What Is a Dry Socket

Your dentist will clean the tooth socket, removing any debris from the hole, and then fill the socket with a medicated dressing or a special paste to promote healing. You’ll probably have to come back to the dentist’s office every few days for a dressing change until the socket starts to heal and your pain lessens.

An Overview of Dry Socket

You probably think having a tooth pulled is not a particularly enjoyable experience. And you no doubt expect to have some discomfort afterward. But that’s OK, you say. You can endure it when you need to. But if the pain becomes intense and perhaps even worsen after a few days, it may be a symptom of a condition called dry socket, or alveolar osteitis.

Only a very small percentage — about 2% to 5% of people — develop dry socket after a tooth extraction. In those who have it, though, dry socket can be uncomfortable. Fortunately, it’s easily treatable.

The socket is the hole in the bone where the tooth has been removed. After a tooth is pulled, a blood clot forms in the socket to protect the bone and nerves underneath. Sometimes that clot can become dislodged or dissolve a couple of days after the extraction. That leaves the bone and nerve exposed to air, food, fluid, and anything else that enters the mouth. This can lead to infection and severe pain that can last for 5 or 6 days.

Who Is Likely to Get Dry Socket?

Some people may be more likely to get dry socket after having a tooth pulled. That includes people who:

smoke
have poor oral hygiene
have wisdom teeth pulled
have greater-than-usual trauma during the tooth extraction surgery
use birth control pills
have a history of dry socket after having teeth pulled

Rinsing and spitting a lot or drinking through a straw after having a tooth extracted also can raise your risk of getting dry socket.

What Are the Symptoms of Dry Socket?

If you look into the site where the tooth was pulled, you’ll probably see a dry-looking opening. Instead of a dark blood clot, there will just be whitish bone. The pain typically starts about 2 days after the tooth was pulled. Over time it becomes more severe and can radiate to your ear.

Other symptoms of dry socket include bad breath and an unpleasant smell and taste in your mouth.

How Is Dry Socket Treated?

You can take a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen, to ease the discomfort. Sometimes these over-the-counter medications aren’t enough to relieve the pain. When that’s the case, your doctor may prescribe a stronger drug or will anesthetize the area.

Your dentist will clean the tooth socket, removing any debris from the hole, and then fill the socket with a medicated dressing or a special paste to promote healing. You’ll probably have to come back to the dentist’s office every few days for a dressing change until the socket starts to heal and your pain lessens.

Your dentist may prescribe antibiotics to prevent the socket from becoming infected. To care for the dry socket at home, your dentist may recommend that you rinse with salt water or a special mouthwash every day.

What Can I Do to Prevent Dry Socket?

Because smoking is a big risk factor for dry socket, avoid cigarettes, cigars, and any other tobacco products for a day or so after your surgery. If you take birth control pills, ask your dentist about performing the extraction on a day when you are getting the lowest dose of estrogen. The hormone can affect the ability of the blood to clot. Also, check with your dentist about other medications you are taking that can interfere with normal blood clotting.

After surgery, avoid drinking through a straw and spitting for the first few days. Also don’t rinse your mouth more than your dentist recommends. If you do rinse, do so gently. Be sure to visit your dentist for all scheduled follow-up visits.

Show Sources

American Dental Association: “Dry Socket.”

Reekie, D, Downes, P, Devlin, CV, Nixon, GM, Devlin, H. British Dental Journal, 2006; vol. 200: pp. 210-213.

Roberts J, Custalow C, Hedges, J. Roberts: Clinical Procedures in Emergency Medicine, 4 th ed, Elsevier, 2004.

What Is a Dry Socket?

The typical scenario for a dry socket is the occurrence of throbbing pain about two to four days after the tooth is extracted. Dry socket pain is often accompanied by bad breath and a foul taste in the mouth. With this onset of pain, it is obvious that proper healing has been interrupted.

A dry socket is a condition in which there is inflammation of the jawbone (or alveolar bone) after tooth extraction. It is also referred to as “alveolar osteitis” and is one of the many complications that can occur from a tooth extraction.

