Dry socket, also known as alveolar osteitis, is a painful dental problem that can develop 4 to 5 days after having a permanent adult tooth pulled out.
The socket refers to the hole in the alveolar bone that is left after the tooth is extracted. Once the tooth is removed, a blood clot typically forms at the site to cover and protect the underlying bone and nerve endings. This protective layer allows the wound to heal by shielding it from further injury or irritation. The blood clot also promotes the growth of new bone and fresh soft tissue at the site.
In the event that this protective layer fails to develop, becomes dislodged, or dissolves, the nerves and bone in the socket will be left exposed to air, food, fluid, and anything that enters the mouth.
Additionally, a person with a dry socket may find it impossible to keep his/her tongue from mechanically stimulating the exposed bone, which is acutely painful to touch, resulting in frequent acute pain.
This total or partial loss of blood clot will not only delay the healing of the socket, but it will result in intense pain inside the socket and along the nerves radiating to the side of your face. The exposed jawbone is likely to become inflamed and the socket may be filled with food debris, further aggravating the pain.
What are the Causes of and Risk Factors for a Dry Socket?
Tooth extraction is a straightforward process that rarely results in a dry socket. The formation of a protective blot clot covering the vacated space is the first step toward the healing of the extraction site, in the absence of which the nerve endings, gums, and jawbone underneath remain exposed and vulnerable to further damage.
Sometimes, the clot may fail to form on its own or gets dislodged or dissolves before the wound has healed. There are a number of factors that can deter the timely formation of this protective layer, including:
- Preexisting bacterial contamination of the socket
- Bone and tissue trauma during tooth extraction
- A small piece of a fractured bone or sharp edges of alveolar socket remaining in the wound after extraction
- Inadequate post-surgery care and oral hygiene
Some people run a higher risk of developing a dry socket following a tooth extraction due to certain factors, which include:
- Excessive smoking or the use of related products is a major risk factor. Tobacco contains nicotine, which hampers the formation of the blood clot and delays the healing process by reducing blood supply to the affected site. Even if a clot develops, the act of deep inhalation when you suck on a cigarette can readily dislodge the protective covering over the lesion.
- People with dense jawbone are increasingly prone to a traumatic extraction and less blood supply, decreasing the chances of blood clot formation and timely healing. The jawbone tends to become progressively denser and has dwindling blood supply with advancing age, making people over 30 years of age with impacted third molars a high-risk category for a dry socket.
- Women have a greater tendency to develop a dry socket than men, which may be on account of certain hormonal factors. The use of oral contraceptives, estrogen replacement therapy, and the normal hormonal changes during menstruation can hamper the healing process and make women more susceptible to this problem.
- Uncontrolled blood sugar levels in people with diabetes increase the risk of a dry socket, as the excess blood sugar harbors more anaerobic bacteria in the bloodstream and thus in the socket also.
- People who have suffered from a dry socket complication in the past are more likely to experience it again.
- Having an ongoing or previous oral infection such as periodontal disease or pericoronitis at the extraction site can predispose one to a dry socket.
- The use of corticosteroids also contributes to the risk of developing a dry socket.
- If you fail to follow your dentist’s instructions regarding at-home care after an extraction, the wound will not heal in time and might even result in a dry socket. Similarly, the inability to practice good oral hygiene can increase your chances of developing this complication.
How to Identify a Dry Socket?
The common signs and symptoms of a dry socket include:
- Pulsating pain that presents a few days after the extraction.
- The pain tends to radiate from the socket to the ear, eye, neck, and temple on the same side of the face as the extraction.
- The jawbone may be visible in the socket and it is sensitive to touch.
- The soft tissues surrounding the socket may appear gray and swollen due to poor healing.
- Foul breath and a bad taste in the mouth due to the accumulation of food debris and bacteria in the socket.
- A partial or total absence of blood clot at the extraction site, making it appear like an empty-looking cavity.
- Swollen lymph nodes.
- Mild fever.
How is a Dry Socket Diagnosed?
