What is a Dry Socket?
How is a Dry Socket Treated?
The medical or dental term for dry socket is aveolar osteitis. By definition, the alveolus is the tooth socket within the alveolar bone after the tooth has been removed, and osteitis means inflammation of the bone. So, it really means inflammation of the bony tooth socket. The tooth extraction usually has limited discomfort but a dry socket has intense pain. Fortunately, a limited number of extractions develop into the dry socket stage, only 2% to 5%, and also fortunately, the treatment with excellent results is quite easy.
Once a tooth is removed, a blood clot forms and closes over the bony socket and completely covers that bone as well as the nerve endings within the bone. Should the blood clot be lost for any reason, those nerve endings and the raw bone are then exposed to air and the oral environment and discomfort is created for the patient. Sometimes this socket may become infected which usually extends the treatment time. The loss of the blood clot occurs more often if the patient is physically active enough to increase their heart rate and the activity dislodges the blood clot. Other factors are smoking, excess extraction trauma, poor oral hygiene, vigorously rinsing, use of birth control pills, and use of a straw or carbonated drinks. The dentist will usually ask that you leave the covering guaze in place for a prescribed amount of time to allow an excellent blood clot to form. Vigorous rinsing is one of the worse things a patient can do. Very slowly rolling your head from side-to-side with warm salt water can provide a soothing affect. Never rinse vigorously.
Often the raw bone can be visible when looking in a mirror. The blood clot should remain in place for 4-5 days giving the socket time to begin healing a lay down a layer of granulation tissue to cover the raw bone. Should you lose the clot for whatever reason prior to that layer of healing, a dry socket most likely will be the result. It may easily be interpreted as an ear ache, when there is absolutely nothing wrong with the ear. But usually the symptoms are a very foul taste and breath, intense discomfort, and it usually occurs 2-3 days after the tooth was removed.
While over-the-counter NSAID’s may be helpful for inflammation, they are seldom enough to manage the discomfort. Even synthetic narcotics only mask the discomfort but do not address the actual cause. The treatment of choice is to utilize a medicated dental paste, sometimes on gauze, which contains a large amount of eugenol (oil of cloves), to place within the socket covering the bone and nerve endings with this soothing dressing. This dressing made need to be replaced every 2-3 days as necessary for a number of days. This provides the patient temporary relief, usually within 45 minutes, and lasts for a few days, or until the bone grows a minimal covering of tissue.
A dry socket will create a delay in healing which possibly could affect near-future treatment plans, so it behooves the patient to follow carefully the post-operative instructions prescribed by your dentist. Also, the lymph nodes or glands may become swollen and tender.
Most dry sockets occur 2-3 days after the removal of the tooth, and then the discomfort may last a week or so afterwards, so it behooves to get the dry socket checked and treated with the special paste as soon as possible. This will need to be changed 2-3 times. The patient should be very careful in that area when brushing their teeth, should not smoke, drink from a straw, drink carbonated drinks, rinse vigorously, eat hard foods, and avoid physical activity.
The lower third molar, often called the wisdom tooth, is the most likely candidate in the mouth to have a dry socket, and the pain radiates back towards the ears, and is often misinterpreted as an ear ache. Proper post-op care is the easiest way to avoid alveolar osteitis, or dry sockets.
Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentists