Alveolar Osteitis (Dry Socket)

Severe dull pain post dental extraction, two-three days later. Tooth socket appears

‘dry’ with exposed bone and no blood clots, gingiva is inflamed.

Treatment

Analgesics

Dental referral for LA debridement and curettage to initiate socket healing Facial Fractures Mandibular fracture (broken jaw)

For simple, undisplaced fractures, advise soft diet, PRN analgesia is sufficient. (No surgical intervention required).

For compound displaced fractures: Amoxicillin 500mg tds orally OR Penicillin G 1.2g IV qid PLUS

Metronidazole 500mg IV bd if infected;

Check tetanus toxoid status and give it if not covered Refer for dental surgery

In children, closed condyle or TMJ fractures, encourage early jaw movement (to prevent ankylosis), soft diet and paracetamol as analgesics. (Do not use aspirin®). Midface fractures

Le Fort types I, II and III or isolated midface fractures, refer for dental surgery.

If compound fracture, initiate benzyl penicillin 1.2g qid IV and metronidazole 1g qid IV for 5-7 days while awaiting transfer for surgery.

Cerebrospinal fluid leaks

Fractures of the facial middle third and skull, which injure the dura, can cause CSF leaks and present as otorrhoea or rhinorrhoea. They predispose to meningitis and must be covered with antibiotics until the leak stops.

Recommended treatment: Rifampicin 600mg oral daily OR

Chloramphenicol 500mg oral qid OR Ceftriaxone IMI 250mg daily.

Continue for two days after CSF leak stops Osteomyelitis