style="font-size:15px;"> 3 Dry socket or alveolar osteitis is the cause and is the most common complication after a tooth extraction. It is characterized by the absence of blood clot within the socket due to its incomplete formation, disintegration, or removal. The empty socket can be easily infected and inflammatory products could activate pain, taste, and smell receptors thus causing pain, dysgeusia, and halitosis.4 No
5 No
Comments: The lack of severe trauma on either mouth or head excludes tooth avulsion, while the severe symptomatology despite its short duration rules out intra‐alveolar carcinomas and metastatic tumors from diagnosis. Osteochemonecrosis is not the cause, as the lady was not under any medications such as biphosphonates which could be responsible for bony necrosis.
Q2 Which is/or are the main predisposing factors for this condition?
1 Preexisting infection
2 Anemia
3 Poor oral hygiene
4 Smoking
5 Vitamin deficiency
Answers:
1 Preexisting inflammation of the teeth or gingivae cause inflammation and disintegration of the blood clot.
2 No
3 Poor oral hygiene allows pathogenic germs to inoculate and grow into the socket of a recently extracted tooth, causing inflammation and lysis of the clot as well as necrosis of adjacent alveolar bone.
4 The sucking action of cigarette smoking dislodges the clot from the socket while at the same time, the smoking chemical, i.e. nicotine, causes local vasoconstriction thus delaying the healing.
5 No
Comments: Severe anemia, especially due to iron or vitamin deficiency, causes low oxygen compilation in the tissues, and indirectly may halt or delay wound healing stages increasing the risk of local infection and secondarily the disintegration of the clot.
Q3 Which is/or are the complication(s) of an untreated dry socket?
1 None
2 Osteomyelitis
3 Low quality of life
4 Increased risk of malignant transformation
5 Paresis of the trigeminal nerve
Answers:
1 No
2 Osteomyelitis is an infection (acute or chronic) of the bone marrow of the mandible or maxilla, induced by various bacteria or fungi, that occurs after a local trauma or difficult extractions, and rarely from dry sockets.
3 Dry socket is characterized by an intense pain which often interferes with the patient's work or social activities in the community, thus reducing his quality of life.
4 No
5 No
Comments: Chronic local irritations and not dry socket inflammation are believed to participate in the development of some oral carcinomas. In dry socket the inflammation is acute and does not have enough time to provoke changes in the affected tissues capable for malignant transformation. Dry socket can rarely cause the spread of pathogenic bacteria into the surrounding tissues at such degree that the induced inflammation can cause pressure and dysfunction of the trigeminal nerve.
Case 4.2
CO: A 68‐year‐old man was referred for evaluation of his dental status and his rotten breath before the beginning of zoledronic acid treatment for his lung cancer spine metastases.
HPC: His bad breath was first noticed by his clinician one month ago when the patient visited him for back pain. His halitosis was constant, worse at mornings and night, and unrelated to his meals.
PMH: His medical history revealed hypertension and respiratory problems such as chronic bronchitis and a small cell carcinoma in the left lung diagnosed two years ago which was surgically removed (lobectomy), unsuccessfully, as recent metastasis into the spine had been shown. His smoking or drinking habits had stopped since the diagnosis of his cancer.
OE: Examination revealed a cachectic man with periodontitis with gingival pockets depth from 4 to 8 mm depth forming thus a suitable place for accumulation of excessive plaque and food debris on his remaining decayed teeth (Figure 4.2). No other oral lesions were detected. His breath was bad, rotten and repulsive. Severe pain and difficulties in posture were reported and according to his oncologist were related to his spine metastasis.
Q1 What is the origin of the bad breath?
1 Smoking
2 Poor oral hygiene
3 Spine metastasis
4 Antihypertensive drugs
5 Periodontitis
Answers:
1 No
2 Anaerobic bacteria are easily found in mature dental plaque, capable of disintegrating food debris and releasing a plethora of volatile molecules which are responsible for the patient's malodor.
3 No
4 No
5 No
Comments: Smoking can cause halitosis in some patients but is not the cause here, as this habit was stopped two years ago. Spine metastasis is associated with pain and moving difficulties and spinal cord decompression, but never with halitosis. Periodontitis and some antihypertensive drugs have been related to chronic halitosis, but cannot be the cause as his bad breath was recent and detected one month ago.
Q2 Which of the volatile gases is mainly responsible for the patient's halitosis?
1 Alcohol
2 Fatty acids
3 Amines
4 Sulfur compounds
5 Nicotine
Answers:
1 No
2 Volatile gases of fatty acids like butyric, valeric,
