Alveolar Osteitis — ORE Part 1 MCQ

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EasyOral SurgeryAlveolar OsteitisORE Part 1

A 35-year-old man undergoes surgical extraction of an impacted lower right third molar. Three days later he presents with severe pain, a foul taste, and an empty socket with exposed bone. What is the most likely diagnosis?

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Correct answer: B — Alveolar osteitis (dry socket)

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

The presentation is pathognomonic for alveolar osteitis (dry socket). The key diagnostic features are: (1) timing—onset at day 3, within the classic 2–3 day window; (2) severe pain, a cardinal feature; (3) foul taste due to halitosis and food debris; and (4) an empty socket with exposed bone, indicating loss of the protective blood clot. This condition is most common after surgical extraction of mandibular molars, as in this case. Osteomyelitis (B) requires systemic signs (fever, purulence, bone destruction) and would present later with true infection; localised alveolar osteitis causes severe pain whereas infected alveoli cause mild or no pain. Post-operative infection (C) is typically more generalised and later in onset. MRONJ (D) requires a history of antiresorptive therapy (bisphosphonates or denosumab), absent here. Mandibular fracture (E) would be associated with trauma or malocclusion, not this clinical picture.

Reference: SDCEP Management of acute dental problems – Alveolar osteitis (dry socket): https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/alveolar-osteitis-dry-socket/. UKHSA Cochrane Review: Local interventions for the management of alveolar osteitis (dry socket), September 2022: https://researchportal.ukhsa.gov.uk/en/publications/local-interventions-for-the-management-of-alveolar-osteitis-dry-s-2/