A dry socket (also referred to as alveolar osteitis) is a severe dental condition that can occur after removing a permanent adult tooth. Most patients understand there will be some level of discomfort following any oral surgery procedure. Many are prescribed pain medication before leaving their dental office. Generally, most patients do not even need to get the prescription filled.
However, when a patient experiences a dry socket, the pain can become quite intense and linger for days. Very few people are affected by a dry socket. Dry socket development after a tooth extraction occurs in only about 2-3% of patients. For those who experience a dry socket, it can be a very trying experience. Fortunately, with treatment, dry socket is treatable and manageable.
How Does A Dry Socket Develop?
Following routine tooth extraction, a blood clot forms covering the extraction site. A dry socket will develop when the blood clot at the tooth extraction site has broken loose, never fully formed, or has dissolved before healing is complete. The blood clot protects underlying bone and nerve tissues.
The clot is the beginning of the process of healing. The gum tissue and bone can refill the socket area. When the clot is removed, the exposed bone and nerves are susceptible to the food, fluid, outside air, and anything else that enters the mouth.
This external exposure of bone and nerves can lead to a dry socket with sharp, severe pain. A dry socket can last for 5 to 6 days. For patients taking Fosamax-type drugs, the pain can last for weeks. A dry socket is considered the most common complication following a tooth extraction.
It frequently happens with the extraction of impacted wisdom teeth in patients with poor blood flow to the socket ( examples include smokers and patients taking Fosamax), those with delayed healing (for example, diabetics ). The pain begins to build and develop approximately 2-4 days following the tooth removal procedure.
Dry socket signs and symptoms may include:
-Sharp, aching pain within 2-4 days after tooth extraction.
-Partial or total loss of the blood clot at the extraction site. You will be able to see a deep hole or space where the tooth used to be. The area will weep fluid when pressed vs. having a blood clot overlying the site.
-Bone that is visible upon visual examination of the empty tooth socket
-Pain that radiates out from the empty socket to your eyes, ear, temple, or neck on the same side of your face as to where the tooth extraction took place.
-Unusual bad breath or a foul odor emanating from your mouth. This foul breath will usually combine with having an unpleasant taste in your mouth.
-If lymph nodes around your jaw or neck become swollen, this is a sign of infection, and you need to be seen by your dentist ASAP. A dental infection can be severe.
Over-the-counter pain medications alone will not control the dry socket symptoms. Your dentist will need to begin treatment to lessen pain and allow for healing.
Treatment of Dry Sockets
Will A Developing Dry Socket Heal Itself?
Taking a nonsteroidal anti-inflammatory drug (NSAID – aspirin or ibuprofen) can help to ease some of the pain but probably will not be strong enough to remove it completely. Persistent, throbbing pain means you should call your dentist immediately. The dentist may prescribe you more potent pain medication to help control the pain or give you local anesthesia to relieve dry socket symptoms.
What will your dentist do to manage symptoms of dry socket?
Your dentist will need to anesthetize and clean the extraction site. This anesthetic will allow for easy and comfortable removal of debris from the space where the tooth once was and allow a new clot to form into the site.
The dentist may then place a medicated dressing or a special paste into the empty socket to promote healing and ease the symptoms. Patients with dry socket dressings typically need to come back for daily dressing changes until the pain subsides.
Placing a warm cloth on the outside of the face also helps promote blood flow. Your dentist may also prescribe an antibiotic at this point to prevent dental infection. At-home care will include rinsing with a salt water mix and eating very carefully (avoiding the dry socket’s side). The site will typically heal completely in 1-2 weeks with treatment.
Risk Factors Of A Dry Socket
Some patients will have predisposing risk factors that will lead to a higher incidence of dry socket following tooth extraction. These can include the following:
Patients who smoke have 2x the chance of developing a dry socket vs. those who do not. Smoking is also believed to slow healing.
Those with poor oral hygiene maintenance will have an increased risk due to the number of bacteria in the mouth. It will be challenging to maintain a sterile area when removing a tooth. This can lead to bacterial contamination of the exposed socket.
Extraction of wisdom teeth (3rd molars)
Increased trauma to the area during the procedure is one of the indicators for increasing the possibility of developing a dry socket. 3rd molars tend to be considered a difficult tooth extraction, especially if they are fully or partially impacted inside the bone.
Previous history of dry socket
If you have a previous history of dry sockets in the past, you are more likely to develop it following another extraction.
Oral contraceptives that contain estrogen have a direct effect on the blood clotting system of the body.
Rinsing and spitting a lot or smoking after having a tooth extracted also can increase the risk to develop dry socket.
These activities will increase the chances of the blood clot dissolving or becoming dislodged. Following tooth extraction, it is crucial to follow closely all of the dentist’s instructions given to ensure proper healing. If you are unsure of directions, ask. Call your dentist to ensure it is not something more serious at the earliest sign of severe pain or discomfort.
Tips To Prevent Of Dry Socket
What can the patient do before surgery
You can take the following steps to help prevent dry socket from happening:
- Choose a dentist or oral surgeon with experience in tooth extractions.
- Stop smoking before your extraction. Smoking and using other tobacco products will increase your risk of developing a dry socket. Consider discussing quitting with your doctor or dentist about a program to help you quit smoking permanently.
- Talk to your dentist or oral surgeon about any prescription or over-the-counter medications or supplements you are taking. These medications may interfere with blood clotting following surgery.
What your dentist or oral surgeon can do
Your dentist or oral surgeon will take several steps to aid in the healing process and prevent dry socket. These steps can include recommending one or more of the following medications, which may help prevent dry socket:
- Antibacterial mouthwashes or gels immediately before and after surgery.
- Oral antibiotics. These will be particularly effective if you have a compromised immune system.
- Application of antiseptic solutions to the wound.
- Application of medicated dressings after surgery.
Dry Socket Conclusion
As always, maintain a regular dental schedule, visiting your dentist, and keeping open communication with your dentist. This open communication to provide medical advice will make you feel comfortable asking questions. You will also know you are getting the proper information to care for your dental health.
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