What is a dry socket? Symptoms, treatment, and how to avoid

Peter March

Written by Peter March DDS, Nichole McKenna DDS

Dry socket, or alveolar osteitis, is rare, but it is still the most common complication after extraction. It happens when a blood clot doesn’t form or becomes dislodged.

This leaves nerves and bone exposed, which can cause significant pain. The good news is that dry socket is simple to diagnose and easily treatable. Read on to find out the causes and risks, how to spot the problem, and your treatment options.

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What causes a dry socket?

Tooth extraction

Picture by Authority Dental under CC 2.0 license

The prevalence rate of dry socket is about 1-5% of those who recently had a tooth pulled. Interestingly, if the extraction pertains to lower wisdom teeth, the chances rise to about 38%.

Other than that, the most common dry socket causes include:

  • not following post-op instructions,
  • smoking or chewing tobacco,
  • bacterial contamination, and
  • trauma.

Smoking and chewing tobacco are bad due to irritants and toxins. Nicotine also constricts blood vessels and decreases blood flow which is important in healing.

Nichole McKenna

Nichole McKenna, DDS

Smoking also causes suction in the mouth, which is the most common way a blood clot is dislodged after extraction.

Bacterial contamination may occur if you’ve had snacks or drinks after the blood clot was dislodged. Poor oral hygiene can also be the culprit.

Trauma happens if you poke the socket with your toothbrush or food. Sucking through straws and vigorous brushing or rinsing can also dislodge the blood clot.

The risk of getting a dry socket is increased by taking oral contraceptives, previous dry socket or periodontal disease, being over 25, and a complicated extraction. Oral contraceptives introduce high levels of estrogen into the oral cavity. This may disrupt normal healing processes. What follows is that dry socket is more common in women than men.

If you’ve had a dry socket before, it is likely to occur again. Let your dentist know. This might not help prevent it, but will speed up diagnosis and treatment.

Dry socket symptoms

If you have a dry socket, pain in the affected area will be the most noticeable of signs.

You may also experience the following symptoms:

  • significant discomfort in the jaw, neck, or ear region,
  • a dry opening instead of a dark clot in the extraction site,
  • bad breath,
  • unpleasant taste,
  • dullness of the jaw, and
  • inflammation in the mouth.

These usually appear about 3-7 days after the extraction. Dry socket signs are pretty obvious, so it’s rare that the issue is misdiagnosed.

How to treat dry socket?

Missing front tooth

Picture by Authority Dental under CC 2.0 license

At first, you may want to start at home. Dry socket almost always heals on its own, so it’s all about how willing you are to experience pain.

Home remedies

If you feel pain 2-3 days after an extraction, use a saltwater rinse to gently disinfect the area. Make sure not to swish it around too vigorously, as this may worsen the problem.

Bite gently on a gauze pad or a teabag to manage the bleeding. You can also take anti-inflammatory painkillers such as ibuprofen or aspirin.

If you are still experiencing pain or swelling after 5 days, report to your dentist. OTC products may not be enough.

Professional treatment

The first step is cleaning the area to remove any food debris or bacteria. A numbing gel may be used to make this less painful.

Your dentist will cover the extraction site with a medicated dressing or a paste. The substance that goes into the socket typically contains Eugenol (clove oil). This will stop the bleeding and prevent infection of the surgical site. He or she may also prescribe a medicated rinse or instruct you to replace the dressing at home after a few hours.

You may receive a prescription for stronger painkillers than the ones easily available at the drugstore.

How to prevent dry socket?

The most important step in preventing a dry socket is to follow post-op instructions closely. This means:

  • take it easy for the rest of the day,
  • place a cold compress on the cheek near the removal site,
  • drink plenty of fluids,
  • do not use straws and avoid sucking motions,
  • steer clear of alcohol and tobacco,
  • eat soft foods only, and
  • rinse your mouth to clean it for 24 hours.

Vigorous activity and exercise raises the risk of trauma and dislodging the blood clot physically. Get plenty of rest and schedule your workout for the following week.

Alcohol and tobacco can slow down healing, so stay away from those as well. Partying can stretch the recovery period out.

Eat soft foods such as puddings and yogurts to prevent trauma to the area.

Don’t brush the extraction site for at least 24 hours. Try to clean the rest of your teeth without touching the area. You can use an antiseptic mouthwash to disinfect your mouth before bed. Research shows that solutions containing chlorhexidine might lower the risk of dry socket.

FAQ

How common is a dry socket?

2-5% of patients who have recently had an extraction suffer from a dry socket. It is slightly more likely in women than men.

What does a dry socket look like?

A dry socket looks like a white hole where your tooth used to be. You may be bleeding from the area, but bone is almost always visible. It may look a little gray.

When can I stop worrying about the dry socket?

Chances of developing dry socket drop to 0% after about 7 days after the extraction.

Will dry socket heal on its own?

A dry socket often heals on its own, but you may experience a significant amount of pain. Keep the area clean by rinsing your mouth gently with warm water or saline solution and keep gauze over the extraction site. Make sure to go easy on the area while brushing.

How long does the dry socket last?

The dry socket healing time is about 3-5 days.

How to smoke after tooth extraction without getting a dry socket?

It’s best to avoid any tobacco products for at least a week after your extraction.

References

  1. Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques - NCBI
  2. The effect of cigarette smoking on the severity of pain, swelling and trismus after the surgical extraction of impacted mandibular third molar - NCBI
  3. Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis) - PubMed
  4. Dry Socket: Incidence, Clinical Features, and Predisposing Factors - NCBI
  5. Salt water mouthwash post extraction reduced post operative complications - PubMed
  6. Comparision Between Neocone, Alvogyl and Zinc Oxide Eugenol Packing for the Treatment of Dry Socket: A Double Blind Randomised Control Trial - NCBI
  7. Effect of chlorhexidine rinse on the incidence of dry socket in impacted mandibular third molar extraction sites - PubMed