Dry Sockets - Causes / Risk factors.

This page discusses some of the factors that can make it more likely that you'll experience a dry socket. They include:

  1. Not following your dentist's post-operative instructions.
  2. A history of experiencing one after other tooth extractions.
  3. Having a difficult or surgical extraction.

The second page of this series explains how smoking, birth control pills, age and tooth location can also be risk factors.

Risk factors.

A) Not following your dentist's post-op instructions.

(We've listed this factor first because it is something that every dental patient has a great amount of control over.)

You can help to prevent a dry socket by helping a proper blood clot form.

It's a fact. People who follow their dentist's directions after having their tooth removed (especially those pertaining to blood clot formation and protection) will have fewer postoperative complications.

1) Clot formation.

Most dentists will advise their patients that:

  • After having their tooth pulled, they should place firm biting pressure on the gauze packing that has been placed over their extraction site for the next 30, and preferably, 60 minutes.

Doing so will help to insure that a proper blood clot has a chance to form in the tooth's socket.

2) Blood clot protection.

Once a clot has formed, a patient must be careful not to disrupt it.

  • During the first 24 hours after an extraction a dental patient should avoid vigorous rinsing, refrain from actions like sucking on a straw or drawing in on a cigarette, avoid alcohol and tobacco use in general, minimize physical stress and exercise, and avoid hot liquids such as coffee and soup (these may tend to dissolve the clot).

Your dentist should provide you with a comprehensive list of instructions. If they don't, ask. (We outline post-extraction instruction in general here.)

B) You have a history of experiencing dry sockets.

If you've been unfortunante enough to have had one before, you should consider yourself to be at somewhat elevated risk for experiencing a dry socket with other extractions.

Quite possibly the factors working against you in this situation are out of your control but don't overlook the obvious. Your previous experience may simply have been due to the fact that you didn't follow your dentist's instructions as closely as you should have.

Be smart. Whatever your circumstances, help to minimize your potential for having a dry socket this time around by strictly adhering to proper post-extraction protocol.

C) Difficult tooth extractions.

All dentists know that there's a correlation between the amount of tissue trauma created during the tooth extraction process and the potential the patient has for experiencing a dry socket.

For example, surgical tooth extractions generally place the patient at a tenfold greater risk for experiencing one.

Why does this relationship exist?

The general hypothesis used to explain this relationship is this. Bone tissue that's been traumatized during the extraction process releases compounds (tissue activators) that then diffuse into the socket's blood clot. These agents cause the blood clot to disintegrate, thus leading to the formation of a dry socket.

As a side note, it's also thought that other compounds (kinins) are released as a result of this trauma. Kinins stimulate nerve pain receptors, thus explaining why a dry socket can be so painful.

Your dentist can't always anticipate how much surgical trauma will take place.

The level of trauma created by a tooth extraction may be planned or unplanned.

a) "Planned" traumatic extractions.

With some tooth extractions, the dentist may know beforehand that it's likely that a fair amount of tissue trauma will take place.

Teeth that are more difficult to extract increase the risk of a dry socket.

Example #1 - Some impacted wisdom teeth (like tooth #1 in our graphic) are substantially encased in bone.

In this type of situation, the dentist will first need to make an incision through gum tissue and then remove that bone that lies over the impacted tooth, before they can even gain access to the tooth itself.

Example #2 - In comparison, when an erupted tooth that has a normal positioning is extracted (such as tooth #2 in our graphic), the dentist already has direct access to the tooth and therefore no gum or bone tissue manipulation (or at least much less) should be needed.

When compared to the first example, extracting this type of tooth should be relatively less traumatic.

b) "Unplanned" traumatic extractions.

A dentist may begin an extraction with the expectation that it will be an easy one, only to discover instead that it's going to be quite difficult. (This is one reason why having a less-experienced dentist remove your tooth may place you at greater risk for having a dry socket.)

With a relatively more-difficult extraction, the tissues surrounding the tooth will need to be manipulated to a greater extent, and over a longer time period. Both of these factors will result in the creation of comparatively more tissue trauma.

 All FYI's ► 

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