Dry Socket

Following a tooth extraction, an empty socket will usually heal on its own, while any pain from the procedure will gradually improve.

Dry socket vs. normal socket: What are the differences?

After tooth extraction, a normal socket will develop a blood clot while the wound heals. In a dry socket, the blood clot will partially or fully detach from the wound, which can worsen the pain.

Dry socket, or alveolar osteitis, is a common complication of tooth extraction. It develops when the blood clot that protects the wound disintegrates or breaks loose, leaving the nerves and bone in the socket exposed.

This article will look in more detail at the differences between dry sockets versus normal healing sockets. It also explores what causes dry socket, as well as treatments and recovery time. We will also look at whether it is possible to experience this condition with no pain.

Following a tooth extraction, an empty socket will usually heal on its own, while any pain from the procedure will gradually improve.

In contrast, with a dry socket, the pain will improve and then suddenly get worse, which could be more painful than the extraction procedure.

The pain of a dry socket may throb and radiate across a large area of the jaw or up towards the ear.

The following table shows the differences between a dry socket versus a normal socket:

Dry socket	Normal socket
Pain that improves, but then gets worse	Pain that continues to improve
No visible blood clot, or a blood clot that has partially disintegrated	Visible blood clot that stays in place until the wound heals
Visible exposed bone or tissue, which may have increased since the time of surgery	No visible exposed bone or tissue
Bad taste in the mouth	No change in taste
Bad smells coming from the wound, which may lead to bad breath	No noticeable change in how the breath smells

Most cases of dry socket develop within 3–5 days after surgery. The risk of this condition decreases over time, so the longer the wound heals, the lower the likelihood.

For standard tooth extractions, complete recovery takes a couple of weeks. However, wisdom tooth extractions can take much longer to heal. Once the wound fully heals, there is no risk of dry socket.

After a tooth extraction, the body creates inflammation. This causes mild swelling around the affected area. Platelets in the blood clump together to form a clot, which protects the wound by sealing it.

If this clot disintegrates, becomes dislodged, or does not form, the empty tooth socket is unprotected. This increases the risk of intense pain due to the exposed nerves in the socket.

Certain risk factors increase the likelihood of developing a dry socket, including:

• Pressure on the wound: Chewing or biting down on the empty socket can dislodge the blood clot. Similarly, using straws, sucking on foods, and blowing the nose can create negative pressure inside the mouth, increasing the risk of the blood clot detaching.
• Location and type of extraction: Dry socket is more common in wisdom tooth removal and tooth extractions from the lower jaw. It is also more prevalent if the extraction is complicated or traumatic , as well as depending on the surgeon’s experience level.
• Preexisting infection: People with bacterial infections in the mouth before undergoing tooth extraction have a higher risk for dry socket. Those with preexisting infections should speak with their dentist about antibiotics.
• History of serious illness and cancer: A 2019 analysis of dental records found that dry socket was more common in people with a history of mouth sores, hospitalization from a serious illness, and cancer.
• Smoking: Most studies suggest there is a link between smoking and dry socket. This may be due to the tobacco itself, or the sucking motion involved in smoking.
• Birth control pills: Females taking birth control pills may have higher rates of dry socket. One study suggests people taking oral contraceptives might have a two-fold increased risk of the condition.

Treatment for a dry socket focuses on reducing pain. The American Dental Association advise going returning to the dentist to manage symptoms.

A dentist will first flush out the socket with a medicated mouthwash or saline. Then, they will fill in the socket with a medicated dressing to control the pain. Depending on how long the pain lasts, people may need to change this dressing after a couple of days.

In most cases, the pain of dry socket improves within 24–72 hours, according to the Canadian Dental Association. In some people, the pain may last up to 7 days.

However, prompt treatment can reduce the pain faster. If the socket dressing is not effective, or the pain persists for longer than a few days, a dentist may reevaluate to see if another condition is responsible for the pain.

For most people, the main symptom of dry socket is severe pain. However, pain tolerance and perceptions differ from person to person. Therefore, some people may experience less pain than others.

Dentists will typically diagnose dry socket based on the presence of pain and breakdown of the clot after a tooth extraction.

The primary treatment for dry socket is pain management, so if the condition causes little or no pain, it does not require treatment. The socket will heal and get better on its own.

However, contracting a bacterial infection is a potential complication following a tooth extraction. People with symptoms that indicate an infection, such as pus from the socket, should seek treatment, even if the affected area is not painful.

People experiencing worsening or severe pain after a tooth extraction should speak with a dentist. If the cause is a dry socket, they can help relieve pain quickly.

