Dressings and extractions (For Dentists)
Sometimes the blogs are just specific for dentists, and this one is specifically for dentists.
Yet again, I was doing another surgery lecture and I was discussing the principle of dressings in extraction sockets that are “infected” I specifically referenced a product during those lectures that’s used widely in dentistry, but it is probably best that I don’t write it down here.
You know the one I mean though, looks a bit like chewing tobacco!
This is the product that has become synonymous with “infected sockets” or “dry sockets” and as the standard treatment, when a patient comes back after an extraction in pain.
It has become so common in dentistry to utilise this “product” that when a patient says that, they are in pain from an extraction; this product has already been opened, with a pair of dental tweezers beside them, ready to be inserted, before the patient even enters the surgery!!!
Let’s think about that again.
It has become so common to use this “product” that it is already out, before the patient walks in and has been examined.
I am writing this in response to two emails from DFT’s who have asked me to explain my comments in the oral surgery lecture and I pointed them this way.
I’m happy to get enter into a debate about this, in what I am about to write, but please do the debate below in the comment section and I will happily get to it.
An extraction site is a healing socket, which seals by secondary intension.
That means, it heals from the bottom, up and from the sides, in.
The tooth comes out, ideally the area fills with a blood clot and then it remodels over time, soft tissue closes over the top and the bone falls in.
This can be painful for up to a week and the socket can look a bit grubby and a bit wet or a bit dry, but generally if it’s well looked after with local measures (usually hot salt mouthwash) it heals even if it’s painful.
Generally in smokers, it takes 2 weeks, therefore if a smoker comes back at 10 days and says their socket is still sore, give them advice on taking pain relief, stopping smoking and local measures (hot salt mouthwash), if a patient comes back with a non-healing socket; then do what a plastic surgeon does to an non healing wound.
Remember that you are a surgeon and surgical principles do apply.
Freeze the area up and scrape it clean until it bleeds, it will then become a normal socket again and it will heal.
The treatment of surgical complications is usually to apply surgical principles and where in some disastrous cases, repeated application or dressing is the way forwards - it’s not required and not even good treatment for that of a painful socket.
At the DFT study, that I presented at in June for Yorkshire and Humber, I demonstrated some order figures from back in 2005/2006 that I did in my old surgery contract at the time, involving about 1000 extractions.
Not one of those patients received a dressing provided by me, for any complication in surgery and I think the numbers are quite dramatic.
The utilisation of dressings is not a substitute for doing things properly and in fact, it is garbage treatment.
So, the dressing in general that we are talking about. Do you know what is in it? I dare you to read the ingredients.
I don’t know what is in it, but I don’t have to, because I don’t use it.
But I have read the ingredients and I don’t like it.
I hope that answers my rants about this particular procedure in dentistry.
Just reflect back and think again, if your dental nursing surgery is getting out material to treat a situation before you have even seen the patient, then you’re on a treadmill.
There is no such thing as a “dry socket” or it is so rare that it is unlikely that you’ll ever seen it.
But it has become a name in dentistry that we use to allow us the opportunity to jam something in there, to get the patient out the chair.
Rubbish treatment. Try doing something better.
Blog Post Number - 2056