What is a Dry Socket & What Does it Look Like?

What Does a Dry Socket Look Like?

A dry socket appears as a whole where the tooth was removed. It can look empty, dry, or have a whitish, bone-like color.

You may also see the bone that once surrounded the extracted tooth. The socket bone can be exposed entirely or 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. By contrast, a socket with a blood clot that is healing properly should appear dark red.

What is a Dry Socket?

A dry socket (alveolar osteitis) is a painful condition that can develop after a tooth extraction becomes exposed and inflamed. This is a common complication that occurs after wisdom tooth removal.

After a tooth extraction, a blood clot forms in the tooth socket, similar to a scab. This allows proper healing and protects the nerve endings and bone under the removed tooth. It also forms a base for new bone and gum tissues to grow around.

However, when this blood clot dislodges or forms incorrectly, the bone and nerves become exposed. As a result, you will experience severe pain, inflammation, and delayed healing.

How Common is a Dry Socket?

Dry socket occurs in approximately 1 to 5% of all extractions and up to 38% of wisdom tooth extractions. They commonly develop in:

• The lower jaw
• People older than 30 years
• Women
• Teeth that were infected before surgery

Signs and Symptoms of Dry Socket

Dry socket pain typically begins within the first 2 to 4 days after extraction, and it can last several weeks.

The following symptoms a few days after a tooth extraction can indicate a dry socket:

• Partial or complete loss of the blood clot where the tooth was pulled
• Being able to see the bone in the socket
• Pain from the socket extending up to the ear, eye, temple, or neck on the same side of tooth extraction
• Severe, localized pain near the extraction site that is typically sensitive to gentle probing, such as brushing
• Bad breath or smell coming from the mouth
• A bad taste in the mouth
• A slight fever

If you had a tooth extracted more than a week ago and haven’t experienced this kind of pain, the clot has probably already begun to heal. This means you’re unlikely to develop a dry socket.

What are the Causes & Risk Factors of a Dry Socket?

A dry socket forms when the blood clot does not form, dissolve, or dislodge before the extraction site heals. According to Dr. Nandita Lilly, one of NewMouth's in-house dentists, "the highest risk for dry socket is within the first 4 days after surgery."

Risk factors associated with dry sockets include:

• Poor oral care ⁠— Neglecting oral care during the healing process can increase bacteria in your mouth
• Taking oral contraceptives ⁠— If you take birth control pills or have high estrogen levels during the healing process, you are more likely to develop a dry socket
• Mechanical motions ⁠— Actions like smoking, sucking through a straw, or aggressive rinsing/spitting can dislodge the blood clot that is forming in the extraction socket
• Previous dry socket ⁠— If you had a dry socket in the past, you are more likely to develop one again
• Trauma ⁠— An injury caused by a complicated extraction like an impacted wisdom tooth
• Food & other substances ⁠— Bacteria from food, carbonated drinks, nicotine, and alcohol can collect inside the pocket, resulting in an infection

Dry Socket Treatment

If you begin to experience symptoms of a dry socket, contact your dentist or oral surgeon as soon as possible. They'll clean out the socket, speeding up the healing process. Antibiotics are only prescribed when there is a verifiable infection at the surgery site.

This is the general process of dry socket treatment:

1. Cleaning the Extraction Site

Your dentist or oral surgeon will numb you. They will then clean the dry socket and flush out any food, debris, and bacteria around the extraction site.

They'll use sterile saline (saltwater) to clean the extraction site and scrape the socket to promote blood flow. Lastly, they will curette the site to help a blood clot form.

2. Dressing the Socket

They will fill the socket with a medicated dressing or special paste. This helps prevent new food particles and debris from entering the tooth socket. It also provides additional pain relief.

3. Follow-up Appointments

After placing the dressing, you'll need to visit your dentist regularly. They'll change the dressing for you during the healing process.

4. Post-Op Medications

Post-surgery, your dentist may prescribe the following to assist with healing:

• Antibiotics
• Pain medication
• Antibacterial mouthwash
• Antiseptic rinses or solutions to irrigate the site

You can also take over-the-counter pain relievers, such as Ibuprofen.

5. Salt Water Rinse

Rinse your mouth with salt water a few times daily to flush out bacteria and food particles. Most mouthwashes are too harsh for extraction sites and contain alcohol, which increases the risk of dry socket formation.

Call your dentist immediately if the pain does not improve with pain relievers or if you develop swelling or pus in the area. This can be a sign of a more serious infection.

How to Take Care of a Dry Socket?

To care for a dry socket at home, you should:

• Take pain medicine and oral antibiotics as prescribed
• Apply ice to the jaw
• Carefully rinse the dry socket as recommended by the dentist
• Apply clove oil to the extraction site for pain relief
• Eat soft foods until fully healed
• Refrain from smoking or drinking alcohol

Oral antibiotics do not significantly decrease the risk of dry sockets because there are hundreds of bacteria types in the mouth. Because of that, you can still develop a dry socket even with good oral hygiene.

How to Prevent a Dry Socket

Don't brush the extraction site for at least a week post-op. Only gently brush the neighboring teeth around the extraction site. The most important things to avoid are smoking, sucking motions, and drinking through straws.

Other ways to prevent dry sockets include:

• Gently rinse your mouth a few times each day
• Carefully follow your doctor's aftercare instructions
• Practice good oral hygiene
• Stick to soft foods like smoothies, eggs, soup, and mashed potatoes
• Don’t drink hot liquids, carbonated drinks, alcohol, and caffeine
• Avoid strenuous exercise while the area is still healing

Complications of Dry Socket

If a dry socket is not treated immediately, the risk of complications can increase. These complications include:

• Infection
• Pain
• Fever and chills
• Redness
• Swelling and tenderness
• Pus from the extraction site
• Delayed healing

Another serious complication of dry sockets is osteomyelitis. This is a chronic bone infection that may require surgical intervention. It is caused by infection spreading to the bone.

Summary

A dry socket (alveolar osteitis) is a painful condition that can develop after a tooth extraction becomes exposed and inflamed. This occurs when the blood clot protecting the tooth socket dissolves, dislodges, or doesn't form properly.

Dry sockets can result from different causes, including trauma, poor oral hygiene, smoking, and other medication. You can prevent it with proper care and following your doctor's advice after the extraction.

Symptoms of a dry socket can range from an unpleasant taste in your mouth to severe pain in the affected area. If a dry socket isn't treated immediately, it can result in serious complications like osteomyelitis.