What is dry socket?
Dry socket is a common and painful complication after a tooth extraction. This article explains why it happens, what the signs are, who is more at risk, what helps prevent it, and when to call your surgeon.
After a tooth is pulled, most people feel less pain each day. If a few days later the pain starts again and is worse than before, it may be dry socket. The name sounds frightening and the pain really is unpleasant, but it helps to know what it actually means and what can lower the risk.
What is dry socket?
The NHS writes that dry socket is a painful condition in which the blood clot does not form properly in the socket, or is dislodged before healing is complete. MyOMS says that in this state the bone and nerve in the socket are left uncovered. The medical name is alveolar osteitis.
A review in the J Oral Maxillofac Surg wrote that its mechanism and causes are multiple, and that evidence-based treatment and prevention have advanced as these mechanisms are better understood. In other words, it does not have a single cause.
How common is it?
For wisdom tooth surgery, MyOMS says it affects about four percent of extractions and is more common in the lower jaw. Figures differ between studies, so treat this number as approximate.
Who is more at risk?
MyOMS lists these factors: smoking, vigorous mouth rinsing, drinking through a straw, food getting trapped, infection at the site, and older age. The NHS also names smoking. Cleveland Clinic gives straws, smoking and vaping, spitting and vigorous rinsing, and touching the site with the tongue as examples. Anything that dislodges the clot raises the risk.
What are the signs?
MyOMS says:
- Severe pain that begins within a few days after the extraction and is stronger than the usual pain after surgery
- Pain that spreads from the socket toward the eye, ear, neck or temple on the same side of the face
- Bone visible in the socket
- Bad breath or a bad taste
Cleveland Clinic writes that the third day is usually the hardest day of pain after an extraction. If, after that, the pain gets worse instead of easing, let your surgeon know. A whitish appearance over the healing site is normal on its own, but tell your surgeon if it comes with pain that keeps growing or if you think you can see bone in the socket.
How is it different from an infection?
MyOMS treats dry socket and infection as two separate complications. MyOMS regards fever, increasing pain, spreading swelling or redness, pus, and a lasting bad taste as signs of infection. If you have any of these, tell your surgeon the same day. Warning signs.
What lowers the risk?
MyOMS gives this list:
- Follow the after-surgery instructions.
- Do not smoke before the surgery or during the healing period.
- Review your medicines with the surgeon so that, if you take a medicine that affects clotting, he or she knows.
- Do not rinse hard in the first 24 hours, and do not brush close to the site.
- Do not use a straw for the first 24 to 48 hours.
For more detail, see the after-surgery care guide and the food guide.
If you think you have dry socket
MyOMS says to contact your surgeon early so the pain can be managed. The surgeon can look at the area and choose how to treat it. If you also have fever or increasing swelling, tell the surgeon the same day. Difficulty swallowing or breathing is an emergency: call 115.
What questions should you ask?
- Is my risk of dry socket higher, for example because of smoking or medicines?
- For exactly how many hours is a straw off limits, and when can I start rinsing?
- If the pain rises again after a few days, whom should I contact, and on what number?