Overview

Dry socket (alveolar osteitis) is a painful dental condition that sometimes happens after you have a permanent adult tooth extracted. Dry socket is when the blood clot at the site of the tooth extraction fails to develop, or it dislodges or dissolves before the wound has healed.

Normally, a blood clot forms at the site of a tooth extraction. This blood clot serves as a protective layer over the underlying bone and nerve endings in the empty tooth socket. The clot also provides the foundation for the growth of new bone and for the development of soft tissue over the clot.

Exposure of the underlying bone and nerves results in intense pain, not only in the socket but also along the nerves radiating to the side of your face. The socket becomes inflamed and may fill with food debris, adding to the pain. If you develop dry socket, the pain usually begins one to three days after your tooth is removed.

Dry socket is the most common complication following tooth extractions, such as the removal of third molars (wisdom teeth). Over-the-counter medications alone won't be enough to treat dry socket pain. Your dentist or oral surgeon can offer treatments to relieve your pain.

Symptoms

Signs and symptoms of dry socket may include:

• Severe pain within a few days after a tooth extraction
• Partial or total loss of the blood clot at the tooth extraction site, which you may notice as an empty-looking (dry) socket
• Visible bone in the socket
• Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction
• Bad breath or a foul odor coming from your mouth
• Unpleasant taste in your mouth

When to see a doctor

A certain degree of pain and discomfort is normal after a tooth extraction. However, you should be able to manage normal pain with the pain reliever prescribed by your dentist or oral surgeon, and the pain should lessen with time.

If you develop new or worsening pain in the days after your tooth extraction, contact your dentist or oral surgeon immediately.

Causes

The precise cause of dry socket remains the subject of study. Researchers suspect that certain issues may be involved, such as:

• Bacterial contamination of the socket
• Trauma at the surgical site from a difficult extraction, as with an impacted wisdom tooth

Risk factors

Factors that can increase your risk of developing dry socket include:

• Smoking and tobacco use. Chemicals in cigarettes or other forms of tobacco may prevent or slow healing and contaminate the wound site. The act of sucking on a cigarette may physically dislodge the blood clot prematurely.
• Oral contraceptives. High estrogen levels from oral contraceptives may disrupt normal healing processes and increase the risk of dry socket.
• Improper at-home care. Failure to follow home-care guidelines and poor oral hygiene may increase the risk of dry socket.
• Having dry socket in the past. If you've had dry socket in the past, you're more likely to develop it after another extraction.
• Tooth or gum infection. Current or previous infections around the extracted tooth increase the risk of dry socket.

Complications

Painful, dry socket rarely results in infection or serious complications. However, potential complications may include delayed healing of or infection in the socket or progression to chronic bone infection (osteomyelitis).

Prevention

What you can do before surgery

You can take these steps to help prevent dry socket:

• Seek a dentist or oral surgeon with experience in tooth extractions.
• If applicable, try to stop smoking before your extraction because smoking and using other tobacco products increase your risk of dry socket. Consider talking to your doctor or dentist about a program to help you quit permanently.
• Talk to your dentist or oral surgeon about any prescription or over-the-counter medications or supplements you're taking, as they may interfere with blood clotting.

What your dentist or oral surgeon may do

Your dentist or oral surgeon will take a number of steps to ensure proper healing of the socket and to prevent dry socket. These steps may include recommending one or more of these medications, which may help prevent dry socket:

• Antibacterial mouthwashes or gels immediately before and after surgery
• Oral antibiotics, particularly if you have a compromised immune system
• Antiseptic solutions applied to the wound
• Medicated dressings applied after surgery

What you can do after surgery

You'll receive instructions about what to expect during the healing process after a tooth extraction and how to care for the wound. Proper at-home care after a tooth extraction helps promote healing and prevent damage to the wound. These instructions will likely address the following issues, which can help prevent dry socket:

