Dry Sockets (Alveolar Osteitis): What are they? / Symptoms and treatments.

Dry sockets (termed alveolar osteitis by dentists and oral surgeons) are a fairly commonplace complication associated with having a tooth extracted.

While the exact details of dry socket formation have yet to be thoroughly explained, their formation is associated with a situation where the blood clot normally expected to occupy an extraction site, and subsequently initiate its healing, is instead lost. As a result, the socket's healing process is interrupted and delayed.

The symptoms of a dry socket include throbbing pain and a foul odor and taste coming from the extraction site. These symptoms characteristically do not appear until some days after the tooth has been removed.

Clinical experience and dental research have identified a number of risk factors that appear to correlate with a patient's potential for developing a dry socket.

In regard to pain relief, non-prescription, or even prescription, analgesics (pain pills) are seldom effective by themselves. In most cases, the most effective treatment involves a dentist inserting a medicated dressing, daily if needed, directly into the dry socket.

What are dry sockets?

A dry socket, more formally referred to as alveolar osteitis by dentists, is a fairly common complication associated with tooth extractions.

• The formation of a dry socket involves a scenario where the blood clot that forms in the tooth socket's after the extraction isn't properly retained (either it disintegrates by way of fibrinolysis or is dislodged).
• Since this blood clot is an important factor in protecting the boney tooth socket and initiating the healing process, the healing of the extraction site is interrupted (becomes delayed).

What are the signs and symptoms of a dry socket?

A) The usual symptoms a person has after a tooth extraction.

With most tooth extractions, a dental patient will notice some level of discomfort (no matter how minor) at their extraction site on the day their tooth is removed. And then, with each day that passes, the discomfort becomes less and less noticeable as the healing process progresses.

B) What happens when a dry socket forms.

In those cases where a dry socket forms, the patient typically notices that their level of discomfort does progressively diminish for the first few days but then, between 2 and 5 days after their extraction, the pain from the extraction site begins to intensify.

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

C) Dry socket signs and symptoms ...

1) Pain.

• Discomfort from the healing extraction site starts to intensify 2 to 5 days after the extraction was performed.
• The pain can be moderate to severe in intensity and often has a throbbing component.
• The pain can be just localized or 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 reddend and inflammed.

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.
• Fever is typically not associated with the presence of a dry socket.

How long do dry sockets last?

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

This doesn't necessarily mean that the pain from your dry socket 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.

How often do dry sockets occur?

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

What causes dry sockets?

The exact pathogenesis of dry socket formation has yet to be determined. There are, however, several contributing factors that seem to place the dental patient at greater risk for experiencing a dry socket.