Pt got 38 extracted 25 days back.Swelling and pain still persist? Is dere ny fracture visible in mandible and what should be the cause of swelling and tenderness in mandible?

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Yea as all predicted - it is a case of alveolar osteitis., locally !! Between it is in close proximity to the neurovascular bundle , and not foramen . The swelling is due to sepsis of wound reason may be mix of many - immune compromise, personal habits., medications skipping ., unsterile instrument !! Rx:- Proceed with wound debridement ., don't injure the nerve.. Induce bleed ., rinse with betadine and place Zoe pack ., Preferably choose a different class of antibiotic from which was prescribed earlier.. please add SET( systemic enzyme therapy ) -BD 1/2 hour before food - as it works on proteolysis and fibrinolysis.. Breaking down the pus blood barriers and takes the antibiotic molecules to the micro-organisms . + adequate analgesic. Thank u

sir I ain't sure how helpful would SET be in such case. kindly explain the role of SET so I could use it in any such case
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Systemic enzyme therapy acts on proteolysis and fibrinolysis properties dr.sid .,the swelling is due to accumulation of pus, plasma with fibrin mantle., that's not disintegrating . So these enzymes breakdown those fibrin mantle around inflamed region thereby causing disintegration and allowing rbc carrying antibiotic molecules to reach the potentially infected site which was not reached before . Thereby causing reduction in inflammation.

vch SET u prefer mostly
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What is the status of extraction socket? It was very close or say touching mandibular foramen. Any harm to that can lead to pain. Look for bony extosis or dry socket. Betadine rinses and zn eugenol pack in the bone exposed area. I am not sure about mandibular fracture line as it can be an artifact too, but please rule it out by repeating clear OPG or CBCT..All the best!

Also I would like to add that please look at traumatic occlusion at healing site by upper 8 if any..
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I wish you would've posted full view of the OPG. generally bilateral views help much more in diagnosing and ruling out artefacts. this seems to be a fracture. and fracture could be the only probable reason for swelling unless abscess has moved onto different fascia. and if the swelling is on lingual side, it is pathognomic on mandibular fracture. nerve injury or irritation could only cause pain, numbness and/or tingling over ipsilateral side of lower lip (neropraxia) but no swellings. swellings with nerve injury are only in situations of neurotmosis and consequential neurilemmoma but all that shall not happen in 25 days and it's very rare phenomenon

it's my mistake in observing the image of OPG here. I re checked the image and concluded there is No fracture of mandible
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i partially agree with dr. pyusha about factor in swelling persistence must be due to traumatic bite from opposing 28, n its removal may help healing.. no presence of fracture fr sure dr. manali..! go ahead with currettage n steps for dry socket management after removal of 28..!

:-) Yes, now plan extraction of upper 8 as it lost its antagonist! Else it will supraerupt..
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Dry socket ?????were the sutures placed ??? prescribe antibiotic and pain killers ......induce bleeding place sutures .....

what exactly the technique or approach was made for extraction? whether it was traumatic?? whether patient had followed the post extraction instructions?

Agree, post ops should have been followed by patient properly. Seems traumatic ext..
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As of the given OPG, no mandibular fracture can be seen. If denuded bony area is present, do introduce ZOE pack. Do not prescribe unnecessary antibiotics. Do only symptomatic treatment. A Dry socket usually shows it's symptoms till 40 days. So NSAIDS will manage the Pain and swelling. Nimesulide and paracetamol combination is prefrred by my side, But generally Tramadol is seen very

Effective in Dry Socket pain releif.
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Dry socket is my first provisional diagnosis bt I wll more focus on infected curettage unless and untill curettage is not performed by dentist its never gives results....Regards

I ain't sure if the concepts have changed recently regarding dry socket management. as what I had learnt was dry socket is a bone portion left exposed and no epithelial covering is formed. what is one gonna curette over the bone? also I'd learned then that lot of research was done and concluded that re bleeding and clot formation doesn't help in dry socket

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