Dry Sockets: What causes dry sockets?

Dental research has yet to definitively determine the exact pathogenesis associated with dry socket formation. However, as we discussed previously, dry sockets result from a situation where the blood clot that normally forms in the tooth's socket after an extraction has not been properly retained.

Dental researchers have identified a number of factors that appear to be associated with an increase incidence of experiencing a dry socket and we have listed many of these factors below. We should bring to your attention however that the results of many studies are conflicting and therefore not all of the (potential) risk factors we list here are necessarily accepted by the dental community as a whole. Your dentist should be able to shed light on those factors that their experience has demonstrated to them are significant.

Dental patients who don't follow their dentist's postoperative instructions have a greater incidence of dry sockets.

We've listed this factor first because this is absolutely something you have control over. People who follow their dentist's instructions after having a tooth extracted, especially those regarding allowing a blood clot to form and then protecting it, will have fewer postoperative complications.

Typically a dentist will advise their patients that after a tooth extraction they should, at minimum, place firm biting pressure on the gauze packing that the dentist has placed over their extraction site for the next 30, and probably preferably, 60 minutes. Under normal circumstances this will provide opportunity for a blood clot to form in the tooth socket. Once a blood clot has formed, the patient must be diligent in their efforts not to disrupt it. This means that for the first 24 hours after the extraction the dental patient should avoid vigorous rinsing, refrain from actions like sucking on a straw or cigarette, avoid alcohol and tobacco use in general, minimize physical stress and exercise, and avoid hot liquids such as coffee or soup. Of course these instructions are generalized. Your dentist should provide you with those postoperative instructions that they feel are important for your specific situation. If they don't, just ask.

Dental patients who have experienced dry sockets with past tooth extractions are at greater risk for developing a dry socket with future tooth extractions.

If you have had a dry socket in association with a previous tooth extraction, you should consider yourself to be at somewhat greater risk for experiencing a dry socket again. Of course it's certainly possible that your previous dry socket experience might have been related to not having followed your dentist's postoperative instructions as closely as you should have. If so, your previous experience might be the motivation you need to follow your dentist's instructions more diligently this time.

Traumatic tooth extractions are more likely to result in dry socket formation.

All dentists know that there seems to be a correlation between the amount of tissue trauma created during the tooth extraction process and the potential for a dental patient to experience a dry socket. The general hypothesis is that the traumatized bone in the area of the extraction site releases compounds (tissue activators) that then diffuse into the blood clot that has formed in the tooth socket. These tissue activators cause the blood clot to disintegrate, thus leading to the delayed healing of the socket. It is also thought that some of the compounds released as a result of this blood clot disintegration are kinins, a type of compound known to stimulate pain receptors (hence causing much of the pain associated with dry sockets).

The amount of trauma associated with a tooth extraction might be planned or unplanned. With some wisdom tooth extractions the dentist will know beforehand that a fair amount of tissue trauma will be created. As an example, if an impacted wisdom tooth is entirely encased in the jaw's bone the dentist will need to both make an incision through gum tissue and remove that bone that lies over the impacted tooth before they can access the tooth itself. In comparison, when a dentist extracts a wisdom tooth that has already erupted into normal position in the mouth then the dentist already has direct access to the tooth and therefore no gum incision or bone removal is likely to be needed.

A dentist may approach an extraction hoping that its removal will be straight forward and simple but instead finds that the extraction is much more difficult than expected. (This is why having a less experienced dentist perform your tooth extraction may place you at greater potential for experiencing a dry socket.) With a difficult extraction the tissues surrounding the tooth will be manipulated to a greater degree. The amount of time over which the tissues are manipulated will be increased also. Both of these factors will result in relatively more collective trauma to the area where the extraction has taken place. Subsequently the patient will be at greater risk for developing a dry socket than if the tooth had come out more easily.