“Dry Socket” is the name for a painful inflammatory process involving the bone of a tooth socket, usually three to four days after a tooth extraction. The technical name for such a condition is Acute Alveolar Osteitis. The word acute means painful, the word alveolar refers to the spongy bone surrounding the tooth root, and the word osteitis means “bone inflammation.”
The pain, which is associated with dry socket, is caused by loss of the blood clot in the extraction socket. When a tooth is extracted, the bleeding that ensues forms a clot, creating a protective barrier between the bone and the oral environment. The trauma of the extraction and/or an infection within the tooth socket creates a breakdown or “lysis” of the protective clot, thus exposing the nerve endings within the boney socket, causing marked pain. The most common signs and symptoms of dry socket are:
- Dull ache or throbbing pain in the area of the extraction
- Gum swelling around the extraction socket
- Foul breath or bad taste emanating from the socket
- Swollen lymph nodes, especially along the lower border of the jaw
All tooth extractions do not develop into dry socket, however, there are certain risk factors that increase the chance of it happening:
- Lower second and third molars have a higher occurrence of dry socket
- Smoking or any other sucking action within the mouth
- Age (adults are more at risk than kids and teens)
- Poor oral hygiene
- Immunocompromised individuals, such as diabetics
Why is it called “dry socket”, as opposed to “wet socket” or some other name? According to some, this is because the socket has a dry appearance once the blood clot is lost and debris is washed away. Another explanation is there is inadequate blood supply to form a good protective blood clot within the socket, thus we refer to this condition as a dry socket due to the lack of blood flow.
The appropriate treatment of dry socket depends on the severity of the pain the patient is experiencing. For mild to moderate pain, NSAID drugs, such as Aspirin or Tylenol, may be enough. Sometimes the doctor may elect to prescribe narcotic pain medication if the pain is moderate to severe. Antibiotics are often prescribed to treat dry socket, however, it’s important to understand they are usually prescribed to prevent an infection from occurring within the extraction socket, not to treat an active infection. Remember, the pain from dry socket is normally caused by stimulation of exposed nerve endings, not infected tissue. Sometimes the doctor may anesthetize the painful area, rinse it clean of debris, and place a medicated dressing called dry socket paste. This paste—which has healing and anesthetic qualities—is wiped into a small piece of sterile gauze, then placed into the socket. The gauze may be removed after a day or two or replaced if the pain has not subsided. Generally, most dry socket symptoms are gone after about a week of healing.