Knowledge, Attitude and Practice Survey of Dental Students and Dental Practitioner about COVID 19

Keywords

Chlorhexidine Gel; Dry Socket; Third Molar Extraction; Metronidazole Gel.

Introduction

Dry socket or alveolar osteitis is a very painful per se, self limiting condition which is relatively common complication following the tooth extraction process. Dry socket was first described in 1896 by Crawford. According to Blum, Dry socket is defined as pain near the extraction socket after post operation, which increase in intensity at any time between the first and third day after extraction of third molar. This particular complication which occur due to partially or totally disrupted blood clot within socket and also with or without halitosis. This incidence varies between 20% to 30% after extraction of impacted third molar and 1% to 80% for all dental extraction. The onset of dry socket occur 1 to 3 days after toothextraction. Etiology of dry socket has not been firmly known as of now, two main theories have been proposed for the ethology of dry socket. Current cure resides with antibacterial agents, antiseptics, antifibrinolytics, anti inflammatory agents. Antiseptics such as chlorhexidine rinses proved to be highly efficient in dry socket prevention and its complication.

The study was prospective ,blind study done to assess and compare the effectiveness of chlorhexidine gel and metronidazole gel placed directly into surgical socket after removal of extraction third molar.

Previously our team has a rich experience in working on various research projects across multiple disciplines (Govindaraju and Gurunathan 2017; A. Christabel et al. 2016; Soh and Narayanan 2013; Mehta et al. 2019; Ezhilarasan, Apoorva, and Ashok Vardhan 2019; Campeau et al. 2014; Kumar and S 2016; S. L. Christabel 2015; Kumar and Rahman 2017; Sridharan, Ramani, and Patankar 2017; Ramesh et al. 2016; Thamaraiselvan et al. 2015; Thangaraj et al. 2016; Ponnulakshmi et al. 2019; “Fluoride, Fluoridated Toothpaste Efficacy and Its Safety in Children - Review” 2018) Now the growing trend in this area motivated us to pursue this project.

Materials and Methods

This study involved both male and female patients, who were under went molar extraction with difficulty score ranging between 7 to 10 in Pederson difficulty index.

Inclusion Criteria

All the patient in the age group of 18-40 years, requiring extraction of 3 rd molar.

Exclusion Criteria

• Patients with immuno compromized patients

• Pregnancy patients and oral contraceptive

• Patients allergic to chlorhexidine and metronidazole

• Patients with hard or soft tissue pathology

• Patients who are addicted or abuse alcohol and tobacco.

Study Design

Study conducted based on 30 participants and they were divided into two groups based on the material applied in the dry socket .All the patients underwent extraction with the same techniques. All the necessary procedures were done with the help of local anesthesia i.e, with 2% lignocaine by the same practitioner to eliminate any bias in the procedure. Patients were reviewed on the 3rd day and second review on 7th day post operation.

Discussion

The most common and painful complication in the healing process of the extraction wound is Dry socket. Alveolar osteitis is an acute non purulent inflammatory process. It is localised in the dental alveolus that creates a delay in wound healing. Its characters include late onset with intense and irradiating pain.The main characteristic of the extraction socket is the denuded appearance. The interior bone exposed in the oral cavity which is whitish. Most crucially it is hypersensitive to contact. Most literature supports that dry socket occurs very infrequently in childhood and that incidence increase with increase in patients age. In this study, there exist no correlation between gender, age, site of extraction and dry socket.

In 1977, Legarth performed a study to see the effect of 0.2% chlorhexidine on dry socket prevention and noted a 45% decrease in dry socket in a group of 60 patients.The bio adhesive 0.2% chlorhexidine gel directly placed into socket will have more direct action on the alveolus.

Various studies have been done to see the major role of metronidazole in the prohibition of dry socket. And its results were found, which says prophylactic metronidazole was found to be effective means of preventing dry socket after regular dental extraction. The antimicrobial activity of metronidazole has been proposed is due to the reduction of nitro group to a more reactive amine group. This amine group attacks the microbial DNA thus inhibiting further synthesis and causing degradation of existing DNA .From the mentioned mechanism of action use of ornidazole as local drug delivery may be an advantageous form of treatment since it would probably eliminate side effects.

By taking into account clinical evaluation and statistical analysis we found that in patient were intra alveolar metronidazole gel was placed there was significant decrease in pain on the 3rd day post operative and 7 th day post operative day. Mouth opening and facial swelling was also reasonable post operative. At the end comparison of chlorhexidine gel and metronidazole gel irrespective of Peterson difficulty index score for mouth opening, facial size and pain, there is statistically significant ,from this it can be concluded that metronidazole gels are effective in reducing post extraction complications.

Our institution is passionate about high quality evidence based research and has excelled in various fields ( (Jayaseelan Vijayashree Priyadharsini 2019; Pc, Marimuthu, and Devadoss 2018; Ramesh et al. 2018; Ramadurai et al. 2019; Sridharan et al. 2019; Ezhilarasan, Apoorva, and Ashok Vardhan 2019; Mathew et al. 2020; Samuel 2021; R et al. 2020; Chandrasekar et al. 2020; J. Vijayashree Priyadharsini, Smiline Girija, and Paramasivam 2018)

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Figure 1:

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Figure 1. Distribution of male and female in each group.

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Table 1:

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Table 1. Mean and p value for pain.

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Table 2:

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Table 2. Mean and p value for facial size.

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Table 3:

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Table 3. Mean and p value for mouth opening.

Conclusion

This study indicates that irrespective of difficulty index, metronidazole gel is effective in decreasing the post operative complications which includes pain, swelling and reduction in mouth opening. The limitation of the present study is small sample size.