Dry Socket - A Post-Extraction Complication

Abstract

A dry socket, otherwise called alveolar osteitis, is a painful condition when the blood clot for an extraction socket gets dislodged. Read about the causes, symptoms, and treatment.

What Is a Dry Socket?

A dry socket is a painful dental condition that occurs after permanent tooth extraction. It can be caused due to improper care of the extraction socket, which leads to dislodgement of blood clots from the extraction socket.

How Prevalent Is Dry Socket?

Dry socket is the most common complication that occurs after tooth removal. A study revealed that about 40 people out of the 2,218 observed to experience some degree of dry socket. The method of tooth extraction determines how likely a patient can experience a dry socket. A dry socket is more likely to develop after your wisdom teeth are removed, but this is also very rare.

Why Does a Dry Socket Occur?

The socket is the area in the jaw bone where the tooth is used to be. When a tooth is removed from its socket, a blood clot is usually formed in the socket. This blood clot that is formed will protect the bone and the nerves. But if the blood clot is displaced or dissolves before the wound has healed or does not form properly, the bone and nerve may remain exposed and cause pain.

If post-extraction instructions are not followed properly.
While extraction, if there was no bleeding from the site.
Bone and tissue damage due to traumatic extraction.
If a small root piece has been left behind in the socket.
Drinking cool drinks using straw soon after extraction.
Sucking things such as ice cubes after extraction.
Touching the extraction site with tongue all the time.
Poor blood supply to the socket due to smoking.
Poor oral hygiene and hence bacterial contamination at the extraction site.
Bacteria: Any pre-existing infection of the oral cavity before tooth extraction (for example, gum disease) may lead to improper formation of the blood clot. Therefore, even if the blood clot is anyhow formed, the oral bacteria present in the mouth will cause it to break down.
Medical conditions such as diabetes (blood sugar levels not under control).
Related Topics
I got my dry sockets packed twice already, then why is the pain not going down?
Post Extraction Instructions for Children and Adults
Can I have dry socket even after placing bone graft in the extracted socket?
Bacterial contamination.
Traumatic tooth extraction.
Remnants of the bones and root fragments present in the wound after surgery.
Smoking: Nicotine is one of the most common chemicals that can cause severe adverse effects on oral health. These are abundantly present in cigarettes, and this chemical can reduce the blood supply in the oral cavity, which may hinder the formation of the blood clot at the tooth extraction site.
Abrupt Movements: Performing certain activities like aggressive rinsing and forceful spitting soon after extraction can dislodge the blood clot can lead to alveolar osteitis.
Biological Factors: Certain factors, like having a poor blood supply, hormonal imbalances, and a dense jawbone, can hinder the development of the blood clot and can increase the chances of acquiring a dry socket following tooth removal.

What Are the Risk Factors Associated With Dry Sockets?

Smoking.
Poor oral hygiene.
History of dry socket.
Having wisdom teeth pulled.
Use of birth control pills.

What Are the Symptoms of Dry Socket?

Throbbing pain at the extraction site.
Pain radiates from the extraction site to the ear, temple region, eyes, neck, and adjacent tooth.
Foul smell or bad breath from the mouth due to food lodgement.
Unpleasant smell.
Bone visible in the socket.
Bad taste in the mouth.
Irritation while having food.
Lymph node enlargement around jaw and neck.
Slight fever.
The blood clot is totally or partially dislodged at the extraction site.

How to Diagnose Dry Sockets?

Worsening Pain: Severe pain following the extraction is a sign of a dry socket. It is usually felt on the same side as the tooth extraction site. The pain may spread from the extraction site to the ear, eye, temple region, or neck. Therefore, diagnosis is usually symptomatic. This pain may develop within three days of tooth extraction but can occur at any time.
Physical Examination: The dentist will also examine the oral cavity to check if there is any blood clot in the tooth socket or an exposed bone.
X-ray: They are usually done to rule out other conditions like bone infections, the presence of small bone fragments embedded in the wound, or osteomyelitis following tooth removal.

When Should You Visit a Doctor for a Dry Socket?

Some degree of pain and discomfort can usually happen after tooth extraction, and it should be relieved with the pain reliever prescribed by your dentist or an oral surgeon with time. But if you develop new or worsening pain in the days after your tooth extraction, consult your dentist or oral surgeon immediately.

What Are the Methods to Treat Dry Socket?

Antibiotic and analgesic medication.
Oral antibiotics, particularly if you have a compromised immune system.
Irrigation of the socket with saline.
Giving an analgesic medicament pack in the socket.
Antibacterial mouthwashes or gels.
Antiseptic solutions are applied to the wound.

Platelet Rich Fibrin (PRF):

Treating dry socket with platelet rich fibrin has great efficacy. PRF has reduced pain on the first day in all patients even with minimal analgesic intake. Pain was drastically decreased during follow-up on the first, second, third, and seventh days. No patients have had allergic reactions to PRF, because it is derived from the patient's own blood. It also showed good wound healing.

Healing Time Required for a Dry Socket:

The average healing time for a dry socket is about seven days.

How to Prevent Dry Socket After Tooth Extraction?

Avoid smoking cigarettes or any tobacco products on the day of extraction or a day after the extraction.
Avoid spitting, rinsing the mouth for at least 24 hours post-extraction, followed by gently rinsing the mouth.
Brush your teeth gently around the affected area.
Avoid sticky food as it can lead to dislodgement of the blood clot.
Drink lots of water.
From the second day after post-extraction, rinse your mouth with lukewarm saline water 3-4 times daily for at least 10-14 days.
Follow home care post-extraction instructions properly.
Maintain good oral hygiene.
For patients taking contraceptive pills, the surgery should be performed if the estrogen dose level is low.