It is also important to see a dentist for:

• pain that does not respond to pain medication
• new or worsening swelling a few days after surgery
• swelling, pus, and fever
• pain elsewhere in the mouth
• broken teeth near the surgery site

Dry sockets become increasingly painful in the days after a tooth extraction. They may also have exposed bone or tissue, or an unpleasant smell. By comparison, normal healing sockets get less painful over time and do not cause any other symptoms.

A dry socket can be very painful, but it is not usually serious. A dentist can provide rapid pain relief via a medicated dressing, while people can also take medication to ease pain and inflammation.

Last medically reviewed on February 17, 2021

How we reviewed this article:

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060391/
• Bienek, D. R., et al. (2016). Risk assessment and sensitivity meta-analysis of alveolar osteitis occurrence in oral contraceptive users.
  https://doi.org/10.1016/j.adaj.2016.01.011
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Dry Socket

Dry socket is a condition that can happen after tooth extraction. It occurs when a blood clot either doesn’t form or is dislodged after tooth removal. Without the clot, your bone and nerves are exposed, leading to dry socket pain. Treatment involves placing medicated gauze in the socket to ease your discomfort.

Overview

What is dry socket?

Dry socket (alveolar osteitis) can happen after tooth extraction. When your dentist or oral surgeon removes a tooth, a blood clot forms in the socket (a hole in the bone where your tooth was). Dry socket happens when that blood clot dislodges (moves) or doesn’t form at all. Without the clot, your bone and nerves are exposed to the oral environment. Dry socket can be painful and delays the healing of the surgical site.

Dry socket vs. clot: What should my extraction site look like?

After a tooth extraction, you should develop a blood clot in the socket (hole) that’s left behind. It’ll look like a dark-colored scab. But if you have a dry socket, the clot will be absent and you’ll be able to see bone. For this reason, dry sockets usually appear white.

What does dry socket feel like?

Dry socket can be extremely uncomfortable. In addition to intense pain at the extraction site, you may experience pain that radiates to your head and neck.

Who gets dry socket?

Research shows that women are slightly more likely than men to develop dry socket. This is probably due to estrogen, as the hormone may dissolve blood clots. Additionally, dry socket happens more often on the lower jaw than the upper jaw.

Symptoms and Causes

What are the warning signs of dry socket?

Worsening pain in your mouth and face two to three days after the extraction is the most common symptom of dry socket. Discomfort can be mild, but it’s often severe. Other dry socket symptoms include:

• Tenderness.
• Bad breath.
• Foul taste.

What causes dry socket?

Experts don’t fully understand why some people are more likely to develop dry socket. Possible risk factors include:

• Trauma at the surgical site due to a difficult tooth extraction.
• Poor oral hygiene, which can cause bacterial contamination.
• Taking oral contraceptives (birth control).

In addition, anything that dislodges the blood clot from your extraction site can increase your risk for dry socket, including:

• Drinking through a straw after your tooth is removed.
• Smoking.
• Swishing too vigorously.

Diagnosis and Tests

How are dry sockets diagnosed?

Dentists typically suspect dry socket when a person experiences severe pain following a tooth extraction. They can confirm the diagnosis simply by looking at the spot where your tooth used to be.

In some cases, your dentist might take dental X-rays to make sure no tooth fragments were left behind.

Management and Treatment

Will a dry socket heal on its own?

Yes, in most cases a dry socket will heal on its own. However, because most people experience moderate to severe dry socket pain, seeing your dentist for prompt treatment can help ease discomfort sooner.

How do you fix a dry socket?

Easing pain and discomfort is the main goal of dry socket treatment. Your dentist may:

• Rinse and clean the socket with salt water.
• Place medicated gauze (soft dressing) in your socket to ease pain.
• Instruct you to take over-the-counter pain relievers and anti-inflammatory medications.
• Show you how to apply ice to reduce discomfort.
• Provide instructions for keeping the surgical site clean at home.

What are common complications or side effects of dry socket?

Pain is the most common side effect of dry socket. This pain can be severe enough to interfere with normal activities. In rare cases, a dry socket can become infected. If this happens, your dentist will prescribe antibiotics to get rid of the infection.

What foods should I avoid?

To reduce your risk for dry socket, avoid hard, crunchy or chewy foods. These foods can dislodge the blood clot. Instead, choose soft foods like yogurt, applesauce, eggs and pasta.

How long does dry socket last?

On average, a dry socket lasts about one week. Your dentist can give you tips for managing your symptoms in the meantime.