• Activity. After your surgery, plan to rest for the remainder of the day. Follow your dentist's or oral surgeon's recommendations about when to resume normal activities and how long to avoid rigorous exercise and sports that might result in dislodging the blood clot in the socket.
• Pain management. Put cold packs on the outside of your face on the first day after extraction and warm packs after that, to help decrease pain and swelling. Follow your dentist's or oral surgeon's instructions on applying cold or heat to your face. Take pain medications as prescribed.
• Beverages. Drink lots of water after the surgery. Avoid alcoholic, caffeinated, carbonated or hot beverages for as long as your dentist or oral surgeon recommends. Don't drink with a straw for at least a week because the sucking action may dislodge the blood clot in the socket.
• Food. Eat only soft foods, such as yogurt or applesauce, for the first day. Be careful with hot and cold liquids or biting your cheek until the anesthesia wears off. Start eating semisoft foods when you can tolerate them. Avoid chewing on the surgery side of your mouth.
• Cleaning your mouth. After surgery, you may gently rinse your mouth and brush your teeth, but avoid the extraction site for the first 24 hours. After the first 24 hours, gently rinse your mouth with warm salt several times a day for a week after your surgery. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water. Follow the instructions of your dentist or oral surgeon.
• Tobacco use. If you smoke or use tobacco, don't do so for at least 48 hours after surgery and as long as you can after that. Any use of tobacco products after oral surgery can delay healing and increase the risk of complications.

Diagnosis

Severe pain following a tooth extraction is often enough for your dentist or oral surgeon to suspect dry socket. He or she will also ask about any other symptoms and examine your mouth to see if you have a blood clot in your tooth socket and whether you have exposed bone.

You may need to have X-rays taken of your mouth and teeth to rule out other conditions, such as a bone infection (osteomyelitis) or small fragments of root or bone remaining in the wound after surgery.

Treatment

Treatment of dry socket focuses on reducing symptoms, particularly pain. Dry socket treatment may include:

• Flushing out the socket. Flushing out the socket can remove any food particles or other debris that may contribute to pain or possible infection.
• Medicated dressings. Your dentist or oral surgeon may pack the socket with medicated gel or paste and medicated dressings. These can provide relatively fast pain relief. The severity of your pain and other symptoms will determine whether you need dressing changes and how often or if you need other treatment.
• Pain medication. Ask which pain medication is best for your situation. You'll likely need a prescription pain medication.
• Self-care. Once the dressing is removed, you may need to flush the socket at home to promote healing and eliminate debris. Typically you'll receive instructions and a plastic syringe with a curved tip to squirt water, salt water or a prescription rinse into the socket. You'll likely need to continue the rinse until the socket no longer collects any debris.

Once treatment is started, you may soon begin to feel some pain relief. Pain and other symptoms should continue to improve and will likely be gone within a few days. However, keep scheduled appointments with your dentist or oral surgeon for dressing changes and other care.

Lifestyle and home remedies

You can help promote healing and reduce symptoms during treatment of dry socket by following your dentist's or oral surgeon's instructions for self-care. You'll likely be told to:

• Take pain medications as prescribed
• Avoid smoking or using tobacco products
• Drink plenty of clear liquids to remain hydrated and to prevent nausea that may be associated with some pain medications
• Rinse your mouth gently with warm salt water several times a day
• Brush your teeth gently around the dry socket area
• Use caution with eating or drinking, avoid carbonated beverages, and avoid smoking or using a straw to prevent dislodging the dressing

Preparing for an appointment

Make an appointment with your dentist or oral surgeon as soon as possible if you develop new or worsening pain after a tooth extraction.

What you can do

To get ready for your appointment, make a list of:

• Any symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment
• Key personal information, such as any medical conditions you have
• All medications you take, including vitamins, herbs or other supplements, and the dosages
• Questions to ask your dentist or oral surgeon to make the most of your time together

Some questions to ask your dentist or oral surgeon may include:

• What are the likely causes of my pain?
• Do I need any tests?
• What type of treatment will I likely need to improve my symptoms?
• What can I take for the pain?
• Is there a generic alternative to the medicine you're prescribing?
• How soon will I feel better?
• How long should I wait to eat or drink after this procedure?
• Are there any restrictions I need to follow?
• Are there any brochures or other printed material that I can have?
• Are there any websites you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you these questions:

• When did the severe pain begin?
• Does the pain occur on its own or does it happen when you drink or touch the area?
• How would you rate the pain on a scale of 1 to 10, with 10 being the most severe?
• Where is the pain located?
• Have you taken pain relievers? What dosage and how often?
• Have the pain relievers helped to some degree?
• Do you have any other symptoms that seem unrelated to your dental pain?
• Have you had a fever?