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Like any minor surgical procedure, a tooth extraction leaves a small wound that needs to heal. Most extraction sites improve without complications and a blood clot forms at the site of the extraction, protecting the underlying bone and nerve endings. Occasionally, a blood clot fails to develop, resulting in a dry socket. Learning how to prevent a dry socket can make a significant difference in recovery after tooth removal.
For patients who have just had a tooth pulled, also called an extraction, a few days of mild discomfort is the norm. But for some, the pain continues and increases for several days. They have what dentists call a dry socket.
When your dentist pulls a tooth, you can expect to have some normal bleeding. As healing begins, a blood clot forms in the hole (socket) in the jawbone left when the dentist removed the tooth. This clot is an important part of the healing process. Similar to a scab that forms over a skin wound, the clot covers the exposed nerve ends, blood supply, and protects the bone.
Dry sockets occur when the blood clot at an extraction site is disrupted. In some cases, the clot dissolves, falls out or fails to form completely. This leaves the hole where the dentist pulled the tooth without any protection for the exposed nerves and blood vessels.
The term dry socket is used because the socket, rather than being filled with a healthy blood clot, is empty and appears “dry.” Debris such as food particles and bacteria can get into the socket, causing bad breath and a foul taste.
A dry socket rarely occurs on the day your dentist pulls your tooth or even on the first day after. Symptoms typically start a few days after the extraction and can last from five to 10 days.¹ Dry socket occurs in up to 5% of most tooth extractions, but rates balloon up to 38% following wisdom tooth extractions².
Most patients experience some discomfort after tooth removal, but pain medication usually controls the symptoms. Clues that a dry socket has occurred include:
Increasing pain three to four days after surgery, sometimes severe
Bad odor or taste
Bare, visible bone in the site that’s greyish or white
Pain that doesn’t adequately respond to pain medications
Swelling into the neck, face, floor of the mouth, or below the eye generally doesn’t indicate a dry socket. Instead, it may be evidence of a bacterial infection. Swelling, especially from lower molars, presents a risk requiring immediate medical attention. Also, puffiness underneath the eyes related to a mouth infection needs evaluation due to the proximity to the brain.³
If a tooth extraction site becomes more uncomfortable after a few days, it’s probably a dry socket. If there’s swelling, fever, or difficulty breathing, don’t wait for evaluation and treatment. Return to the dentist who performed the procedure, or find a dentist nearby who can help.
No single cause has been identified as the universal culprit of the failure to form a clot, which leads to dry socket. Common theories for the cause of dry sockets include trauma during extraction, bacterial infections, biochemical agents and a condition known as fibrinolysis, which means a breakdown of the normal blood clot.⁴ Why does the blood clot break down? That is a question dental science is still struggling to answer.
There are some common risk factors that increase your chance of getting a dry socket. They include smoking habits, your age and gender, systemic diseases, difficulty of the surgery, the surgeon’s experience and techniques used, use of oral contraception, oral hygiene habits, and use of certain types of local anesthetics for the surgery.⁵
Knowing if you have one or more of these risk factors can help determine treatment planning and can also help both patient and dentist take every precaution to prevent a dry socket after unavoidable extractions.
If the pain at your tooth extraction site is getting worse three days after your procedure, you may have a dry socket. You might be able to see the bare grayish-white bone at the extraction site. Intense pain, throbbing, foul taste, and odors usually signal a dry socket. Swelling and pain in the face, neck, or ears might signal a bacterial infection that a dentist must address with prescription medications.
No one fully understands what causes dry socket, but researchers do know certain factors affect the risk of developing this problem. Some of the ways to control aggravating the risk include:
Avoid smoking after having a tooth removed for at least the first 48 hours. One study showed that smoking triples the risk of dry socket.⁶ In addition, higher levels of use seem to lead to higher incidences of this painful condition.
Be careful with anything that loosens or dislodges a new clot. Don’t spit, drink through a straw, or rinse during the first 24 hours to avoid dislodging the blood clot. Choose soft foods, chew away from the area, and let hot foods and drinks cool down.
Estrogen may influence dry socket formation, and women on birth control pills face double the risk than non-users. Women on birth control should try to schedule tooth extractions in days 23 through 28 of their menstrual cycle. Studies show lower risk of dry socket during this last phase.⁷
While there’s limited research on the effect of nutrition on dry socket incidence, good eating affects the healing of oral wounds. Vitamins and minerals provide building blocks for repair and new bone growth. While soup and yogurt are great choices, salmon also offers a healthy protein source that’s rich in omega-6 fatty acids. Omega-6 fats lower general inflammation in the body, including in the mouth.
While the direct causes of dry socket remain a mystery, bacteria may play a role. Before tooth removal, spend extra time cleaning your teeth, gums, and tongue.
Contact your dentist and explain that you have a dry socket and need to see the dentist immediately. Dentists have several options to treat your dry socket. They might irrigate the site to remove debris and get a better view of the area. A medicated dressing may be placed in the socket to ease the pain and protect the exposed nerves. If the pain persists, your dentist may need to X-ray the area to rule out bone fragments or other foreign bodies that might be interfering with normal healing. They may need to prescribe antibiotics and stronger pain medication to assist in the healing process.
If you have a tool removed, take the following precautions to minimize your risk of getting a dry socket:
See a dentist or oral surgeon with experience in tooth extractions
Read and follow all post-operative instructions
Do not smoke before or after surgery for at least one week
Brush and floss daily so your gums are healthy, and teeth are plaque free
Dry socket treatments may be covered by dental insurance. Check with your carrier before having surgery to see how your policy handles emergency visits.
This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.
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