Alveolar osteitis after mandibular extraction — ORE Part 1 MCQ

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EasyOral SurgeryAlveolar osteitis after mandibular extractionORE Part 1

A 28-year-old smoker returns three days after extraction of a lower molar with severe throbbing pain radiating to the ear. The socket is empty with exposed bone and a foul taste, but there is no facial swelling or fever. What is the most likely diagnosis?

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Correct answer: C — Alveolar osteitis

The diagnosis is alveolar osteitis (dry socket). This condition characteristically presents 2–5 days post-extraction with severe throbbing pain (often radiating to the ear or neck), an empty extraction socket with exposed bone, halitosis or foul taste, and occurs most frequently after mandibular molar extractions. Smoking is a known risk factor. The absence of fever and facial swelling excludes acute osteomyelitis and Ludwig's angina, both of which present with systemic signs. Oroantral communication follows upper molar extraction, not lower. Trigeminal neuralgia is a chronic neuropathic disorder unrelated to dental extraction. The exposed bone, timing, and location are pathognomonic for alveolar osteitis.

Reference: Cochrane Database Syst Rev. 2022 Sep 26;9(9):CD006968. Daly BJ, et al. Local interventions for the management of alveolar osteitis (dry socket). https://pubmed.ncbi.nlm.nih.gov/23235637/