***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Alveolar osteitis ( AO ) is a common complication after third molar surgery . One of the most studied agents in its prevention is chlorhexidine ( CHX ) , which has proved to be effective . Objectives : The aim of this r and omized double-blind clinical trial was to evaluate the efficacy of 0.2 % bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of m and ibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO . Study Design : The study was a r and omized , double-blind , clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d’Hebron and was approved by the Ethics Committee . A total of 160 patients r and omly received 0.2 % bioadhesive gel ( 80 patients ) or bioadhesive placebo ( 80 patients ) . Results : 0.2 % bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22 % compared to placebo with differences that were not statistically significant . Smoking and the use of oral contraceptives were not related to higher incidence of dry socket .  Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences . 0.2 % bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses . Conclusions : A 22 % reduction of the incidence of alveolar osteitis with the application of 0.2 % bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial . The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extraction s and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance . Key words : Alveolar osteitis , dry socket , chlorhexidine bioadhesive gel , m and ibular third molar surgery Objective : The aim of this prospect i ve clinical trial was to evaluate the incidence of postoperative complications following  surgical extraction of lower third molars ( L8 ) and the risk factors and clinical variables associated with these complications . Subjects and Methods : Three-hundred and twenty-seven consecutive patients ( 128 men and 199 women , mean age = 23.1 ± 3.9 years , range : 18–40 ) were recruited to this study . The L8 of all the patients were surgically extracted . Immediate and late complications like pain , swelling , trismus , paresthesia , bleeding , dry socket , infection and fracture were assessed 3 and 7–14 days , respectively , following the surgery . Results : The most frequent immediate and late complications were slight pain , swelling , and trismus . Thirty-nine ( 11.9 % ) patients reported dry socket and 10 ( 0.3 % ) reversible sensory nerve complications . More immediate and late complications were experienced by females ( p = 0.000 and 0.016 , respectively ) . Older subjects reported more late complications . Frequent immediate and late complications were associated with preexisting pericoronitis , longer duration of operation , extraction of two molars , flaps with vertical incision , extraction s with bone removal , extraction s without tooth sectioning and distoangular impactions ( p ≤ 0.05 ) . Linear regression analysis showed that the above factors were able to predict postoperative complications . Conclusion : The most frequent immediate and late complications were slight pain , swelling , and trismus . Preoperative complaints , angulation of the impacted molars , duration of surgery , type of surgical flap , the need for bone removal and tooth sectioning could predict and had an impact on the incidence of postoperative complications following L8 removal . Females and older patients were likely to have more postoperative complications following surgical extraction of L8 Objective The purpose of the study was to determine if the intra-alveolar application of topical metronidazole gel could reduce the incidence of alveolar osteitis ( dry socket ) following routine tooth extraction in molar and premolar extraction sites . Design This was a multicentre , double blind , r and omised , placebo-controlled clinical trial . A total of 302 patients took part , of which 23 returned with alveolar osteitis . Of these , eight had received the metronidazole gel  and 15 the placebo . Setting The study was carried out in three general dental practice s by general dental practitioners working in Engl and over the period 2000 - 2003.Main outcome measures Following extraction of either a molar or premolar tooth , either a 25 % metronidazole gel or KY Jelly was syringed gently into the socket . A painful post operative complication was recorded if either a dry socket was present or the patient returned with pain . Results and conclusions The difference in the incidence of alveolar osteitis between the placebo and the active gel groups was not significant and it was concluded that 25 % topical metronidazole gel was not effective in reducing the incidence of alveolar osteitis . It was found that the incidence of alveolar osteitis reduced with increasing age and was more likely to occur in a patient with a previous history of the condition Background The aim of this study was to assess the efficacy of a single prophylactic dose of amoxicillin and /or dexamethasone in preventing postoperative complications ( PC ) after a surgical removal of a single m and ibular third molar ( M3 ) . Methods This study is a r and omized , placebo controlled clinical trial . Four groups were included : Group 1 ( G1 ) included a prophylactic dose of 2 g of amoxicillin and 8 mg of dexamethasone ; Group 2 ( G2 ) included a prophylactic dose of 2 g of amoxicillin and 8 mg of placebo ; Group 3 ( G3 ) included a prophylactic dose of 8 mg of dexamethasone and 2 g of placebo and ; Group 4 ( G4 ) placebo . Results Fifty patients were included . It was observed one case of alveolar infection ( 2 % ) and two of alveolar osteitis ( 4 % ) result ing in three PC ( 6 % ) . No statistical differences were observed between therapeutic groups for development of PC , trismus , pain and edema . The use of antibiotics showed an absolute risk reduction ( ARR ) for PC development of 3.52 % and the number needed to treat ( NNT ) was 29 . Conclusion Prophylactic antibiotics and corticoid in a single dose regimen did not bring any benefit on M3 surgeries Purpose : Alveolar osteitis ( AO ) is the most common postoperative complication of dental extraction s. The purpose of this study was to compare the effectiveness of 1 % versus 0.2 % chlorhexidine ( CHX ) gel in reducing postoperative AO after surgical extraction of m and ibular third molars , and assess the impact of treatment on the Oral HealthRelated Quality of Life ( OHRQoL ) . Material and Methods : This clinical study was a r and omized , double-blind clinical trial . Eighty eight patients underwent surgical extraction of one retained m and ibular third molar with the intra-alveolar application of 0.2 % CHX gel . Afterwards , they were assigned to one of two groups : 1 % CHX gel ( n=42 ) or 0.2 % CHX gel ( n=46 ) . The patients applied the gel twice a day to the wound for one week . All