A dry socket is a complication that develops after the surgical removal of a tooth, especially the back teeth (molars). It is one of the most common complications of tooth extraction, affecting 1% to 5% of adults and up to 38% of lower wisdom teeth extractions.
A dry socket is a healing complication that arises 2–3 days after teeth removal.
Loss/dislodgement of blood clots from the teeth sockets leads to a dry socket.
A dry socket can be very painful, cause difficulty in opening the mouth, and lead to serious jawbone infections.
Besides conventional treatment methods focusing on symptom control, novel regenerative approaches are gaining ground in dry socket therapy.
Surgically extracted teeth stand a 10% more chance of developing a dry socket. Want to decrease your risk of developing this painful condition? This article is for you.
What is a dry socket?
A dry socket, also known as “alveolar osteitis,” occurs 2–3 days after a tooth is removed.
A hole is left behind in the area when a tooth is removed. This hole, surrounded by gums and jaw bones, is known as a tooth socket. Usually, this socket is filled with blood clots within hours after the tooth is removed. These clots protect and help in the healing of the area.
When the blood clot is not formed or dislodged from the socket, complications begin. The sensitive nerve endings and bone in the socket get exposed to the oral environment directly. Food particles and the tongue get in contact with these nerve endings and lead to severe pain and frequent discomfort in the socket. Left untreated, a dry socket can lead to life-threatening consequences like chronic jaw bone infection and permanent nerve damage.
What are the symptoms of a dry socket?
Usually reported within 3-7 days of teeth removal, a dry socket can be very painful and associated with other discomforts.
Intense and throbbing pain at the socket site, typically 2-3 days after the tooth removal, is the distinguishing feature of a dry socket. Pain severity increases and peaks around the 3rd day after the extraction. Pain may radiate to the head and neck of the affected side.
Difficulty opening the mouth.
Continuous bleeding from the socket area.
Bad breath and a foul taste in the mouth.
White exposed bone surface or a blackish decayed bony slough in the socket.
If you have recently had a tooth removed and experience any of these symptoms, visit your dentist or oral surgeon immediately.
Causes of a dry socket
Some of the common causes of dry sockets are:
Trauma (extensive bone cutting and instrumentation to gain access to the teeth) to the socket and surrounding bones during tooth removal. That's why the last molars (partially erupted or difficult to access during removal) are the most frequently affected.
Conditions like high blood pressure (hypertension) and diabetes can delay healing.
A forceful swishing of water in the mouth within hours of teeth removal.
Habits like smoking and frequent tongue contact (in the socket). Studies confirm that a person who smokes half a pack of cigarettes daily is 3–5 times more likely to develop a dry socket.
Drugs like oral contraceptives and hormonal supplements can delay healing.
How is a dry socket diagnosed?
Severe pain and discomfort after a tooth removal raise the possibility of a dry socket. A dentist might inquire about any other symptoms you are experiencing and inspect your mouth (the affected area) for a blood clot in your tooth socket (or visible, exposed bone).
You may need X-rays of the affected area to rule out other diseases, such as a bone infection (osteomyelitis).
How to manage a dry socket?
It’s best to visit a dentist if you suffer from a dry socket. A dentist will walk you through the remedies.
Systemic antibiotics before and after the surgical extraction of third molars reduce the risk of dry sockets. Many studies show that using topical antibiotic ointment is effective.
The use of antiseptic mouth rinses (0.12 percent chlorhexidine) is beneficial. It is usually started three days before the procedure and continued after surgery.
Dentists widely use a topical medicated dressing containing eugenol (oil of clove). It is particularly efficient in improving the healing of the affected site.
Every other day, intraoperative lavage (flushing out the socket) helps reduce the risk of deep bone infections.
Painkillers are often prescribed to reduce discomfort.
Low-Level Laser Therapy (LLLT), Platelet Rich Plasma, Platelet Rich Fibrin, and Concentrated Growth Factors are novel and emerging techniques to treat dry sockets. These focus on regenerating the socket cells and promoting healing.
To encourage healing and remove trapped debris in the socket, you can follow a self-flushing routine at home. Following your dentist's advice can help to improve recovery and lessen symptoms during dry socket therapy. You will most likely be instructed to:
- Take painkillers as directed.
- Avoid smoking.
- Drink plenty of water.
- Gently rinse (not forcefully) your mouth with warm salt water.
- Brush your teeth (with a soft brush) in the dry socket area.
- Try to avoid hot and spicy foods.
- International Journal of Maxillofacial Imaging. A literature review on dry socket.
- International Journal of Dentistry: Case Report. Late complication of a dry socket treatment.
- Dentistry Review. Management of Dry Socket: New regenerative techniques emerge while old treatment prevails.