There are lots of reasons you might need to get a tooth extracted. It might be deeply diseased. Or it could be a root canal tooth – a dead tooth – that’s come to be a source of focal infection. (A focal infection is where the effects of illness show up far away from the infection itself – for instance, when periodontal bacteria contribute to heart disease or rheumatoid arthritis or various cancers.)
Whatever the cause, it’s important that you opt for a skilled surgeon who’s aware of the risk of cavitations and thus knows how to clean the site thoroughly and properly to lower the risk of residual infection in the jaw (another common type of focal infection). That many surgeons remain unaware of this possibility is borne out by statistics. According to research by Hal Huggins and Thomas Levy, over half of all extraction sites – and nearly all wisdom tooth sites – had cavitations.
Another common risk of extraction is dry socket – a condition in which a blood clot doesn’t completely form in the empty tooth socket. And according to recent research in JADA, the risk appears to be much higher for women, due to estrogen levels.
Women who used birth control developed alveolar osteitis 13.9% of the time, whereas women who didn’t take hormonal contraceptives developed dry socket 7.5% of the time, the researchers found. However, all women developed dry socket more often than men.
Though smoking was found to have a larger effect than oral contraceptive use on the development of dry socket, it wasn’t by much. High levels of estrogen interfere with the blood’s ability to clot. This is why it’s suggested that women taking birth control schedule any needed extractions during the last week of their menstrual cycle, when estrogen levels are at their lowest.
Aside from this and the usual advice – don’t smoke, don’t use straws, don’t do any heavy lifting or anything else that might disturb the formation of a clot (the first step of healing) – is there anything we can do to help lower the risk?
The answer comes in three letters: PRF. That stands for platelet rich fibrin, which – as we’ve noted before – does wonders in supporting good healing following dental surgeries (not to mention reducing post-surgical pain and discomfort!). We’ve used it for every surgical extraction since 2009.
And it’s not just our clinical experience that tells us it’s good stuff. Research has repeatedly shown as much. Interestingly, most of it has focused on those sites most likely to develop cavitations, the third molars (wisdom teeth). In fact, according to cavitation specialist Dr. Wesley Shankland, dry socket itself may be a symptom of those areas of infected, decaying tissue.
The difference PRF makes can be stark. For instance, one study in the International Journal of Dentistry found that dry socket occurred in just 1% of cases in which PRF was placed on the surgical site. Without PRF, the rate was 9.5%. What’s more, those without PRF needed more than 6 hours of additional treatment to deal with the effects of dry socket.
This retrospective review demonstrated that preventative treatment of localized osteitis can be accomplished using a low cost, autogenous, soluble, biologic material, PRF, that PRF enhanced third-molar socket healing/clot retention and greatly decreased the clinical time required for postoperative management of [dry socket].
Another study by the same authors found a dry socket rate of 8% with ZERO incidence in the PRF group. And a similar study in the Journal of Oral Maxillofacial Surgery found comparable results to these: an overall dry socket rate of 14.74% but with frequency “significantly lower” in the PRF group.
Clearly, PRF is a difference maker – and, best of all, it’s 100% biocompatible since it’s made from a sample of your own blood.
In a way, it offers a nice reminder of how the body contains the stuff of its own healing. The goal then becomes to supporting it as well as possible in doing exactly what it already knows how to do.