Tooth extraction is accompanied by a certain degree of pain, which dissipates with time as the wound heals. If, however, you experience severe or worsening pain after the surgery, it is necessary to get your socket examined by a dentist or oral surgeon.
The dentist will take an account of your dental history as well as the symptoms that you may be experiencing. Next, your socket will be clinically examined by the doctor to check if there is a blood clot present or whether you have exposed bone, both of which are telltale signs of a dry socket.
The doctor may also suggest X-rays taken of your mouth and teeth to eliminate the possibility of other complications, such as a bone infection (osteomyelitis) or small remnant fragments of the bone or roots of the extracted tooth in the socket after surgery, which may be responsible for your pain.
Common Preliminary Treatment for a Dry Socket
The conventional treatment for a dry socket primarily hinges on pain management. Prophylactic antibiotic therapy that is prescribed by the dentist on the day of extraction in high-risk patients (uncontrolled diabetics and smokers) may reduce the risk of a dry socket.
- First, the site is gently irrigated with chlorhexidine or saline to remove any debris that could cause pain or infection.
- The dentist or oral surgeon will then pack the surgical site with a resorbable or nonresorbable analgesic-medicated dressing to cover the exposed bone.
- The doctor will determine if and how often you need to change the dressing depending upon the severity of your pain and symptoms. A nonresorbable dressing must be removed after 2-3 days.
- The dentist may also prescribe postoperative pain medication, including NSAIDs (e.g., ibuprofen) or a mixture of narcotic with acetaminophen and codeine (e.g., Tylenol® 3) in case of severe pain.
- The dentist will instruct you about the necessary self-care measures to promote healing once the dressing is removed. You will be expected to flush the socket at home, and the dentist will show you how.
- If there is no respite even after 72 hours of this preliminary treatment, your dentist may take radiographs to rule out the presence of a foreign body at the extraction site, bone destruction, or other possible etiologies.
Natural Treatment Options for Dry Socket
Here are some home remedies to help your dry socket heal better and faster.
1. Dab Clove Oil
Clove oil works by acting as a physical barrier between the exposed bone along with the exposed nerve endings and the oral environment. It helps relieve pain and decreases the number of visits to the emergency room.
- Dip a small cotton swab in clove oil.
- Place the swab in the socket for 1 minute.
- Remove the swab and rinse your mouth with warm water.
- Do this a few times throughout the day.
2. Apply Cold Compress
Pain in the jaw and cheek is common among those suffering from a dry socket. A cold compress is a tried-and-tested remedy that you can easily use at home to alleviate pain. The cold temperature has a numbing effect on the nerves, which reduces pain.
- Dip a thin towel in cold water and wring out the excess water.
- Place the cold towel on your face in the area where you are experiencing pain.
- Hold it there for about 15 minutes.
- Repeat this four to five times a day for 2 days.
- After 2 days, switch to warm compresses to help decrease the pain and swelling.
3. Rinse Your Mouth with Saline Water
Gently rinsing your mouth with warm salt water 24 hours after a tooth extraction is highly effective at preventing dry socket. The warmth of the solution helps reduce pain and swelling, and the salt helps prevent any infection.
A 2014 study published in the International Journal of Oral and Maxillofacial Surgery found that saline mouth rinses are beneficial in the prevention of alveolar osteitis after dental extractions. This study suggests using a saline mouth rinse two times daily.
- Mix a ½ teaspoon of table salt in 1 glass of warm water.
- Stir it well, so that the salt fully dissolves in the water.
- Use this solution to rinse your mouth gently, two to three times a day.
4. Apply Honey to the Affected Area
Honey has anti-inflammatory and analgesic properties. It can reduce the symptoms associated with a dry socket including inflammation, swelling, and fluid oozing from the wound.
A 2014 study found that honey dressings for dry socket resulted in a significant reduction in inflammation, edema, pain, and discomfort. It also showed evidence of preventing further infection.
A 2016 study reports that treatment of dry socket with honey dressing showed a significant decrease in the CRP levels from the pretreatment values, indicating fast recovery.
- Put raw honey on a sterile gauze.
- Place the gauze directly on the affected area.
- Change the gauze every few hours if you keep it on consistently.
