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Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London W1G 8YS E-mail e-mail: bdj@bda.org Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space. Sir, an interesting paper published as an abstract in the BDJ ( 204: 559)1 discusses the relationship of cigarette smoking to post-operative complications from dental extractions among female prison inmates. The authors report that dry socket is increased following third molar extractions and surgical extractions but not specifically in smokers. I can concur with this finding. My colleagues and I operate a dental service at Styal Women's Prison, where the majority of the women require several extractions and over 95% smoke. From 1 April 2007 – 31 March 2008 out of 481 routine extractions and minor surgical procedures (364 by the author) there were seven post-operative complications, which could be classified as alveolar osteitis. Since the majority of women smoke post-operatively, diligently ignoring the written and verbal instructions given, we feel that this complication rate of 1.45% is lower than most published reports. I feel that the major contributing factor to the development of dry socket is a traumatic extraction and any patient factors post-operatively have relatively little bearing on this complication. The extractions, although grossly carious and frequently infected, are relatively 'easy'. Interestingly despite 70% of the women being infected with Hepatitis C, with potential liver damage, no cases of post-extraction haemorrhage occurred during the year. We do, however, routinely place Alvéo-Penga2 in all sockets, as recommended by the manufacturers; maybe this is the secret!

Dry socket secrets