Dry socket: Symptoms, risk factors, and treatment

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No one likes having a tooth extracted. Developing a complication such as dry socket after a tooth extraction may be some people's worst nightmare.

With proper care, dry socket can be avoided. If it does develop, it is only a temporary condition that will resolve quickly with appropriate treatment.

What is dry socket?

Dry socket may occur after tooth extraction.

Dry socket, also known as alveolar osteitis, is a painful complication that sometimes happens after having a tooth extracted.

After a tooth has been removed, a blood clot normally forms where the tooth was. The blood clot protects the underlying bone, tissues, and nerves as the site heals.

In cases of dry socket, the blood clot does not form or is dislodged, leaving the bone and nerves exposed.

Risk factors

Not everyone who has a tooth extracted will develop dry socket. Dentists are not certain what causes dry socket, but certain factors can increase the risk of developing it.

These factors include:

smoking

using chewing tobacco

use of oral contraceptives or estrogen replacement therapy

not following care instructions after the tooth extraction

poor oral hygiene

infections in the gum or teeth around the extraction site

having had dry socket in the past

using a drinking straw after the tooth extraction

Symptoms

The symptoms of dry socket are easy to identify. While no two cases of dry socket are the same, common symptoms include:

severe pain at the site of the extraction within 3 days

missing blood clot at the extraction site

bone visible at the extraction site

foul smell coming from the mouth

bad taste in the mouth

pain radiating from the tooth socket to the ear, eye, temple, or neck on the same side

While a certain amount of pain and discomfort is normal after having a tooth pulled, worsening pain or severe pain is not normal.

Anyone experiencing severe pain that does not improve after a tooth extraction should see their doctor or dentist to rule out dry socket or other complications.

Diagnosis

A dentist or oral surgeon will likely suspect dry socket for any case of severe pain following a tooth extraction, but will also examine the person for signs of any other complications.

If necessary, the person will be sent for X-rays to rule out a bone infection, or to see if fragments of the bone or roots of the extracted tooth remain and are causing the pain.

Treatment

Hands of a man and woman holding up a dental x-ray.

In some cases, a dental X-ray may be required to diagnose the cause of pain.

The treatment for dry socket consists primarily of pain management. A dentist will likely do the following to manage the symptoms:

flush the socket to remove any irritating debris

pack the socket with medicated dressings

prescribe pain medication

After the dentist or oral surgeon treats dry socket in the clinic, the person will need to continue with home care for several days.

Home treatment usually includes:

gently flushing the socket with a saline solution or medicated rinse for several days

continuing to take pain medication as needed

Anyone with dry socket should keep any follow-up appointments with their dentist or oral surgeon to ensure proper healing.

Management and lifestyle changes

While medical management of dry socket will help relieve pain and promote healing, self-care at home is equally as important.

A person may need to make lifestyle adjustments while treating dry socket.

These changes include:

stop using chewing tobacco

quit smoking

rinse mouth gently with warm water several times a day or as directed by a dentist

take care when brushing teeth around the affected area

drink plenty of clear liquids

avoid foods that will irritate the area

avoid carbonated beverages

avoid drinking through a straw

use hot and cold packs on the jaw or cheek as directed

Prevention

Quitting smoking can reduce the risk of developing dry socket.

Before surgery, a person having a tooth extraction can do the following things to reduce the risk of developing dry socket:

stop smoking or using other tobacco products, including chewing tobacco

research dentists and oral surgeons thoroughly to ensure they have sufficient experience in removing teeth

stop taking any medications that interfere with blood clotting as directed by a doctor or dentist

Immediately following the surgery, the oral surgeon will take several precautionary measures to prevent dry socket. These steps include:

packing the affected area with sterile gauze

prescribing antibacterial mouthwash or oral gel to use following the surgery

prescribing antibiotics if needed

At home, a person can take further steps to prevent dry socket after the surgery. These include:

resting following the surgery

avoiding sports and other activities that may knock the blood clot out of place

drinking lots of water after the surgery and avoiding carbonated, hot, and alcoholic drinks

eating only soft foods the day after the surgery

taking care when eating to avoid disturbing the wound until it has healed

avoiding any tobacco products for the first several days following surgery

practicing good oral hygiene as directed by the dentist or doctor

avoiding the area immediately around the healing wound when brushing teeth for the first day following surgery

Outlook

Dry socket, though very painful, usually improves soon after beginning treatment if a person follows the doctor's instructions.

However, a person being treated for dry socket should follow up with their doctor or dentist to ensure no other complications have developed.

After developing dry socket once, a person is at higher risk to develop it again following another tooth extraction.

Healthy