The occurrence of a dry socket is relatively rare, occurring in about 2% of tooth extractions.
However, that percentage rises to at least 20% when it involves the removal of mandibular impacted third molars (lower wisdom teeth).

Dry Socket and Tooth Extraction

What is the treatment for dry socket?

A dry socket is a condition that may result after a tooth extraction if the blood clot that normally fills the socket is lost. The dry socket leaves underlying nerves exposed, which is very painful. The condition is treated by a dentist who cleans the wound and places a special dressing into the socket. Over-the-counter anti-inflammatory medications like ibuprofen may be used to treat pain and decrease swelling.

Dry sockets can be caused by bacterial, chemical, mechanical, or physiological factors. Source: iStock

What causes dry socket?

A dry socket is caused by the partial or total loss of a blood clot in the tooth socket after tooth extraction. 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.

In general, a dry socket is a result of bacterial, chemical, mechanical, and physiologic factors. Below are examples for each:

Bacterial: Preexisting infection that is present in the mouth prior to a dental extraction such as periodontal disease (or periodontitis) can prevent the proper formation of a blood clot. Certain oral bacteria can cause the breakdown of the clot.
Chemical: Nicotine used by smokers causes a decrease in the blood supply in the mouth. As a result, the blood clot may fail to form at the site of recent tooth extraction.
Mechanical: Sucking through a straw, aggressive rinsing, spitting, or dragging on a cigarette causes dislodgement and loss of the blood clot.
Physiologic: Hormones, dense jawbone, or poor blood supply are factors that prevent blood clot formation.

What are risk factors for getting dry socket?

Prior to tooth extraction, risk factors for developing a dry socket include smoking, the presence of an impacted wisdom tooth, being female, and being above the age of 30.

Smoking is a risk factor for developing a dry socket due to the nicotine found in cigarettes. Exposure to nicotine reduces the blood supply available to the healing socket and can prevent the proper formation of a blood clot at the extraction site.

Extraction of impacted third molars (wisdom teeth) can be traumatic as some surrounding gum tissue and jawbone may need to be removed or may be adversely affected during surgery. Although the extraction is necessary, the resulting trauma can increase the chances of a dry socket.

Previous infections such as periodontal disease or pericoronitis at the site of the extraction can predispose an individual to a dry socket.

Women have been found to develop a dry socket more so than men. This may be related to hormonal factors such as the use of oral contraceptives or normal hormonal changes during a woman’s cycle.

Patients older than 30 years of age with impacted third molars have an increased risk of dry sockets. With age, the jawbone becomes denser and has less blood supply available. A dense jawbone increases the risk of a traumatic extraction and less blood supply decreases the chances of blood clot formation and timely healing.

A tell-tale sign is a socket that has a partial or total loss of a blood clot. Symptoms of dry sockets are often painful. Source: Bigstock

What are dry socket signs and symptoms?

A tell-tale sign is a socket that has a partial or total loss of a blood clot. The jawbone may be visible in the socket and the surrounding tissue may appear gray due to poor healing.

Early signs and symptoms of a dry socket include the following:

A throbbing steady pain presents a few days after tooth extraction.
The pain may radiate to other parts of the head such as the ears and eyes on the same side of the face.
Bad breath and a bad taste may also be present due to the accumulation of food debris and bacteria in the socket.

QUESTION

A dentist can diagnose dry sockets based on a physical exam and symptoms. Source: Getty Images

How is dry socket diagnosed?

Diagnosis of a dry socket is based on the history of dental treatment, clinical examination, and the individual’s symptoms. The timing of when symptoms begin may be an indicator of a dry socket. During normal healing, the discomfort of extraction should lessen over time. However, if the pain increases, this is an indication that healing is delayed and could possibly be due to a dry socket.

Typically, symptoms of a dry socket develop two to four days after tooth extraction.
Most dry sockets happen within the first week after tooth extraction.