Dry socket, which is also known as “Alveolar Osteitis”, is an inflammation of the alveolar bone socket after tooth extraction.
It is the most common complication following tooth extractions, especially the extraction of the third molar (wisdom tooth). The risk of developing dry socket increases with extractions involving impacted lower wisdom teeth.
Even though a dry socket is extremely uncomfortable and can be quite painful, it is preventable and treatable.
When Can I Stop Worrying About Dry Socket?
You are safe from a dry socket when you are past the first week of extraction with no unusual occurrences.
In order to avoid having to worry about dry socket in the first place, it is advisable to take preventive measures, especially in the first 24 hours following an extraction.
Following the post-extraction instructions such as avoiding smoking, avoiding sucking on a straw and avoiding poking the extraction area with your tongue would give you less cause to worry.
Also, you would need to be very gentle with your mouth after having an extraction. Clean your mouth gently and avoid and avoid hard foods. Keep your diet soft and chew your food on the opposite side of the mouth, away from the extraction site.
Avoid drinking very hot drinks or acidic drinks that could break down the blood clot, as well as drinking alcohol or using alcohol-based mouthwash
After tooth extraction, the dentist would typically place cotton gauze over the extraction site and ask you to bite firmly. This is done in order to achieve hemostasis, that is, to stop the bleeding.
Once the socket stops bleeding, a blood clot forms in the socket. This clot acts as a protective plug over the exposed socket, covering the bone and nerves underneath. The blood clot is very vital in the healing process because it makes up the framework on which new bone would develop to fill up the socket, and soft tissue (gum) would form over the socket.
The gums should grow and fully close within three to four weeks following extraction. However, the bone underneath continues to remodel, and the process could take up to six months to fully complete. Obviously, you would be oblivious to this because the gums would have healed and you would carry on your daily activities as normal.
What Causes Dry Socket?
Dry socket occurs when there is an interference with the protective blood clot. The condition would arise when the blood clot fails to form or when the blood clot has been accidentally dislodged. The absence of the blood clot would leave the socket exposed.
This means the bone and nerves would be exposed to the conditions in the mouth, thereby causing severe pain. Food debris could potentially get into the socket as well, further worsening the pain. Dry socket pain usually becomes noticeable from one to three days post-extraction.
Factors that can interfere with blood clot staying in the socket include the following:
- The presence of an existing infection in the mouth before extraction was done.
- Some actions done after having an extraction could mechanically force out or dislodge the blood clot. Such actions include sucking candy or sucking through a straw, dragging action on a cigarette, vigorously rinsing the mouth and spitting. This is why your dentist may tell you to avoid using a straw for the next few days following extraction and to be gentle if you have to spit.
- In smokers, exposure to nicotine can cause a reduction in the blood supply in the new socket. This reduced blood supply may, in turn, prevent the blood clot from forming in the extraction socket.
- Some physiologic factors such as increased bone density and hormones could interfere with the formation of the blood clot.
Symptoms of Dry Socket
The symptoms of dry socket are:
- Severe pain from the extraction site which usually starts a few days after extraction. The pain could also be radiating, spreading from the extraction site to the ears, eyes, neck or temple, usually on the same side of the extraction.
- An empty socket with little or no blood clot. The exposed whitish bone could be visible.
- A bad taste in the mouth.
- Bad breath
How Is Dry Socket Treated?
Your dentist would first make a diagnosis of dry socket by noting your symptoms and doing an oral examination. The treatment of dry socket may include the following:
- Re-establishment of bleeding. Your dentist would clean out all debris from the socket and make it bleed again.
- A gauze is given to bite on to stop the bleeding and form a blood clot. The socket will also be filled with a medicated dressing or paste to facilitate healing.
- You would be placed on a painkiller and antibiotics to take care of the pain and prevent the socket from getting infected.
- Finally, you may also be asked to a gentle rinse of the area with warm salt water, more like, holding the warm salt water over the area. This would help the healing process by increasing blood flow to the area, helping to kill bacteria as well as acting as an irrigation solution to cleanse the area.
Dry socket can be a very uncomfortable condition that is caused when the blood clot in the socket does not form or gets dislodged. It could be prevented and could also be treated. Following the post-extraction provided by your dentist and taking extra precautions would reduce the risk of having a dry socket and cause you to worry less.
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