Dry Socket

Dry socket (alveolar osteitis) is a condition that occurs when a blood clot at the site of a tooth extraction becomes dislodged, exposing underlying bone and causing increasing pain. It's the most common complication following tooth extraction, but with meticulous postoperative care and avoidance of risk factors, dry socket can sometimes be prevented. When it does occur, treatment usually provides immediate relief.

Signs and Symptoms

Dry socket has several tell-tale signs and symptoms, including:

• Partial or total loss of the blood clot at the extraction site, which you may notice as an empty-looking (dry) socket
• Pain that increases between two and three days after tooth extraction and that typically becomes severe and unrelenting
• Pain that radiates from the socket to the side of your face
• Unpleasant taste in your mouth

Causes

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 socket. The clot provides the foundation for the growth of new 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. However, the biological process of a dry socket remains the subject of study. Some researchers believe 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 percent to 5 percent of all tooth extractions, but it's much more common after extraction of wisdom teeth and impacted wisdom teeth in particular.

Risk Factors

Certain factors can increase your risk of developing a dry socket after a tooth extraction. These include:

• Smoking and tobacco use. Chemicals in cigarettes or other forms of tobacco may contaminate the wound site. In addition, the act of sucking on a cigarette may physically dislodge the blood clot prematurely.
• Taking oral contraceptives. High levels of estrogen can greatly increase the risk of dry socket by dissolving the blood clot.
• Not following post-extraction guidelines. If after oral surgery you don't follow instructions, your risk of dry socket increases.
• You've had dry socket in the past. Having had a dry socket once means you're more likely to get it again.
• Tooth or gum infection. Current or previous infections around the tooth to be extracted increase the risk of a dry socket.

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 Mr. Erasmus right away so that you can get properly assessed and treated.

Screening and Diagnosis

In order to determine if you have dry socket, or another condition, Mr. Erasmus will ask about your symptoms and examine your mouth. He will check to see if you have a blood clot in the socket and whether you have exposed bone.

Complications

Dry socket can cause a variety of complications. Pain, of course, is the major complication. Because of the pain and repeat trips to see Mr. Erasmus for treatment, you may miss time at work or school.
Dry socket also delays the healing process after a tooth extraction. Gum tissue normally takes three to four weeks to heal, while bone can take up to four months to heal, and dry socket can delay this process.
Dry socket can also interfere with the placement of dental implants or with other dental procedures, and these may need to be rescheduled until you've healed completely.

Treatment

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

• Medicated dressings. This is the main way to treat dry socket. Mr. Erasmus generally packs the socket with medicated dressings. You may need to have the dressings changed several times in the following days. 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. Mr. Erasmus will flush 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 Mr. Erasmus 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 or mouthwash into the socket. You may need to continue to do this daily for up to three 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

Steps that both you and Mr. Erasmus take may go a long way in helping prevent dry socket or to reduce your risk.

What Mr. Erasmus 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 believe that preventive treatment with antibiotics isn't appropriate because it may contribute to problems such as antibiotic-resistant bacteria.
Talk to Mr. Erasmus about using these medications or precautions when you have tooth extraction surgery:

• Antibacterial mouthwashes immediately before and after surgery
• Antibiotics

What you can do before tooth extraction surgery

• 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 Mr. Erasmus 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.
• Gently brush teeth adjacent to the extraction site.
• Don't rinse your mouth vigorously or excessively.
• Resist the desire 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.

Self-Care

Dry socket rarely results in infection or serious complications. But getting the pain under control is a top priority. You can help promote healing and reduce symptoms during treatment of dry socket by:

• Holding cold packs to the outside of your face to help decrease pain and swelling
• Taking pain medications as prescribed
• Not smoking or using tobacco products
• Drinking plenty of clear liquids to remain hydrated and to prevent nausea that may be associated with some pain medications
• Rinsing your mouth gently with warm salt water several times a day
• Brushing your teeth gently around the dry socket area
• Keeping scheduled appointments with Mr. Erasmus for dressing changes and other care
• Calling for a sooner appointment if your pain returns or worsens before your next scheduled appointment