Dry Socket Facts
Dry socket is a condition in which there is inflammation of the jawbone (or alveolar bone) after tooth extraction. Source: iStock
- A dry socket is a fairly common complication of tooth extraction characterized by severe pain.
- It occurs when the tooth socket loses the blood clot that forms after a tooth is extracted and the bone inside the socket becomes exposed.
- It is one of the most painful dental problems one can experience. A dry socket is also referred to as alveolar osteitis.
What Causes Dry Socket?
Normally, after a tooth is extracted, a blood clot will form as the first step in healing to cover and protect the underlying jawbone. If the blood clot is lost or does not form, the bone is exposed and healing is delayed. Source: iStock
The blood clot that forms after a tooth extraction is essential for optimal healing of the underlying tissue. Destruction or loss of the blood clot prevents normal healing and causes alveolar osteitis. There are a variety of reasons why the initial blood clot could be lost or destroyed prematurely. The body reacts to local infection and inflammation, trauma, bacteria, and estrogen to destroy the blood clot, leaving an exposed socket. So it is important to minimize these risk factors as much as possible.
How Often Does Dry Socket Happen?
A dry socket will occur in only a small percentage of tooth extractions, but it becomes much more common in the extraction of lower (mandibular) wisdom teeth.
What Are Dry Socket Symptoms and Signs?
Symptoms of a dry socket include a throbbing steady pain that presents a few days after tooth extraction. Source: Bigstock
A patient may first notice signs of a dry socket 3 to 4 days after extraction of the tooth by feeling moderate-to-severe pain that could last anywhere from 10 to 40 days. The exposed bone of a dry socket is very sensitive and leads to an intense dull aching pain that throbs and radiates around the affected side of the jaw often to the patient's ear. Frequently, the patient affected by a dry socket will also complain of a bad odor or bad taste in their mouth.
What Is the Treatment for Dry Socket?
Treatment for dry socket is intended to make a patient more comfortable by reducing dental pain but it generally won't accelerate the healing process. It is very important to diagnose the dry socket correctly and not confuse it with something equally as painful like a root canal problem. It is diagnosed by visualizing or probing the exposed bone of an extraction site and noting the patient's symptoms of pain and foul odor or taste.
The dry socket is treated by flushing the extraction site with warm salt water solution and packing the socket with gauze or a gelatin sponge coated with an antiseptic dressing. Clove oil when mixed into a paste has been used effectively in treating dry sockets due to its soothing properties. The dressing is replaced every 1 to 3 days, depending on the severity of pain, until the pain goes away. As soon as the pain is gone, the socket must be allowed to heal on its own.
What Are Home Remedies for Dry Socket?
To ease the pain and mild swelling, the patient can take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. Also, a small drop of clove oil can be applied to a cotton ball and placed over the socket until the patient can see a doctor for a proper dressing. A rinse with warm salt water will help promote healing as well.
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How Do You Prevent Dry Socket?
There are some things that can be done to lessen the probability of a tooth extraction resulting in a dry socket. The most important thing a patient can do to prevent a dry socket is follow the post operative instructions given at the time of extraction. These include avoiding the use of tobacco products and activities where the extraction site could be traumatized in any way. Also, avoid things like sucking forcefully through a straw or spitting as these actions could dislodge the blood clot.
Having the wisdom teeth removed as soon as it is determined necessary by a dentist or oral surgeon is also very important. Since the presence of bacteria and infection tends to contribute to the premature destruction of the blood clot, removing impacted wisdom teeth before they get infected, inflamed, or painful will help avoid a dry socket. Waiting until they are painful or infected puts the patient at increased risk.
There is also a link to oral contraceptive use and the incidence of dry socket. The estrogen dose in birth control pills is what contributes to the destruction of the clot, so planning an extraction during days 23 through 28 of the tablet cycle will help avoid this contributing factor to a dry socket.
Medically reviewed by Kenneth Rotskoff, MD, DDS; Board Certified Dentistry, Oral/Maxillofacial Surgery
Little, James W., et al. Dental Management of the Medically Compromised Patient 6th ed. Mosby, 2002.
McArdle, Barry F. "Preventing the negative sequelae of tooth extraction." Journal of the American Dental Association 133.6 (2002): 742-743.
Neville, Brad W., et al. Oral & Maxillofacial Pathology 2nd ed., Saunders Company, 2002.
Peterson, Larry J., et al. Contemporary Oral and Maxillofacial Surgery 4th ed., Mosby, 2003.