Dry Socket

Dry socket is a uncommon complication that could occur after tooth removal. Also called as alveolar osteitis, it is very common after third molar tooth removal.

Normally, after tooth removal a blood clot forms inside the socket, that protects the underlying nerves and bone, which helps in healing and later in formation of a new bone. If this blood clot is disturbed, displaced/dislodged before the complete healing, socket is exposed to air, fluids, food or anything that enters the mouth. This leads to infection and severe throbbing pain and a dry socket is formed.

The best differentiation between a normal extraction pain and a dry socket pain is the timing.

Pain after a tooth removal usually peaks and wanes in 24 hours, but the pain from dry socket typically starts 3-5 days after tooth removal and lasts for more than 2 weeks if not treated by professional.

Most common symptoms of dry socket include the following:

  • Severe/ throbbing pain typically 3-5 days after tooth extraction
  • Pain that radiates from the site to ear, temple, eye, neck of the same side.
  • On looking, the socket is pale or empty with partial or complete loss of blood clot.
  • There is bad/fetid odour of mouth.
  • The bone is visible clearly.
  • Altered/unpleasant taste in mouth.
  • Lymph nodes of neck could be enlarged and painful on touch.
  • Mild fever.

A defined cause for dry socket is still unclear. But there are few risk factors for dry socket, which include:

  • Bacterial contamination of socket.
  • Smoking/tobacco use- the chemical in cigarette delay the normal healing, act of sucking on the cigarette can dislodge the blood clot.
  • Tooth removal after radiotherapy in cancer patients.
  • Improper Home care-vigorous mouth washing, bad oral hygiene can dislodge the clot/infect the socket.
  • Oral contraceptives use-they alter the hormones and the healing process is delayed.
  • Drinking carbonated beverages(cola, beer, sparkling water etc).

Make an appointment with your dentist or oral surgeon at the earliest. Few of the basic question you could be asked from your dentist are- the timing of start of pain, any previous history of dry socket, any habits, any current medications that you are taking etc.

Few tests and diagnosis that your dentist might undertake-

  • Examine your mouth/tooth socket visually.
  • Examine your lymph nodes.
  • An x-ray of the tooth socket could be taken, to see any infection if present(osteomyelitis).

Prime goal in treating dry socket is to relieve the pain.

  • Analgesic medication- they are prescribed to relieve you of pain.
  • Antibiotics- to control infection.

The other treatments done to heal a dry socket are the following:

  • Flushing with Irrigant: your dentist cleans the tooth socket with saline(sterile salt water). Any debris/ food particles are removed.
  • Medicated dressing: There are many medicated dressing that are packed into the socket. They are changed at regular follow ups. This provides a faster pain relief. Few of the medicated dressing used are-
    • Antibacterials
    • Obtundants
    • BIPP(iodoform paste)
    • Alvogyl(eugenol, iodoform,butamen)
    • Zinc oxide eugenol in cotton pellets.

Studies have shown that- regular use of Chlorhexidine mouthwash 24 hours after tooth extraction reduces the chances of dry socket. Prevention of dry socket can be done by-

  • Regularly taking any medications prescribed after tooth removal.
  • Good oral hygiene maintenance.
  • Good home care after tooth removal
  • Avoiding smoking after tooth removal
  • Avoiding alcoholic beverages after tooth removal.
  • Avoid vigorous mouth rinse for 2-3 days after tooth removal.
  • Good nutrition and diet.

Last updated on 11 December, 2018.

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