Dry Socket Symptoms and Treatment

What is a Dry Socket?

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

After tooth extraction, a blood clot forms to allow for proper healing. The blood clot creates a protective layer over the nerve endings and bone under the removed tooth. It also forms a base for new bone and soft tissue to grow around.

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

What Causes Dry Socket?

Dry sockets usually form when:

1. The blood clot fails to develop altogether after your dentist extracts the tooth
2. The blood clot dissolves or dislodges from the extraction site before it heals 

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
• Tobacco use and smoking — Nicotine, cigarettes, and tobacco can slow down or interrupt the healing process
• Drinking through a straw or spitting too hard — These actions 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

Dry Socket Treatment

If you develop a dry socket, visit your dentist as soon as possible for treatment. Your dentist will clean out the socket, speeding up the healing process. Antibiotics are only prescribed when there is a verifiable infection at the surgery site.

Dry socket treatment consists of five steps, including:

Step 1

First, your dentist or oral surgeon will numb you. They will then clean out the dry socket and flush out any food, debris, and bacteria around the extraction site. Lastly, they will curette the site to help a blood clot form. 

Step 2 

They will fill the socket with a medicated dressing or special paste. This provides additional pain relief. 

Step 3 

If you have a non-resorbable dressing placed, you may need to visit your dentist regularly. They will change it out for you during the healing process. 

Step 4

Post-surgery, your dentist may prescribe antibiotics, pain medications, and/or solutions to irrigate the site to assist with healing. You can also take over-the-counter pain relievers, such as Ibuprofen.

Step 5

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 you develop swelling or pus in the area. This can be a sign of a more serious infection.

Signs and Symptoms of Dry Socket

If you experience any of the following symptoms a few days after a tooth extraction, you likely have 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
• Severe, localized pain near the extraction site that is typically sensitive to gentle probing, such as brushing
• Eventually, radiation of the pain to the temples, eyes, neck, or ears on the same side of the extraction site
• Bad breath (halitosis) and/or a bad taste in the mouth
• A slight fever is also possible

How to Prevent Dry Socket

Here are some ways to prevent dry sockets:

• Gently rinse your mouth a few times each day
• Carefully follow your doctor’s aftercare instructions  
• Practice good oral hygiene  
• During the first two days after the extraction, only eat soft foods, such as soups, smoothies, scrambled eggs, and mashed potatoes 
• Don’t drink caffeine, alcohol, hot substances, carbonated beverages, or smoke tobacco products for at least a week
• Patients should also avoid using straws to reduce the chance of dry socket formation

Complications of Dry Socket

If a dry socket is not treated immediately, it can lead to the following:

• 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

Dry sockets can result from different causes, including trauma, poor oral hygiene, smoking, and other medication. 

It's important to treat this condition early to prevent complications. You should also follow your doctor's advice regarding post-extraction care to prevent a dry socket.