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Dry Socket

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Thankfully, this condition is rare, considering the number of people who undergo tooth extractions each year. Learn how dry socket develops, what causes it, when to seek medical attention, and much more.

Dry socket, or alveolar osteitis, is a condition that develops in 2–5 percent of people who have a tooth extraction. Dry socket is the name dentists use to describe the exposure of bone in the socket. Typically, this condition develops after a lower back tooth is removed. In most cases, pain decreases for two to three days and then suddenly worsens. Although it is painful and unsightly, a dry socket can easily be treated.

How Dry Socket Develops

A socket is a hole in your bone where a tooth has been removed. In most cases you can feel the gap in the gum line with your tongue. Once a tooth is removed, a blood clot forms in the socket, protecting the nerves and bone underneath. If the blood clot is somehow dislodged or dissolves too soon after the extraction, it leaves the bone and nerves exposed to air, food, and liquids that enter the mouth. Often this will lead to an infection that causes pain and delays healing. This condition is known as dry socket (Alveolar Osteitis).

Dry Socket Symptoms

The symptoms are similar for most patients. Within the first two to three days after a tooth extraction, the blood clot protecting the hole in the bone dislodges or dissolves. The pain from the extraction suddenly reappears with much greater intensity. This sudden increase in pain is the first indication that the blood clot is no longer protecting the bone and nerves. Additional symptoms may include:

  • Earache
  • Bad breath
  • Foul taste in mouth
  • Bone is visible in socket
  • Pain that increases over a period of a few days
  • Swollen lymph nodes around neck and jaw

What Causes Dry Socket?

In most cases, dry socket develops when the clot does not properly form, dissolves too quickly, or is dislodged before healing is complete. Smoking can cause the blood clot to dislodge, as can sticking your tongue into the empty socket. Other causes of dry socket include:

  • Tiny fragments of bone or roots accidentally left in wound after surgery
  • Difficult extraction, resulting in severe bone and tissue trauma at surgical site
  • Bacterial contamination within socket
  • Dislodging the clot by rinsing and spitting within the first twenty four hours after extraction.

Diagnosing Dry Socket

If you are experiencing symptoms of dry socket after a tooth extraction, you should seek medical attention from your dentist to prevent complications. To diagnose dry socket, your dentist will ask you questions about what was happening at the time the blood clot was dislodged. For example, he or she may ask you whether you were drinking through a straw or smoking cigarettes. X-rays may be taken of your teeth and mouth to determine what may have caused the blood clot to dissolve or dislodge.

When to See Your Dentist

Pain and discomfort are normal after a tooth extraction. Most patients are prescribed pain medication to alleviate these symptoms. If the pain does not lessen, or if it increases and becomes unmanageable over the course of two or three days, or if you develop new symptoms, you should contact your dentist or oral surgeon immediately.

You should contact your dentist if:

  • Pain returns
  • Symptoms worsen or do not go away after a day or two
  • New, unexplained symptoms develop
  • You develop signs of infection (headache, dizziness, fatigue, fever, and general ill feeling)

Dry Socket Treatment

Without treatment, dry socket usually goes away on its own within a few weeks. However, most dental professionals suggest seeking medical attention to prevent the spread of infection and damage to the exposed nerves and bone. Typically, the goal of treatment for dry socket is reducing the symptoms. Sometimes a person with this condition will need to have their dentist replace an anesthetic or medicated dressing every other day for the first week, depending on the severity of the pain. Other times, treatment involves flushing out the socket to remove debris. Pain medication may be prescribed if over-the-counter medication is ineffective.

If you are instructed to flush out your socket at home, you will be given a plastic syringe with a curved tip. You will need to fill the syringe with either salt water or a prescription rinse to flush out and remove any food or debris that has collected in the socket.

Most people experience relief within hours of receiving treatment, with symptoms continuing to improve over the next five to ten days. With proper care and treatment, infection and serious complications can be avoided. Other ways to promote healing and reduce symptoms are:

  • Avoid smoking or using tobacco products.
  • Take medications as directed.
  • Use cold compresses on the outside of your face to decrease pain and swelling.
  • Stay hydrated with clear liquids, especially when using pain medications that may cause nausea.
  • Rinse your mouth with salt water several times a day, or as directed by your dentist.
  • Use caution when brushing, flossing, and rinsing around the extraction site.

Preventing Dry Socket

Preventing dry socket is not difficult. Your dentist or oral surgeon will instruct you on how to care for your wound following surgery. Many dentists recommend:

  • Using an antibacterial mouthwash or gel immediately before and after surgery
  • Taking oral antibiotics, especially if your immune system is weak
  • Applying antiseptic solution to the surgical site
  • Using medicated dressings after surgery
  • Resting more than usual in the first few days following surgery
  • Eating soft foods only for the first twenty-four hours
  • Drinking plenty of water and other clear liquids
  • Avoiding smoking in the first twenty-four hours after surgery
  • Do NOT drink from a straw for the first week to avoid suction and dislodgment of the blood clot.
  • Do NOT Rinse your mouth for the first twenty four hours.
  • AFTER the first twenty four hours, rinse your mouth with a salt water solution (½ tsp of salt for every ½ cup water) every two hours while awake and after each meal for one week following surgery.

Risk Factors for Dry Socket

Some people are more likely to develop dry socket than others. People at risk are those who:

  • Have poor oral hygiene
  • Have a history of dry socket
  • Have had their wisdom teeth pulled
  • Use birth control pills
  • Experience more trauma after tooth extraction surgery
  • Fail to follow their dentist’s or oral surgeon’s instructions
  • Spit excessively after an extraction, or rinse their mouth out more than their dentist recommends
  • Drink through a straw after surgery

If you are on birth control, talk with your dentist about performing the extraction on a day when your estrogen levels are at their lowest. Estrogen can affect the ability of the blood to clot. Also, inform your dentist or surgeon of any medications you are taking before surgery.

Talking to Your Dentist

Here are some questions to ask your dentist or oral surgeon about dry socket:

  • Which over-the-counter pain relievers do you recommend?
  • How many cigarettes should I limit myself to each day for the first week?
  • If over-the-counter medications are not working, how soon can I begin taking prescription strength medication?
  • What are some of the complications of dry socket?
  • What else can I do to prevent dry socket from developing?

References:

Roberts: Clinical Procedures in Emergency Medicine, 5th ed; CHAPTER 65 – Emergency Dental Procedures
C.A. Rinzler “The Encyclopedia of Dental and Oral Health” (Infobase Publishing, Inc. 2011) 54-55
Prevalence, clinical picture, and risk factors of dry socket in a Jordanian dental teaching center, Nusair YM – J Contemp Dent Pract – 01-JAN-2007; 8(3): 53-63

Page updated June 2012

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