***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: Treatment of osteitis after surgical removal of the third molar of the m and ible is still a clinical problem . A total of 140 patients undergoing operations for removal of an impacted third molar of the m and ible , were included in a double-blind study . Placebo or antibiotics - azidocillin , erythromycin , clindamycin and doxycycline - were given to the patients preoperatively and for the following 7 days . The concentrations in serum , alveolar serum and m and ibular bone were measured and the postoperative courses - pain , trismus , swelling and wound-healing - were recorded . No correlation was obtained between the antibiotic concentration and the postoperative complaints , except in the azidocillin group on day 2 , in which fewer complaints were noticed in patients with high concentrations of the drug at the time of operations . The 80 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 60 patients in the placebo groups . Only 15 operations lasted more than 15 min and the three of them which subsequently result ed in alveolitis were in the placebo groups . Antibiotics significantly reduced pain on day 7 postoperatively . In general , no statistically significant differences in trismus and swelling could be demonstrated between the patient groups . However , there was a significant difference between the placebo and doxycycline groups with respect to swelling ( day 2 postoperative , P < 0.01 ; day 5 postoperative , P < 0.05 ) . Thus systemically administered antibiotics offered only slight advantages in routine operations of impacted third m and ibular molars , but could decrease the rate of infections after traumatic operations OBJECTIVES The purpose s of this study were to evaluate the use of 0.12 % chlorhexidine gluconate as a prophylactic therapy for the prevention of alveolar osteitis and to further examine subject-based risk factors associated with alveolar osteitis . STUDY DESIGN The trial was a r and omized , double-blind , placebo-controlled , parallel-group study conducted among 279 subjects , each of whom required oral surgery for the removal of a minimum of one impacted m and ibular third molar . Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine or placebo mouthrinse for 30 seconds for 1 week before and 1 week after the surgical extraction s. This regimen included a supervised presurgical rinse . Alveolar osteitis diagnosis was based on the subjective finding of increasing postoperative pain at the surgical site that was not relieved with mild analgesics , supported by clinical evidence of one or more of the following : loss of blood clot , necrosis of blood clot , and exposed alveolar bone . RESULTS In comparison with use of the placebo mouthrinse , prophylactic use of the chlorhexidine mouthrinse result ed in statistically significant ( p < 0.05 ) reductions in the incidence of alveolar osteitis . With chlorhexidine therapy , the subject- and extraction -based incidences of alveolar osteitis in the evaluable subset ( 271 subjects ) were reduced , relative to placebo , by 38 % and 44 % , respectively . The corresponding odds ratios that describe the increased odds of experiencing alveolar osteitis in the placebo group were 1.87 and 2.05 for subject- and extraction -based analyses , respectively . In comparison with nonuse of oral contraceptives , the use of oral contraceptives in female subjects was related to a statistically significant increase in the incidence of alveolar osteitis ( odds ratio = 1.92 , p = 0.035 ) . Relative to male subjects , the observed incidence of alveolar osteitis for female subjects not using oral contraceptives was not statistically significant ( odds ratio = 1.18 , p = 0.64 ) . Smoking did not increase the incidence of alveolar osteitis relative to not smoking ( odds ratio = 1.20 , p = 0.33 ) . CONCLUSIONS These data confirm that the prophylactic use of 0.12 % chlorhexidine gluconate mouthrinse results in a significant reduction in the incidence of alveolar osteitis after the extraction of impacted m and ibular third molars . In addition , oral contraceptive use in females was confirmed to be a risk factor for the development of alveolar osteitis A double-blind study evaluated the ability of 0.12 % chlorhexidine rinse to decrease the incidence of localized alveolar osteitis after the removal of m and ibular third molar teeth . One hundred sixty extraction sites in 80 patients were evaluated . A statistically significant decrease in the incidence of dry socket was seen in patients using the chlorhexidine rinse with no significant adverse reactions . Thus a 0.12 % chlorhexidine rinse is shown to be an effective means of decreasing alveolar osteitis that may follow removal of third molar teeth OBJECTIVE The purpose of this study was to evaluate whether immediate placement of medicated dry socket packing would decrease the incidence of alveolar osteitis ( dry socket ) with lower third molar extraction s. STUDY DESIGN In 100 patients , 200 lower third molars were extracted . One half of the sockets were packed to the crest of the alveolar ridge with a