Do children get dry socket?—The incidence and pattern of presentation of alveolar osteitis in children and adolescents following dental extractions

Background

Alveolar osteitis (AO) is widely reported as the most common post-operative complication following surgical and non-surgical exodontia. Despite being one of the most studied complications in dentistry, there is no established consensus on its aetiology, alongside a relative paucity of studies looking exclusively into AO incidence in children and adolescents.

Objectives

To determine the incidence, risk factors and pattern of presentation of AO in children and adolescents following exodontia, as well as identifying concepts and theories to provide a basis regarding why such a common post-operative complication reportedly manifests so rarely in the paediatric population.

Methods

This cross-sectional analysis forms part of a prospective service evaluation of the exodontia service provided by Newcastle Dental Hospital. All patients aged 5–16 who underwent dental extractions of deciduous and/or permanent teeth under general anaesthetic (GA) between 15 June 2020 and the 15 July 2020 were telephoned 1 week following their procedure to determine if any had developed post-operative complications. Data were cleaned manually and analysed using descriptive statistics, exploratory analysis with chi-squared tests and multivariable analyses. A scoping review was performed using the PubMed, OVID Medline and Scopus databases.

Results

Four of 150 patients (2.8%) developed AO and reported extreme pain which began 2–3 days after removal, lasted 2 days after onset, and were all associated with the non-surgical removal of lower first permanent molar teeth. All patients who developed AO were female and aged between 9 and 10 years old. Mandibular sockets were significantly associated with development of AO (p = 0.026).

Conclusions

Despite the belief that AO rarely manifests in children, the incidence of paediatric AO in this study is in line with that of AO found in the adult literature. The literature is inconsistent and conflicting regarding current understanding of AO. As far as possible, an atraumatic approach to exodontia should be adopted. We have proposed four underlying concepts which may benefit from future research given the paucity of research exclusively into dry socket in children and adolescents.