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Dry socket (alveolar osteitis) is a painful inflammation that can develop in the jawbone's open tooth socket after a tooth has been removed. Dry sockets often develop after extraction and are more common after extraction of the third molars, or wisdom teeth removal.
A socket appears as a hole in the jawbone where a tooth was previously. After a tooth is removed during oral surgery, a blood clot forms in the socket. A blood clot protects the bone and nerves underneath as it heals. A dry socket occurs when the blood clot is lost or prevented from forming. When the blood clot cannot form properly, the bone and nerves are exposed to the air, which causes severe pain and delays healing.
Dry socket is a common but treatable condition. Dry socket occurs in approximately 1% to 5% of all extractions and up to 38% of wisdom tooth extractions. Dry sockets are more frequent in the lower jaw, in patients older than thirty years, in female patients, and in teeth that were infected before surgery.
A dry socket forms when the blood clot at the site of surgery dissolves or is dislodged.
Common factors that cause dry socket include:
Symptoms of dry socket are:
Factors that increase the risk for dry socket include:
A dry socket looks like a hole left after tooth extraction, where exposed bone within the socket or around the perimeter is visible. The opening where the tooth was pulled may appear empty, dry, or have a whitish, bone-like color.
Typically, a blood clot forms over your empty socket. This clot protects the wound while it heals and promotes new tissue growth. Without a blood clot over the socket, raw tissue, nerve endings, and bone are exposed.
The socket bone can be exposed entirely or can be covered by food debris or clumped bacterial material. When surrounded by food debris or bacteria, the socket can appear in various colors, including black, yellow, and green.
On the other hand, some patients sometimes may not be able to visibly notice a dry socket, just a hole after tooth extraction.
A dry socket is treated by a dentist or an oral surgeon, who may treat it by:
Your dentist may also decide to:
To prevent dry socket, patients should follow their dentist's instructions, which may include:
To care for a dry socket at home, patients should:
Oral antibiotics do not significantly decrease the risk of dry sockets because there are hundreds of bacteria types in the mouth. For that reason, even if patients do everything they are supposed to, they may still develop dry sockets.
A dry socket may look like an empty hole at the tooth extraction site. It may appear dry or have a whitish, bone-like color.
During the healing process, a red-colored blood clot forms in the socket. The clot is then slowly dissolved away and replaced with fibrin, an insoluble protein formed during blood clotting. Fibrin can appear in a whitish color. Eventually, the gums grow over the fibrin, and the pink color reoccurs until full healing.
In most cases, a dry socket will heal on its own. However, in many cases, as the site heals, patients will likely continue to experience discomfort. Patients should visit a doctor to treat dry sockets to prevent complications.
Patients who develop dry socket complain of pain 3 to 5 days after surgery. This pain is usually worse than it was immediately after extraction.
Dry sockets are more common in the lower jaw. The pain often radiates to the ear or neck, or other areas in the jaw. Pain can also be accompanied by bad breath and a bad taste in the mouth. Dry socket is not an infection and is not accompanied by swelling, redness, or fever.
In patients with dry sockets, the pain may keep them up at night and is often not fully treated by over-the-counter pain relievers such as ibuprofen. If things were getting better after surgery and suddenly worsen, it may be a sign of a dry socket.
Patients should contact a dentistry or healthcare professional if it's a few days after surgery and they have severe pain around the area of tooth removal. Dry sockets are easily diagnosed and treated.
Alemán Navas, Ramón Manuel, and María Guadalupe Martínez Mendoza. “Case report: late complication of a dry socket treatment.” International journal of dentistry vol. 2010 (2010): 479306. doi:10.1155/2010/479306 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022165/
Dry Socket. www.healthlinkbc.ca/health-topics/d89937762
“Dry Socket: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, https://medlineplus.gov/ency/patientinstructions/000780.htm
Mamoun, John. “Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques.” Journal of the Korean Association of Oral and Maxillofacial Surgeons vol. 44,2 (2018): 52-58. doi:10.5125/jkaoms.2018.44.2.52 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932271/