one-quarter-inch radiograph-detectable filament gauze that contained 9 % eugenol , 36 % balsam of Peru , and 55 % petroleum jelly . The medicated packing was removed 1 week after surgery . None of the patients were taking antibiotics . Patients were instructed to increase their oral hygiene before and after surgery and were to use 0.12 % chlorhexidine gluconate 2 days before and 3 days after surgery . RESULTS ; Two hundred bilateral lower third molars of varying difficulty were extracted . The overall alveolar osteitis rate was 34 ( 17 % ) . The immediately packed lower third molar sites had an alveolar osteitis rate of 8 ( 8 % ) . The sockets that were not packed with medicated packing the day of surgery had an alveolar osteitis rate of 26 ( 26 % ) . The difference was statistically significant ( P = .001 ) . CONCLUSION The results of this study suggest that placement of medicated dry socket packing immediately after lower third molar extraction decreases the alveolar osteitis rate PURPOSE This study evaluated the efficacy of topical viscous 2 % lidocaine jelly for the alleviation of pain experienced during the instrumentation of m and ibular third molar extraction sites diagnosed with alveolar osteitis and for pain relief during the postinstrumentation period . PATIENTS AND METHODS Thirty adult patients with a diagnosis of alveolar osteitis in a m and ibular third molar extraction site were included in this prospect i ve , double-blind study . Each patient had their sutures removed , the socket irrigated , and 2 % lidocaine jelly placed on the tip and side of the tongue to blind the patient against the test substances . The subjects were then r and omly distributed into two groups . Group 1 had a nonactive jelly base placed into the socket 2 minutes prior to the placement of a st and ard obtundant dressing . Group 2 had viscous 2 % lidocaine jelly placed into the socket in the same manner . Patients subjectively quantified their pain intensity pretreatment , during instrumentation , immediately postmanipulation , at 5-minute intervals to 30 minutes , and at 45 and 60 minutes . They also subjectively quantified their pain relief at each of the time intervals following instrumentation . RESULTS There was no statistical difference between the pretreatment pain experienced by both groups . The use of 2 % lidocaine jelly had a measurable ( P = .056 ) , but not statistically significant , effect on pain due to instrumentation . At every time interval thereafter , the use of 2 % lidocaine jelly elicited a statistically significant ( P < .05 ) decrease in pain perception , and a statistically significant increase in pain relief when compared with the inactive jelly . CONCLUSION Topical viscous 2 % lidocaine jelly is a useful adjunct during the treatment of alveolar osteitis , especially in the early ( < or = 60 minutes ) postinstrumentation period The incidence of alveolar osteitis can be reduced significantly by lavage of the oral cavity and the area around the lower third molar with an antiseptic mouthwash before extraction . Evaluation of m and ibular third molar extraction s provides indications of preventive measures to avoid the occurrence of alveolar osteitis . A group of r and omly selected patients was given an oral lavage with a phenolated antiseptic mouthwash before extraction . The use of an oral lavage before extraction result ed in fewer instances of alveolar osteitis than in extraction s that were not preceded by lavage Prophylactic metronidazole was found to be an effective means of preventing ' dry socket ' after routine dental extraction s. The oral anaerobic bacterial may be implicated therefore in the development of the disorder . It has been confirmed in this study that ' dry socket ' occurs following three per cent of routine dental extraction s and almost exclusively in the m and ible . The causes of the condition are probably numerous and may even vary from patient to patient , but the control of infection by anerobic organisms may be important in its prevention or early resolution . The prophylactic administration of metronidazole ( Flagyl ) has been shown to be a simple and effective method of prevention which would suggest the implication of anaerobic organisms in ' dry socket ' . The drug appears to be free from side effects when a dosage of 200 mgs eight hourly for three days is given Abstract Gelfoam saturated with sterile lincomycin solution was effective in the reduction of dry socket in subjects who had undergone extraction of impacted m and ibular third molars . The occurrence of dry socket was reduced to 1.1 per cent in the patients who received topical lincomycin in Gelfoam , as compared to 7.8 per cent when the Gelfoam contained saline solution instead of lincomycin 
    Output:
    
RESULTS Prevention methods remain the key to avoiding this complication .
Prophylactic placement of topical antibiotics can be considered , whereas systemic antibiotics should be reserved for patients who are immunocompromised .
This paper provided a comprehensive review of the etiology , pathophysiology , and current treatment of dry socket in dental practice