Alveolitis – Causes, Symptoms and Treatment
Alveolitis is an inflammation of the alveoli – the tiny air sacs in the lungs – or of the tooth socket after a dental extraction. It can be triggered by allergens, infections, or autoimmune processes.
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Alveolitis is an inflammation of the alveoli – the tiny air sacs in the lungs – or of the tooth socket after a dental extraction. It can be triggered by allergens, infections, or autoimmune processes.
What is Alveolitis?
Alveolitis refers to an inflammation of the alveoli – either the small air sacs in the lungs responsible for gas exchange, or the bony tooth socket (dental alveolus) in the jaw following a tooth extraction. Depending on the affected tissue, a distinction is made between pulmonary alveolitis and alveolitis sicca (dry socket).
Forms of Alveolitis
Extrinsic Allergic Alveolitis (Lungs)
Extrinsic allergic alveolitis (EAA), also known as hypersensitivity pneumonitis, is an inflammation of the lung tissue caused by an excessive immune response to inhaled organic dusts, mold spores, or animal proteins. Well-known forms include farmer's lung (caused by mold in hay) and bird fancier's lung (caused by bird proteins).
Alveolitis Sicca (Dry Socket)
Alveolitis sicca is a painful inflammation of the tooth socket following a dental extraction, occurring when the protective blood clot is prematurely dissolved. This leaves the underlying bone exposed and highly sensitive.
Causes
- Inhalation of allergens: Mold spores, bird droppings, animal proteins, wood dust
- Infections: Bacterial or viral pathogens can trigger inflammation of the alveoli
- Autoimmune conditions: Such as those occurring in pulmonary fibrosis or sarcoidosis
- Tooth extraction: Premature loss of the blood clot in the tooth socket (alveolitis sicca)
- Medications and toxic substances: Certain drugs or chemicals may cause alveolitis
Symptoms
Pulmonary Alveolitis
- Cough, often dry and persistent
- Shortness of breath, especially during physical activity
- Fever and general feeling of illness
- Fatigue and reduced physical performance
- In chronic cases: weight loss and cyanosis (bluish discoloration of the lips)
Alveolitis Sicca
- Severe, persistent pain in the jaw area after tooth extraction
- Bad breath (halitosis)
- Visible exposed bone in the extraction wound
- Radiating pain toward the ear or temple
Diagnosis
The diagnosis of pulmonary alveolitis is based on a combination of:
- Medical history: Occupational exposure, hobbies (e.g., bird keeping), environmental factors
- Pulmonary function tests: Detection of restrictive ventilatory impairment
- Imaging: Chest X-ray and high-resolution computed tomography (HRCT)
- Bronchoalveolar lavage (BAL): Airway washout for cellular analysis
- Blood tests: Detection of specific antibodies against allergens
- Lung biopsy: In unclear cases for histological confirmation
Alveolitis sicca is diagnosed by dental inspection of the extraction wound.
Treatment
Pulmonary Alveolitis
- Allergen avoidance: The most important measure – eliminating exposure to the triggering substance
- Corticosteroids: Anti-inflammatory treatment with medications such as prednisolone for acute or severe cases
- Immunosuppressants: For chronic forms or insufficient response to corticosteroids
- Respiratory therapy: Physiotherapy to improve lung function
- Oxygen therapy: In cases of severe oxygen deficiency
Alveolitis Sicca
- Wound irrigation: Gentle cleaning of the wound by the dentist
- Medical dressings: Antiseptic or analgesic wound dressings placed in the socket
- Pain medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics
- Antibiotics: In cases of signs of bacterial superinfection
Prognosis
The prognosis of pulmonary alveolitis strongly depends on the stage of the disease and consistent allergen avoidance. Acute forms often resolve completely with timely treatment. Chronic forms may progress to pulmonary fibrosis, causing permanent impairment of lung function. Alveolitis sicca generally heals completely within a few weeks.
References
- Lacasse Y. et al. – Hypersensitivity Pneumonitis: An Update. Seminars in Respiratory and Critical Care Medicine, 2020.
- World Health Organization (WHO) – Chronic Respiratory Diseases Overview. who.int, 2023.
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) – S2k Guideline on Extrinsic Allergic Alveolitis, 2021.
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