Dry socket (alveolar osteitis) is a temporary dental condition that sometimes occurs after extraction of a permanent adult tooth. Dry socket occurs when the blood clot at the site of the tooth extraction is dislodged, exposing underlying bone and nerves and causing increasing pain. Dry socket is the most common complication following tooth extractions, such as the removal of impacted wisdom teeth. When it occurs, dry socket usually strikes one to three days after a tooth extraction. The most common hallmark of dry socket is significant pain.

Complications of Dry Socket

Complications and problems that dry socket may cause or be associated with include:

• Pain
• Absence from work or school
• Delayed healing after tooth extraction
• Infection
• Interference with other needed dental procedures

Causes of Dry Socket

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 provides the foundation for the growth of new tissue and bone. In some cases, though, the clot doesn't form properly or is physically dislodged before complete healing. With the clot gone, bone and nerves in the socket are exposed to air, fluids and food. This can cause intense pain, not only in the socket but also along the nerves radiating to the ear and eye on the same side of your face. But the precise cause of dry socket remains the subject of study. Some researchers suspect that several issues may be at play, including:

• Bacterial contamination of the socket
• Difficult or traumatic tooth extraction surgery
• Roots or bone fragments remaining in the wound after surgery

Dry socket occurs in about 3 to 5 percent of all tooth extractions. It's much more common after extraction of wisdom teeth and impacted wisdom teeth in particular.

Signs & Symptoms of Dry Socket

Signs and symptoms of dry socket can 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 or eye on the same side of your face
• Bad breath or a foul odor coming from your mouth
• Unpleasant taste in your mouth
• Swollen lymph nodes around your jaw or neck

Diagnosis of Dry Socket

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 your other symptoms and examine your mouth. He or she checks to see if you have a blood clot in your tooth socket and whether you have exposed bone. You may also need to have X-rays taken of your mouth and teeth to rule out other conditions.

Treatments of Dry Socket

Treatment of dry socket is mainly geared toward reducing its symptoms, particularly pain. Dry socket treatment includes:

• Medicated dressings. This is the main way to treat dry socket. Your dentist or oral surgeon generally packs the socket with medicated dressings. 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.
• 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 contributes to pain or infection.
• 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 your 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, mouthwash or a prescription rinse into the socket. You may need to continue to do this daily for three or four weeks.

Once treatment is started, you may begin to feel some relief in just a few hours. Pain and other symptoms should continue to improve over the next few days. Complete healing typically goes smoothly and generally takes about 10 to 14 days.

Prevention of Dry Socket

Steps that both you and your dentist or oral surgeon take may go a long way in helping prevent dry socket or helping reduce your risk.

What your dentist or oral surgeon can do

Although dry socket has been recognized since the late 1800s, medical science has yet to develop a surefire way to prevent it. Some research suggests that treatment with certain medications such as antibiotics before or after oral surgery may reduce your risk of dry socket. However, this practice remains controversial, and some say that preventive treatment with antibiotics isn't appropriate because it may contribute to problems such as antibiotic-resistant bacteria.

Talk to your dentist and oral surgeon about using these medications or precautions when you have tooth extraction surgery:

• Antibacterial mouthwashes or gels immediately before and after surgery
• Oral antibiotics
• Antiseptic solutions applied to the wound
• Medicated dressings applied after surgery

What you can do before tooth extraction surgery

• Seek out a dentist or oral surgeon with experience in tooth extractions.
• If you take oral contraceptives, try to time your extraction to 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.
• 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 tooth extraction surgery

• Avoid spitting for the first few days.
• Don't drink with a straw for the first few days.
• Don't drink carbonated beverages for two to three days after your tooth extraction.
• Gently brush teeth adjacent to the extraction site.
• Don't rinse your mouth vigorously or excessively.
• Resist the urge to touch the extraction site with your fingers or tongue.
• Eat soft foods and foods that don't have residuals, which are particles that may lodge in your socket. Avoid pasta, popcorn and peanuts, for example. Instead, eat mashed potatoes, pudding, or clear or cream soups.

When to seek Medical Advice

When you've had a tooth extracted, any discomfort you experience normally gets better with each passing day. If you develop new or worsening pain in the days after your tooth extraction, don't try to tough it out. Contact your dentist or oral surgeon right away so that you can get properly evaluated and treated.