patients were evaluated for AO . Results : In the 0.2 % CHX gel group , 13 % of AO incidence was found , while in the 1 % CHX gel group , AO incidence was 7 % , a difference that was not statistically significant . Variables such as sensation of pain and inflammation at baseline and during one week , as well as OHRQoL of the patients at 24 hours and 7 days post- extraction , gave no statistically significant differences . Conclusions : There are no significant differences in AO after surgical extraction of m and ibular third molars , when comparing applying 1 % CHX gel twice a day for 7 days with 0.2 % CHX gel . Key words : Alveolar osteitis , chlorhexidine gel , third molar PURPOSE To assess risk factors for alveolar osteitis . MATERIAL S AND METHODS A prospect i ve nested case-control study was conducted in an urban community dental clinic in Valdivia , Chile . A cohort of 1,355 patients who underwent dental extraction s was included . Eight predictor variables ( risk factors ) , namely patient gender , hygiene , tooth location , previous surgical site infection , traumatic extraction , systemic diseases , alcohol consumption , and tobacco use , were considered in a risk factor model . A binary regression logistic analysis was performed to determine significant associations . RESULTS In total 1,302 participants completed the follow-up . Eighty incident case patients with alveolar osteitis and 80 matched control patients were included . A statistically significant association was found between  traumatic extraction  ( odds ratio [ OR ] , 13.1 ; 95 % confidence interval [ CI ] , 5.4 to 31.7 ) , tobacco smoking after extraction ( OR , 3.5 ; 95 % CI , 1.3 to 9.0 ) , previous surgical site infection ( OR , 3.3 ; 95 % CI , 1.4 to 7.7 ) , and the development of alveolar osteitis . CONCLUSIONS Previous surgical site infection , traumatic extraction , and tobacco smoking are associated with an increased risk of alveolar osteitis PURPOSE To measure the association between the menstrual cycle and the frequency of alveolar osteitis ( AO ) . MATERIAL S AND METHODS In a study with a single-blind design , patients with bilateral impacted third molar teeth underwent r and omized surgical extraction : one tooth during the menstrual period and one during the middle of the cycle . The postoperative examiner was unaware of the menstrual cycle status of the patients . The predictor variable was the timing of the menstrual cycle and was grouped as mid-cycle and menstrual period . The outcome variable was AO , which was measured ( without knowledge of the menstrual cycle timing ) at 2 to 7 days postoperatively . Other study variables included  oral contraceptive ( OC ) use , smoking status , irrigation used during surgery , extraction difficulty , surgeon experience , number of local anesthetic cartridges used , and patient age . Appropriate bi- and multivariate statistics were computed , and the level of statistical significance was set at P < .05 . RESULTS A total of 145 female patients , with a mean age of 24 years , underwent 290 third molar extraction s. The overall frequency of AO was 23.45 % . The frequency of AO was significantly greater in the middle of the cycle than during the menstrual period inboth the OC users and nonusers ( P < .05 ) . Although OC users revealed a significantly greater frequency of AO compared with nonusers ( P < .05 ) , no statistically significant differences were found between the 2 groups during the menstrual period ( P > .05 ) . CONCLUSIONS According to the results of the present study , the menstrual cycle could be a determinant risk factor in the frequency of AO . We recommend that elective procedures be performed during the menstrual period in both OC users and nonusers to eliminate the effect of cycle-related hormonal changes on the development of AO PURPOSE This prospect i ve r and omized clinical study assessed the efficacy of pain control for post extraction alveolar osteitis comparing the use of eugenol on a gauze strip versus a thermo setting gel containing 2.5 % prilocaine and 2.5 % lidocaine . PATIENTS AND METHODS Thirty-five patients who presented with post extraction alveolar osteitis were r and omly assigned to either a control group or test group . After irrigation of the extraction site with normal saline solution , the control patients were treated with eugenol on a gauze strip placed in the socket and the test patients were treated with the thermo setting gel placed directly into the socket . All patients were given a series of visual analog scales to record their pretreatment pain and post-treatment pain at 5 , 10 , and 15 minutes and then at 1-hour increments during waking hours for the next 48 hours . They were also given a prescription for an analgesic to use for breakthrough pain during the 48-hour period , if necessary , and instructed to record the dose and timing of any pain medication taken . All patients were seen for follow-up at 48 hours after treatment . RESULTS The mean pretreatment pain score was 6.72 on a scale ranging from 1 to 10 for the eugenol group and 6.37 for the prilocaine-lidocaine group ( SE , 0.46 ) , and the 2 groups were not different ( P = .62 ) . In the immediate post-treatment period ( 0 - 15 minutes ) the pain levels were significantly reduced in both groups ( Ps < .001 ) . However , the thermo setting gel produced a significantly greater reduction in pain ( mean , 3.23 ; SE , 0.62 ) than the eugenol ( mean , 4.83 ; SE , 0.43 ) ( P = .022 ) . Over the next 48 hours , the pain level was nominally less with the thermo setting gel , but this difference was not statistically significant ( Ps = .2 ) . CONCLUSION Although the efficacy of the 2 treatments was not significantly different , the nominal superiority and ease of using the thermo setting gel warrant further investigation The aim of the present study was to determine the effect of saline mouth rinse on postoperative complications following routine dental extraction s. Patients aged ≥16 years , who were referred to the or 
    Output:
    
All treatments included in the review were aim ed at decreasing the incidence of dry socket .
Locally administering chlorhexidine or applying platelet-rich plasma reduces the likelihood of developing this complication .
Antibiotic prescription does not avoid postoperative complications after lower third molar surgery .
With regard to risk factors , all of the articles selected suggest that patient age , history of previous infection and the difficulty of the extraction are the most common predisposing factors for developing dry socket .
There is no consensus that smoking , gender or menstrual cycles are risk factors .
Taking the scientific quality of the articles evaluated into account , a level B recommendation has been given for the proposed- procedures in the prevention of dry socket