Alveolar osteitis: are we overdiagnosing?

Alveolar osteitis (AO), also known as dry socket, is a painful postoperative complication that occurs most commonly after mandibular third molar extraction. However, its reported incidence varies widely (from 1–5% in routine extractions to more than 30% in high-risk cases), suggesting potential diagnostic inconsistency. Evidence indicates that AO is frequently diagnosed using overly broad criteria, particularly when normal postoperative pain within the first 24 hours is misinterpreted as pathology. Standard definitions, such as Blum’s, require both worsening pain over postoperative days 1–3 and partial or total loss of the blood clot. This review evaluates whether AO is overdiagnosed, examining diagnostic criteria, incidence data, clinical behaviour and implications for practice. Findings suggest that overdiagnosis is plausible, and may result in unnecessary interventions, excessive antibiotic use and misapplication of intra-alveolar agents. Clearer diagnostic thresholds and uniform terminology are recommended.