After a dentist extracts a tooth, a common complication is a “dry socket.” This painful complication occurs in less than 5% of patients after routine extractions and up to 38% for lower wisdom teeth.1
After a tooth is removed, a hole is left in the gums where the tooth roots were attached to the jawbone. A blood clot forms in the remaining hole—the tooth “socket”—that protects the exposed nerve tissue and blood supply that previously supported the tooth.
When something interferes with the formation of the clot or the blood clot is dislodged, the socket becomes “dry” and the nerves are unprotected. The pain comes from any stimuli such as air moving across the socket during breathing, changes in temperatures from foods and drinks, jaw movements when talking or eating, and any other source that might irritate the exposed nerves.2
Dry socket symptoms
Most patients experience some discomfort for a few days after a tooth is removed. Usually, over-the-counter pain medications are sufficient to dull this minor pain. Following your dentist’s instructions for post-operative care means you will be back to normal in a day or two.3
But if a dry socket occurs, pain won’t abate within three days of surgery and you may experience intense throbbing at the extraction site, accumulation of debris in the socket and a foul odor. Pain can also radiate through the jaw and into the ear or neck. Most patients have no doubt when a dry socket occurs.4
Dry socket causes
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.5 Why does the blood clot break down? That is a question dental science is still struggling to answer.
Dry socket risk factors
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.6
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.
Can I prevent a dry socket?
A thorough review of your health and dental history can help the dentist assess you for the risk factors listed previously in this article that might make you more likely to get a dry socket. Preventing dry socket is one of the primary goals of the common post-operative instructions given by dentists.7
- Eat soft foods
- Avoid using straws
- Keep the area clean
- Change the gauze packs with clean hands
- Avoid smoking, alcohol, and carbonated drinks
Being aware of risk factors and following your dentist’s post-op instructions are the best ways to ensure you do not develop a dry socket.
How are dry sockets treated?
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 a stronger pain medication to assist healing process.8
How can I minimize my risk of getting a dry socket?
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.
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Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice. It 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.