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Dry socketBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/dry-socket/DS00778
Dry socket (alveolar osteitis) is a painful dental condition that can occur after extraction of a permanent adult tooth.
Dry socket occurs when the blood clot at the site of the tooth extraction has been dislodged or has dissolved before the wound has healed. Exposure of the underlying bone and nerves results in severe pain.
Dry socket is the most common complication following tooth extractions, such as the removal of impacted wisdom teeth. If dry socket occurs, the pain usually begins one to three days after the extraction.
Over-the-counter medications alone don't adequately treat dry socket pain. Therefore, your dentist or oral surgeon will initiate treatments to lessen pain and promote healing.
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
- Swollen lymph nodes around your jaw or neck
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.
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.
Dry socket occurs when the clot doesn't form properly, dissolves too soon or is physically dislodged before complete healing. With the clot gone, the extracted tooth's root space does not fill in with new tissue. The bone and nerves in the socket are then exposed to air, fluids and food. This can cause intense pain, not only in the socket but also along the nerves radiating to the side of your face.
The precise cause of dry socket remains the subject of study. Researchers suspect that several issues may be at play, including:
- Bacterial contamination of the socket
- Severe bone and tissue trauma at the surgical site due to a difficult extraction
- Very small fragments of roots or bone remaining in the wound after surgery
Factors that can increase your risk of developing dry socket include:
- Smoking and tobacco use. Chemicals in cigarettes or other forms of tobacco may inhibit 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. Proper at-home care after a tooth extraction helps promote healing and prevent damage to the wound. Failure to follow guidelines 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 tooth to be extracted increase the risk of dry socket.
Preparing for your appointment
Make an appointment with your dentist or oral surgeon as soon as possible when you develop new or worsening pain after a tooth extraction. Be prepared to answer the following questions:
- When did the severe pain begin?
- 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?
Tests and diagnosis
Severe pain following a tooth extraction is often enough for your dentist or oral surgeon to suspect dry socket. Your dentist or oral surgeon also will ask about any other symptoms and examine your mouth. He or she will check 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.
Treatments and drugs
Treatment of dry socket is mainly geared toward reducing its symptoms, particularly pain. Dry socket treatment includes:
- Flushing out the socket. Your dentist or oral surgeon flushes the socket to remove any food particles or other debris that has collected in the socket and that may contribute to pain or infection.
- Medicated dressings. Your dentist or oral surgeon packs the socket with medicated dressings. This step provides relatively fast pain relief. You may need to have the dressings changed several times in the days after treatment starts. The severity of your pain and other symptoms determines how often you need to return for dressing changes or other treatment.
- Pain medication. Talk to your doctor about which pain medications are best for your situation. If over-the-counter pain relievers aren't effective, you may need a stronger prescription pain medication.
- Self-care. You may be instructed how to flush the socket at home to promote healing and eliminate debris. To do this, you'll be given a plastic syringe with a curved tip to squirt water, salt water, or a prescription rinse into the socket. You'll be instructed to continue the rinse until the socket no longer collects any debris.
Once treatment is started, you may begin to feel some pain relief in just a few hours. Pain and other symptoms should continue to improve and will likely resolve within five to 10 days.
Lifestyle and home remedies
Dry socket rarely results in infection or serious complications. But getting the pain under control is a top priority. You can help promote healing and reduce symptoms during treatment of dry socket by following these tips:
- Hold cold packs to the outside of your face to help decrease pain and swelling.
- 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.
- Keep scheduled appointments with your dentist or oral surgeon for dressing changes and other care.
- Call for an appointment if your pain returns or worsens before your next scheduled appointment.
Your dentist or oral surgeon will take a number of steps to ensure proper healing of the socket and to prevent dry socket. You'll be instructed on steps you can take to prevent the complication.
What your dentist or oral surgeon may do
Your dentist or oral surgeon may discuss with you the following medications that may help prevent dry socket:
- Antibacterial mouthwashes or gels immediately before and after surgery
- Oral antibiotics, particularly for people with compromised immune systems
- Antiseptic solutions applied to the wound
- Medicated dressings applied after surgery
What you can do before surgery
You can take the following steps to help prevent dry socket:
- Seek a dentist or oral surgeon with experience in tooth extractions.
- If you take oral contraceptives, schedule your extraction, if possible, during days 23 to 28 of your menstrual cycle, when estrogen levels are lower.
- Stop smoking and the use of other tobacco products at least 24 hours before tooth extraction surgery. 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 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. These instructions will likely address the following issues that can help prevent dry socket:
- Activity. After your surgery, plan to rest for the remainder of the day. Resume normal activities the next day, but for at least a week, avoid rigorous exercise and sports that might result in dislodging the blood clot in the socket.
- Beverages. Drink lots of water after the surgery. Don't drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. 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 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
- Cleaning your mouth. Don't brush your teeth, rinse your mouth, spit or use a mouthwash during the first 24 hours after the surgery. After that time, gently rinse your mouth with warm salt water every two hours while awake and after meals for a week after your surgery. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water. After the first 24 hours, resume brushing your teeth, being particularly gentle near the surgical wound.
- Tobacco use. If you smoke, don't do so for at least 24 hours after surgery. If you chew tobacco, don't use it for at least a week. Any use of tobacco products after oral surgery can delay healing and increase the risk of complications.
- Benko P. Emergency dental procedures. In: Roberts J, et al., eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa.: Saunders Elsevier; 2009. http://www.mdconsult.com/das/book/body/214478851-3/0/2083/0.html. Accessed Aug. 13, 2010.
- Noroozi AR, et al. Modern concepts in understanding and management of the "dry socket" syndrome: Comprehensive review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontics. 2009;107:30.
- Blum IR. Contemporary views on dry socket (alveolar osteitis): A clinical appraisal of standardization, aetiopathogenesis and management: A critical review. International Journal of Oral and Maxillofacial Surgery. 2002;31:309.
- Preparing for third molar removal. NIH Clinical Center. National Institutes of Health. http://www.cc.nih.gov/ccc/patient_education/tests_procedures.html. Accessed Aug. 13, 2010.
- Cardoso CL, et al. Clinical concepts of dry socket. Journal of Oral and Maxillofacial Surgery. 2010;68:1922.
- Wisdom teeth. American Association of Oral and Maxillofacial Surgeons. http://www.aaoms.org/wisdom_teeth.php. Accessed Aug 13, 2010.