Dry Socket - A Post-Extraction Complication

What is a dry socket?

A dry socket is a painful dental condition that occurs after permanent tooth extraction in which the bone in the extraction socket is exposed due to the dislodgement or absence of the formation of the blood clot. A dry socket is also called alveolar osteitis or fibrinolytic osteitis.

How Prevalent Is Dry Socket?

A 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. Dry socket occurs in about two to five percent of dental extractions. A dry socket has more chances of occurrence in the mandibular teeth than in the maxillary teeth. Dry socket is also more common in molar teeth extractions, especially the third molars with about a 30 % incidence rate. The method of tooth extraction determines how likely a patient can experience a dry socket.

Why Does a Dry Socket Occur?

The socket is the area in the jaw bone where the tooth 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. Some of the reasons for a lack of formation or dislodgement of the blood clot include the following.

• If post-extraction instructions are not followed properly.

• While extracting, 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 straws 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).

• Traumatic tooth extraction.

• Remnants of the bones and root fragments are 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 a 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 and 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?

1. 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.

2. 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.

3. X-rays: 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 to 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 the dentist or an oral surgeon with time. But if the patient develops new or worsening pain in the days after tooth extraction, a dentist or oral surgeon should be consulted immediately.

What Are the Methods to Treat Dry Sockets?

• Antibiotic and analgesic medication.

• Oral antibiotics, particularly for individuals with 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 sockets with platelet-rich fibrin has great efficacy. PRF has reduced pain on the first day in all patients even with minimal analgesic intake. The pain 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 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 the day after the extraction.

• Avoid spitting, rinsing the mouth for at least 24 hours post-extraction, followed by gently rinsing the mouth.

• Brush 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 mouth with lukewarm saline water 3-4 times daily for at least 10 to 14 days.

• Follow home care post-extraction instructions properly.

• Maintain good oral hygiene.

• For patients taking contraceptive pills, surgery should be performed if the estrogen dose level is low.

What Are the Complications of Dry Sockets?

Dry socket, if not treated for a prolonged period may lead to:

• Pain.

• Infection.

• Absence from work.

• Interference with other dental procedures.

• Delayed healing in the socket.

• Progression to chronic bone infection (osteomyelitis).

Conclusion:

A dry socket is a common complication of extraction. With proper patient education and simple preventive measures, the chances of getting this complication can be drastically lowered. A dry socket heals completely without any complications in most cases if treated promptly and if proper oral hygiene is maintained.