraction site may still ache and bother you. If the pain is not severe, there is no bad breath, inflammation or swelling of the gums, the process is going as it should. At this time, it is important to maintain oral hygiene, try to speak less and not chew on the problematic side of the jaw.

Day 7

On the 7-8th day, the painful sensations subside. Granulations gradually replace the blood clot; only traces of it can be seen in the center of the tooth socket. The outside of the wound is covered with a layer of epithelium, while bone tissue is actively forming inside. If you experience discomfort, swelling of the gums, or pain, you should see a dentist. It may be necessary to re-process the hole and add medication. In practice, if the patient followed the instructions after tooth extraction, complications rarely occur.

Factors influencing the rate of gum healing

How long does it take for tissue to heal after extirpation? Each patient has their own regeneration time. The process is influenced by the following factors:

Causes of inflammation of the socket

Inflammation of the tooth socket, the surrounding soft tissues or the periosteum cannot be missed (we recommend reading: what to do if the periosteum sticks out after tooth extraction?). The process is accompanied by pain, swelling in the problem area, and general malaise. Body temperature often rises, it becomes painful to speak and swallow. Inflammation of the socket is caused by the following factors:

infection with ARVI, infections after removal (it is important to be healthy at the time of surgery);
weakened immunity due to diet or any disease;
the presence of carious teeth, from where pathogenic bacteria spread to other parts of the oral cavity;
incorrectly selected anesthesia;
poor handling of instruments, non-compliance with sanitary conditions during manipulations, as a result of which infection penetrates into the wound;
serious damage to the gums during extirpation;
the cyst from the extracted tooth remained in the socket.

In any situation that interferes with the healing process of the hole after tooth extraction, you should consult a dental surgeon. An x-ray, complete blood count, autopsy, and re-cleaning may be indicated. Additionally, the doctor will prescribe physical therapy and supportive medications to improve your well-being. After cleaning, the doctor puts Neomycin powder (an antibiotic) into the hole and covers it with a tampon. Symptoms of inflammation then disappear within 1-2 days.

What should I do if my gums still hurt after a week?

Normally, pain in soft tissues subsides gradually, and already on the 7th day the patient does not feel severe discomfort. However, with complex removal, the gums take a long time to heal and hurt at night. In this case, you should contact the doctor who removed the tooth. At home, suffering will be alleviated by painkillers (Tempalgin, Nalgesin, Nurofen, Solpadein) and rinses:

weak soda solution;
furatsilin solution (1-2 tablets per glass of water);
decoction of calendula, sage or oak bark;
antibacterial drug Miramistin.

How to properly care for your gums after tooth extraction?

Tooth extraction should be agreed as a last resort when modern dental methods are unable to restore it. If extirpation cannot be avoided, it should be entrusted to an experienced surgeon with a good reputation.

The procedure will be performed under local anesthesia; the doctor will not let you go home until he is sure that the bleeding from the hole has stopped. Self-absorbing cones with iodine and other antiseptic and hemostatic drugs are placed in it.

Additionally, the doctor advises on wound care in the first days. The rules after tooth extraction are as follows:

you should slowly get up from your chair and go out into the corridor;
sit for about 20 minutes (sudden movements and fussing can cause unwanted bleeding);
do not eat or drink for 3 hours after manipulation;
do not rinse your mouth for the first 2 days;
do not touch or remove the turunda in the hole if the doctor left it;
if a white clot, a tampon with medicine, which was placed during the intervention, falls out, you need to rinse your mouth with a chlorhexidine solution and be sure to know how to do it correctly;
when food gets into the wound after tooth extraction, do not pick with a toothpick, but rinse gently;
make “baths” for the hole with an antiseptic, as the doctor advises;
when chewing, try not to touch the affected area;
When cleaning, do not touch the problem area so as not to tear off the clot;
from the third day, rinse your mouth with herbal decoctions or antiseptic solutions;
use topical preparations (Solcoseryl gel, Metrogil denta) as recommended by the dentist;
for pain and inflammation, apply cold compresses to the cheek for 15 minutes;
you cannot heat the problem area, take a bath, or steam in a sauna;
avoid alcohol, smoking, physical activity (we recommend reading: how many days after tooth extraction can you drink alcohol?);
Consult a doctor if the hole with the clot turns black.

What does a normal healing socket look like after time? Neat, not inflamed, without pain and discomfort. When this is not the case, a dentist should be consulted. He will take measures that will prevent infection or relieve inflammation.