Dry Sockets

Dry sockets can on rare occasion result after a tooth is extracted. The blood clot healing in the extraction socket is unexpectedly dislodged leaving a bare painful open area.

The technical term for this condition is acute alveolar osteitis. Generally the pain involved with a dry socket is intense, throbbing and unceasing. This pain is often worse than the pain associated with the tooth prior to extraction. A foul odor may be associated with this condition. Pain medication often does a sub par job of relieving the discomfort associated with this situation.

What causes dry sockets to occur?

Difficult surgical extractions leave patients more susceptable to this problem. Any action that forms suction within the mouth can raise risk level and should be avoided. Actions that should be avoided include but are not limited to: smoking, sucking through through a straw, spitting, vigorous mouth rinsing, sneezing, or coughing. Eating should be very light within the first 24 hours after tooth extraction to protect the affected area.

In addition to the sucking action smokers use with cigarettes, smoking is thought to decrease the amount of oxygen available to the healing tissue, thereby, increase the risk of having a dry socket. Avoid smoking for at least the first 48 hours post extraction.

Alveolar osteitis seem to occur in 5-10% of extractions. Frequency is greater with teeth of the lower jaw(mandible) and in cases involving wisdom teeth.

Women are at greater risk than men for this condition due to hormone fluctuations associated with the menstrual cycle. Women taking oral contraceptives are at even greater risk.

Prevention of Acute Alveolar Osteitis.

Routine dental exams, cleanings and xrays. This regimen will hopefully allow problems to be when they are small and easily treatable. Mainaining good oral hygiene during the healing period. Women should schedule extractions during the last week of their menstrual cycles (days 23 through 28). This is when estrogen levels are lowest. Commence with a light, warm salt water rinse beginning 24 hours post tooth extraction. Avoid drinking through a straw, smoking or spitting for at least the first 48 hours post tooth extraction. Avoid alcohol for 48 hours as it can change bleeding patterns after an extraction. Avoid hard foods for 24 hours then carefully chew on the opposite side for an additional 24 hours to minimize injury to the extraction site. Carefully follow the post operative instructions given by the dentist and/or his staff.

Treatment for a dry socket.

Follow all post operative instruction very closely to avoid getting one. The pain associated with this condition will cause many regrets for patients that deviate from the healing protocol. The dentist may debride the socket of debris which also will cause new blood flow and clotting. Dental staff may place eugenol based iodoform gauze packing material into the socket to ease discomfort while healing commences. The site may need packed daily for up to 7-10 days although most need on 3-5 placements of analgesic packing. Take oral pain relievers. These have varied effectiveness for each individual. Even though the oral cavity is in discomfort, maintaining a proper diet is important to facilitate socket healing.
Dry Sockets can be a very uncomfortable and unforgettable experience. No patient wants to add this situation to their list of dental experiences. They are best avoided through prevention by receiving regular dental checkups, cleanings and xrays. By following this regimen, problems are usually found when small and extraction of teeth hopefully can be avoided. When tooth removal can not be avoided, closely follow the instructions provided by the dental staff.