5. Use Turmeric Paste to Relieve Pain
Turmeric is an analgesic and anti-inflammatory herb that can help deal with the pain of a dry socket. In addition to reducing pain, turmeric speeds up the healing process.
A 2018 study found that turmeric, when used in the management of alveolar osteitis, leads to a significant reduction in pain, inflammation, and discomfort.
- Mix a ½ teaspoon of turmeric powder and a little water or milk to form a paste. Use a cotton swab to apply the mixture on the area of the dry socket. Wait for 20 minutes, and then rinse your mouth with lukewarm water. Do this two to three times a day, as needed.
- Another option is to mix 1 teaspoon of turmeric powder in 1 glass of lukewarm water. Use this solution to rinse your mouth a few times daily until the pain is gone.
6. Chew Garlic Cloves
As garlic is an anti-inflammatory and a natural antibiotic, it is also effective at reducing pain in the gums and teeth due to a dry socket. It can also reduce the risk of infection.
- Place a fresh garlic clove in your mouth and crush it with your teeth. The pain will gradually subside as the juice of the garlic spreads inside your mouth. Spit out the clove after 5 minutes and rinse your mouth with warm water. Do this two to three times a day or as needed.
- Alternatively, make a paste of 2 fresh garlic cloves and a little salt using a mortar and pestle. Apply this paste to the extraction site for at least 30 minutes before rinsing it off with lukewarm water. Repeat as needed to relieve the pain.
7. Avoid Using Tobacco
Be it smoking cigarettes or chewing tobacco products, both may increase your risk of dry socket. The harmful chemicals and toxins in cigarettes and other forms of tobacco prevent healing. They may even contaminate the affected site and slow down the healing process.
Furthermore, the act of smoking or chewing tobacco may physically dislodge the blood clot.
A 2011 study published in the Open Dentistry Journal notes that smoking along with surgical trauma and single extractions is a predisposing factor in the occurrence of a dry socket.
Hence, it is recommended to stop smoking completely before and after your extraction. If needed, seek help from experts to quit permanently.
The following remedies are neither backed by scientific evidence nor are they reviewed by our health experts. Nonetheless, a number of general users have reported an improvement in their condition using these anecdotal remedies.
Eat Soft Foods and Stay Hydrated
After getting your wisdom tooth removed, it is essential to stay hydrated to reduce the risk of a dry socket. Lack of water in the body will halt cellular migration, decrease oxygenation of the blood, and delay healing of the wound.
Also, during the first 2 days after a dental extraction, you need to be careful about what you eat.
- Drink plain water at regular intervals throughout the day. Try to drink from the side of the mouth opposite from the extraction site as much as possible.
- Stick to soft foods such as smoothies, yogurt, applesauce, boiled potatoes, boiled eggs, clear soup, and pudding. As your wound starts healing, shift from soft to semisoft foods.
- You can also eat ice cream. Because it is cold, it will help reduce the pain.
- Do not eat anything that leaves residual food particles in your mouth for a few days.
- Avoid eating hard, chewy, crunchy, and spicy foods for a few days. These foods may pool in the socket and cause irritation or infection.
- While eating, chew on the other side of your mouth.
Try Tea Tree Oil
Tea tree oil is a natural antiseptic that can be used to heal conditions such as a dry socket. It can also prevent infection of the tooth and gums if impurities get stuck where the raw bone is exposed.
- Dip a cotton swab in water to moisten it.
- Put 1 or 2 drops of tea tree essential oil on it.
- Gently press the swab against the area of the dry socket.
- Wait for 5 minutes, and then rinse it off with lukewarm water.
- Do this two to three times daily as needed.
Most Common Sites of Occurrence
- Distal sites (e.g., third molars)
- More common in the mandible than in the maxilla
Despite being the most common complication associated with adult tooth extraction, dry socket is relatively rare. In a 2014 study published in the International Journal of Dentistry, 1182 patients with a total of 1362 teeth extracted during the 4-year period were analyzed, out of which 1.4% of teeth developed dry socket.
However, an increased incidence of dry socket is reported in cases where the mandibular impacted third molars or lower wisdom teeth are removed. Approximately 1% to 5% of all tooth extractions result in some degree of dry socket, but the chance of occurrence increases to 38% in mandibular third molar extractions.
How to Prevent a Dry Socket?
- Given that smoking makes one increasingly susceptible to developing a dry socket, its best to swear off it for 7 days after the extraction and 1 day before the extraction. Similarly, using any other tobacco product such as cigars or chewing tobacco is also prohibited before and after surgery. You can enlist the help of your doctor or dentist who can help you manage your addiction through nicotine patches and guide you towards complete cessation.
- Excessive estrogen in the body is known to come in the way of the blood-clotting process, which is a major concern when dealing with a condition like a dry socket. This is particularly true for women who are on oral contraceptives, as these pills generally contain high levels of the said hormone. Women who take birth control pills should ask their dentist to schedule the extraction on the day when they are getting the lowest dose of estrogen.
- Give your dentist or oral surgeon a complete rundown of all the prescription or over-the-counter medications or supplements that you are currently on to help him/her rule out any drug that might interfere with normal blood clotting.
- Once the tooth has been removed, it is important to practice proper oral hygiene as directed by the dentist or doctor. Avoid rinsing your mouth too much in the first few days after surgery. Even when you do rinse your mouth, try to do it gently.
- Only soft foods should be consumed in the days immediately after the surgery to avoid disturbing the wound.
- Carbonated drinks, alcohol, and hot beverages are completely off-limits, at least until the lesion has healed. Hot beverages are to be avoided for the first 24 hours after surgery to reduce oozing from the socket, following which warm foods/drinks are not a problem. Up your intake of cold, clear fluids instead in the days following the extraction.
- Try to rest as much as you can on the day of the surgery, and take things a bit slowly thereafter, until the wound has healed to a certain degree. It is absolutely imperative that you comply with your doctor’s recommendations about when to resume normal activities and how long to avoid rigorous exercise and sports that might cause the blood clot to fall out.
- Keep up with all the follow-up visits scheduled with your dentist to avoid any undue complications.
Moreover, you must follow your dentist’s post-extraction home care guidelines to the tee, which include the following:
- No drinking from a straw for the first 24 hours of the tooth extraction. Minimize drinking through a straw and spitting for the first few days.
Complications of a Dry Socket
Painful as it may be, a dry socket is a rather non-threatening condition that tends to resolve with proper treatment and home care. However, if left untreated, the problem can give way to more serious complications. These include:
- Nerve injury, which can cause temporary or permanent problems, such as tingling or numbness.
- Infection in the socket, which can progress into a chronic bone infection (osteomyelitis). If you experience symptoms such as high temperature, yellow or white discharge from the extraction site, and persistent pain and swelling, chances are the wound has been infected.
- Bleeding at the affected site.
When to See a Doctor
A certain degree of pain and discomfort is normal after tooth extraction. However, you should be able to manage the pain with a 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.
It is important to get treated for a dry socket to minimize pain and discomfort. You can help promote healing and reduce symptoms of a dry socket using home remedies. Also, follow the instructions given by your dentist.
- Always look for a dentist or oral surgeon with experience in tooth extractions.
- Do not increase the dosage of prescription medications or take over-the-counter painkillers without consulting your dentist.
- Visit your dentist as scheduled for dressing changes and other care measures. If your pain returns or worsens before your next appointment, feel free to call your dentist.
- Women taking oral contraceptives who need to have their wisdom teeth removed should schedule it during the last week of their monthly birth control pills. High estrogen levels due to oral contraceptives may increase the risk of a dry socket.
- Use an antibacterial mouthwash and toothpaste before and after the surgery.
- For a few days following a tooth extraction surgery, avoid the extraction site when brushing your teeth.
- For the first 24 hours after your surgery, it is important to avoid any type of rigorous exercise or other physical activities that might result in dislodging the blood clot from the socket.
- Maintain proper oral hygiene to help heal a dry socket.
- Do not touch the wound with your fingers or other objects.
- Try to sleep with your head elevated to reduce the pain.
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