Dry Sockets After Wisdom Tooth Removal

What is Dry Socket?

Dry socket, also known as alveolar osteitis, is a painful complication that can develop after tooth extraction.

After tooth removal, a blood clot typically develops in the resulting hole in the bone and gums (socket). This blood clot acts as a protective covering over the socket while it heals. It also serves as a foundation for new soft tissue and bone growth.

The underlying bone and nerves are exposed if a blood clot doesn’t form or it dissolves or dislodges too early. This condition is called dry socket.

The cause of dry socket is often unclear. But several risk factors increase the risk of developing dry socket after a tooth extraction. They include:

• Poor oral hygiene
• Bacteria, food particles, or other debris collecting or getting stuck in the socket
• Putting pressure on the healing socket, such as drinking with a straw, spitting too hard, or other sucking motions, all of which can dislodge the blood clot 
• Complex tooth extractions that cause trauma to the surrounding bone and gums
• Smoking or chewing tobacco products
• Not following aftercare instructions after surgery
• Taking oral contraceptives (birth control pills)
• Having previous cases of dry socket
• Being female (likely due to estrogen levels)
• Having a current or previous tooth or gum infection near the extracted tooth
• Immunocompromised or diabetic people who have delayed wound healing

The most common complication associated with tooth extraction is dry socket. Around 2 to 5% of people experience dry sockets following wisdom tooth extraction. 

According to Dr. Nandita Lilly, the highest risk for dry socket is within the first 4 days after surgery.

Dry Socket Symptoms

Dry socket can cause several symptoms that tend to develop 1 to 3 days after surgery, including:

• Severe pain that can radiate to the ear, temples, neck, or eye on the same side of the face as the tooth extraction
• Inflammation in or around the socket
• Bad breath or an unpleasant smell coming from the mouth
• A foul taste in the mouth

When to See Your Dentist

After tooth extractions, you will schedule post-surgery visits with your dentist or oral surgeon.

Seek medical attention as soon as possible if you have:

• Intense pain that lasts longer than 4 days after surgery or is not well-managed by pain medications 
• Severe pain that worsens or progresses
• An empty tooth socket 
• Noticeable bone in the wound site
• A bad smell coming from your mouth or an unpleasant taste

Diagnosis

A dentist can often diagnose dry socket by examining the affected area and assessing your symptoms. They may take X-rays to ensure no tooth fragments were left in the gums. They will also check for bone infections.

How is Dry Socket Treated?

Home remedies can help reduce pain associated with dry socket and help it heal quicker. But dry socket always requires treatment from a dentist or oral surgeon. 

Home remedies include:

• Pain and anti-inflammatory medications (prescribed or over-the-counter)
• Applying cold compresses, cold packs, or ice packs wrapped in a cloth to the face near the affected area for 20 minutes on and 20 minutes off
• Gently rinsing with warm salt water 

Once dry socket develops, a dental healthcare professional will often:

• Clean and rinse the socket and surrounding area with salt water
• Curettage or scrape the bone of the socket to promote bleeding
• Pack the socket with medicated gauze or paste to cover exposed bone and nerves and reduce pain
• Prescribe oral antibiotics to help clear any present infections 
• Recommended using antibacterial mouth rinses and gels

Most people will need to have the dressing covering their dry socket changed or removed by a dentist.

Complications Associated with Untreated Dry Socket

Some people with dry socket may only experience minor pain. But dry socket pain is often very severe.

Untreated dry socket can also:

• Delay the healing process
• Cause an infection in the socket 
• Cause an infection in the jaw bone that can result in bone loss

What is the Outlook for Dry Sockets?

With proper treatment and good at-home care, a socket often resolves within 7 to 10 days. Most people experience pain relief once treatment starts. 

5 Tips to Avoid Dry Socket After Wisdom Tooth Removal

Because the cause is often unknown, there may be nothing you can do to prevent dry socket from developing. But you can do a few things to reduce the risk of developing dry socket.

Tips include:

1. Follow Pre- and Post-Surgery Instructions

You might need to take oral antibiotics before surgery, especially if you have immune conditions. You may also need to use antibacterial gels or mouthwashes immediately before surgery.

After surgery, most people should:

• Take pain medications as prescribed
• Drink plenty of water and clear liquids to prevent dehydration and nausea from pain medications 
• Get plenty of sleep and rest
• Only resume normal activities when a doctor says it’s safe to
• Flush the socket at home using a plastic syringe and water, saltwater, or prescription rinses around 5 days after surgery; continue until the socket no longer collects debris
• Always follow pre- and post-operative care instructions from your doctor

2. Practice Good Oral Hygiene

Practicing good oral hygiene helps keep the socket clean and prevents dry socket. It can also promote healing. 

After surgery, brush the teeth gently and avoid brushing the extraction site for 24 hours. 

Once 24 hours have passed, gently rinse the mouth with a warm salt water rinse several times daily for a week. Make a DIY salt water rinse by mixing ½ teaspoon of table salt into an 8-ounce glass of water. A doctor may also suggest rinsing the mouth with antibacterial mouth rinses.

3. Don’t Smoke or Use Tobacco 

Smoking or using tobacco products increases the risk of dry socket significantly and can interfere with the healing process.

Do not smoke or use tobacco products for 3 days or more after tooth removal surgery. Quitting smoking or tobacco use before surgery also reduces the risk of dry socket.

4. Avoid Putting Pressure on the Healing Socket

Things that put pressure on the healing socket can disturb a protective blood clot. Avoid drinking through a straw and other sucking motions for at least 1 week after surgery. Avoid poking and probing the healing socket with your finger or a toothpick.

5. Avoid Irritating Foods and Drinks

Only eat soft foods for at least a week after surgery. Eating crunchy, hard foods and chewing on the same side as where the extraction was done can cause debris to enter the socket and dislodge the blood clot. 

Also avoid drinks that are:

• Carbonated 
• Hot
• Too cold
• Caffeinated
• Alcoholic

Summary

Dry socket occurs when a blood clot doesn’t form properly or dissolves or dislodges from the socket too early. This leaves the bone and nerves exposed. It usually develops after a tooth extraction or removal and can delay healing. 

There are several ways to prevent dry socket and reduce its symptoms at home. Dry socket typically requires medical attention and care from a dentist or oral surgeon.