Compliance with post-extraction instructions and its association with alveolar osteitis (dry socket): a prospective observational study

Alveolar osteitis, also known as dry socket, is a common complication following tooth extraction and is characterized by pain and delayed healing. Compliance with post-extraction instructions may influence healing outcomes; however, quantitative data on compliance and its association with alveolar osteitis are limited in Pakistan. The primary outcome of this study was to assess compliance with post-extraction instructions, and the secondary outcome was to examine its association with the occurrence of alveolar osteitis. A prospective observational study was conducted among 303 patients who underwent surgical or nonsurgical tooth extraction at the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, using a non-probability consecutive sampling technique. Ethical approval was obtained, and written informed consent was provided by all participants. Extractions were performed by operators with varying levels of clinical experience, and standardized post-extraction instructions were delivered verbally. Baseline data were collected at the time of extraction, and patients were followed up after one week to assess compliance using a validated ten-item questionnaire (score range 0–10). High compliance was defined as adherence to ≥ 80% of instructions (score ≥ 8). Descriptive statistics were computed for all variables using SPSS v. 25. Binary logistic regression analysis was performed to identify factors associated with compliance and alveolar osteitis. Among the 303 participants, 51.2% were male, and 48.8% were female. A total of 161 patients (53.1%) demonstrated high compliance (score of 8 or above), whereas 142 patients (46.9%) showed partial compliance (score 5–7). Binary logistic regression analysis indicated that higher compliance was associated with a lower likelihood of developing dry sockets after adjusting for demographic and clinical variables ( P < 0.05). Factors associated with higher compliance included higher education level, surgical extraction, impacted tooth, and posterior tooth extraction. Employment and self-employed were associated with lower odds of compliance. Higher compliance with post-extraction instructions was independently associated with lower odds of alveolar osteitis. Both behavioural and procedural factors were associated with post-extraction outcomes. These findings highlight the importance of structured patient education and adherence monitoring in clinical practice.