Dry Socket Causes, Symptoms & Treatment

What is a Dry Socket?

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

Three to five days after your dentist pulls the tooth, you will start to feel severe pain, which typically indicates a dry socket. With or without treatment, the pain will last between 10 and 15 days.

After a tooth is extracted, 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.

However, when this blood clot dislodges or forms incorrectly, the nerves become exposed. As a result, you will experience intense pain and inflammation inside the socket. Food debris can also move into the socket, which increases the pain. 

Dry Socket Causes

There are a few different ways a dry socket can form, including:

  1. After your dentist extracts the tooth, the blood clot can fail to develop altogether
  2. The blood clot dissolves or dislodges from the extraction site before it heals
  3. A bacterial infection forms in the empty socket after surgery

Trauma at the extraction site (e.g., an impacted tooth) can result in a dry socket. For example, when a tooth does not emerge or only grows in partially, it is considered an impacted tooth.


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If you have a small jaw, you are also more likely to develop impacted third molars (wisdom teeth). Serious oral infections and cysts can form if these teeth are not removed.

Other risk factors associated with dry sockets include:

  • Poor oral care — neglecting oral care during the healing process can result in a dry socket
  • Teeth or gum infections If you have an infection near the extraction site (e.g., cavities or gum disease), you have an even higher chance of developing a dry socket
  • 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 smokingnicotine, cigarettes, and tobacco can slow down or interrupt the healing process
  • Previous dry socket — if you had a dry socket in the past, you are more likely to develop one again

Symptoms of Dry Socket

If you experience any of the following symptoms a few days after a tooth extraction, dry socket formation is likely:

  • 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, the pain can radiate 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 Sockets

To prevent a dry socket, dentists recommend rinsing your mouth a few times each day. You should also follow the wisdom teeth removal aftercare instructions carefully and practice good oral hygiene. Refrain from brushing the extraction site for at least a week after surgery. 

During the first two days after the extraction, only eat soft foods, such as soups, smoothies, scrambled eggs, and mashed potatoes. Do not 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.

Dry Socket Treatment Options

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

Dry socket treatment consists of four steps, including:

Step 1 — first, your dentist or oral surgeon will clean out the dry socket and flush out any food, debris, and bacteria around the extraction site.

Step 2 — then, they will fill the socket with a medicated dressing. This helps prevent any new food particles and debris from entering the tooth socket.

Step 3 — after the dressing is placed, you must visit your dentist regularly to have it changed out during the healing process. 

Step 4 — post-surgery, your dentist may prescribe you antibiotics, pain medications, and/or irrigation solution to assist in healing. You can also take over-the-counter pain relievers, such as Ibuprofen.

Step 5 It is also important to rinse your mouth with salt water a few times each day 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.

If the pain does not improve with pain relievers, or you develop worse breath, call your dentist immediately. This may be a sign of a more serious infection.

Resources

Balaji, S. M., and Daniel M. Laskin. Textbook of Oral and Maxillofacial Surgery. Elsevier, a Division of Reed Elsevier India Private Limited, 2013.

“Dry Socket.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 Jan. 2017, www.mayoclinic.org/diseases-conditions/dry-socket/symptoms-causes/syc-20354376.

“Dry Socket: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/patientinstructions/000780.htm.

Shafer, A. William, et al. Shafer's Textbook of Oral Pathology. Elsevier, a Division of Reed Elsevier India Private Limited, 2015.

Updated on: July 13, 2020
Author
Alyssa Hill
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Medically Reviewed: April 3, 2020
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Lara Coseo
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