Chlorhexidine in the prevention of dry socket: effectiveness of different dosage forms and regimens

Dry socket (DS) is a potential postoperative complication of dental extractions. It is clinically diagnosed by the presence of a denuded socket secondary to premature loss of the blood clot, and manifests as slight discomfort for the patient, followed by sudden worsening with intense or lancing pain. Since the underlying etiology is not clear, the best treatment is prevention. Chlorhexidine (CHX) is an antiseptic that acts upon the bacteria of the oral cavity, and is widely used in dental practice.

A metaanalysis is made of the different CHX treatment regimens used for the prevention of DS, with the proposal of a management protocol designed to maximize the efficacy of such treatment.

Literature searches were made in the PubMed Medline, Cochrane and ISI Web of Knowledge databases, crossing the terms: alveolar osteitis, dry socket and chlorhexidine. The search was limited to randomized or nonrandomized clinical trials.

Twelve clinical trials using CHX in rinse or gel form at doses of 0.12% or 0.2% with different administration regimens for the prevention of DS were identified.

After reviewing the existing medical literature, it can be concluded that 0.2% CHX gel, applied every 12 hours for 7 days after extraction is the best available option for the prevention of DS. However, this is also the most expensive option, and since CHX is not subsidized by the Spanish public healthcare system, it occasionally may be more advisable to use the 0.12% rinse with the same dosing regimen.