I find it weird that there are certain things that people choose to throw out the window once they leave dental school. We are taught certain methods, but it is not uncommon to skip some steps once our professors are not watching us, and then we complain about the difficulties.
I am not saying I never have any problems with oral surgery with my patients. I do. However, I very rarely have any incidences of dry socket. A large part of my practice deals with extractions. I am in public health, and I have approximately one case of dry socket per year.
I enjoyed Dr. Barry McArdle’s article, "Preventing the Negative Sequelae of Tooth Extraction" (June JADA). I agree with him that you need to take those small extra steps. However, he missed one that most private practitioners skip.
Why is it that few private practitioners use sterile saline for surgical procedures? It is the standard of care from the view of the American Dental Association and the Centers for Disease Control and Prevention. Yet, when I ask around, everyone uses the air-water syringe for irrigation during extractions.
We were all taught to use sterile saline in school. We would all expect our oral surgeons to use sterile saline. How many studies have been done about biofilm and the bacterial count in waterlines? Is this not the most obvious answer?
I previously worked in another clinic in which there were three dentists. I was the only one who used sterile saline, and I had to fight the staff for its use. I was the least experienced at surgery, but I had by far the least incidence of postoperative problems, especially dry socket—two in two years. The other doctors would have about one a week. I don’t think it was a lack of skill on their part. So I want to give my opinion unequivocally: waterlines equal biofilm equal bacteria equal dry socket.
Maybe I oversimplify, but this has certainly made me look good to my patients in my practice. And a little saline costs less than multiple postoperative follow-ups over the span of a year.
