Dry Sockets (alveolar osteitis).

a) What are they? - A dry socket is a post-operative complication that delays the normal healing process that takes place after a tooth extraction.

Formation involves a situation where the blood clot that should occupy the extraction site is instead lost.

b) Signs and symptoms - The signs of a dry socket include throbbing pain and a foul odor and taste coming from the extraction site. These symptoms typically do not appear until several days after the tooth has been removed.

c) Treatment - Pain medications on their own, even prescription ones, are seldom effective in managing the discomfort associated with a dry socket. The most effective treatment is one where the patient's dentist inserts a medicated dressing (daily if needed) directly in the wound. In a pinch, this home remedy can be used to provide relief.

d) Risk factors / Prevention - Dental research and clinical observation have identified a number of risk factors that correlate with the potential for developing a dry socket. Identification of these factors can be useful in preventing their formation.

If an extraction site's blood clot is lost, a dry socket will form.

A) Why they form.

While the exact pathogenesis of dry socket formation (more formally "alveolar osteitis") has yet to be determined, the following factors are involved.

1) The blood clot is lost.

Formation involves a scenario where the blood clot that forms in the tooth's socket immediately after its removal isn't properly retained. Either it disintegrates (by way of a process termed fibrinolysis) or else is dislodged (by an activity such as vigorous rinsing).

2) Healing is delayed.

Since this blood clot is an important factor in initiating the healing process, and protecting the boney tooth socket as it takes place, the progress of the extraction site's healing is interrupted and subsequently delayed.

B) Signs and symptoms.

With most tooth extractions, the patient will notice some degree of discomfort at their extraction site on the day their tooth is removed (hopefully this will be just minor). And then, with each day that passes after that, the level of discomfort should gradually subside.

What happens with a dry socket?

In those cases where a dry socket forms, the patient will typically notice that their level of discomfort has progressively diminished for the first few days (just like with normal healing). But then, between days 2 and 5 after their extraction, their pain has begun to intensify.

While the initial timing of symptoms can vary, 95% of dry socket cases are noticed within the first week.

1) Pain.

  • Discomfort from the extraction site starts to intensify 2 to 5 days after the tooth was initially removed.
  • The pain can be moderate to severe in intensity. It often has a throbbing component.
  • The pain may just be local. In some cases, it may radiate from the extraction site to the patient's ear or eye (on the same side of their face).

2) Appearance.

  • The tooth socket will appear to be empty (not filled in with a blood clot or granulation tissue).
  • When looking down into the socket (if possible) exposed bone is visible. It may be partially covered with a grayish-yellow layer of necrotic tissue or accumulated debris.
  • The gum tissue around the extraction site is typically reddened and inflamed.

3) Other signs and symptoms.

  • The patient may notice a foul odor or taste coming from their extraction site.
  • Lymph nodes in the jaw or neck may be tender and enlarged.
  • Dry sockets are typically not associated with the presence of a fever.

C) How long do they last?

Once a dry socket has developed, it takes about 7 to 10 days for new granulation tissue (a sign of renewed healing) to form and cover over the socket's exposed bone.

Lower wisdom tooth extractions have a higher incidence of dry socket formation.

This doesn't necessarily mean that your pain will last for this entire time period, and hopefully it won't. But, in general, you can expect that the overall healing time frame of your extraction site will be delayed on the order of a week or longer.

D) How often do dry sockets occur?

  • For routine tooth extractions, the incidence rate for experiencing a dry socket runs on the order of .5 to 5%.
  • Extractions involving lower teeth, especially molars, are statistically more likely to result in one forming.
  • In general, surgical extractions (like the procedure used to remove impacted teeth) have a tenfold higher incidence rate.
  • Dry sockets may occur in as many as 37% of the cases involving the extraction of mandibular (lower) impacted wisdom teeth (like the tooth show in our illustration).

Our next page discusses factors that generally raise a person's risk.

 All FYI's ► 

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Topic- Dry Sockets.
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