Dry Sockets -

What are they? | Signs and symptoms. | How long do they last? | Healing time frame. | Frequency of occurrence.

A tooth socket, post-extraction.

A tooth socket after extraction.

What is a dry socket? (alveolar osteitis)

This condition is a common post-operative complication associated with having a tooth extracted.

It involves a situation where an extraction site's healing process is interrupted (delayed) due to the loss of the blood clot that normally occupies the empty tooth socket (the dark outline in our picture).

a) Signs and Symptoms

The predominate signs of a dry socket include: 1) Throbbing pain and 2) A foul odor and taste coming from the extraction site. Characteristically, these symptoms do not appear until a few days after the tooth was removed.

Learn more about signs and symptoms ...

b) 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, there are some home remedy methods that can be used to provide pain relief.

c) Risk Factors / Prevention

Research and clinical observation have identified a number of factors that correlate with a patient's risk for developing a dry socket. Understanding these factors can be useful in preventing their formation.

Learn more about risk factors and prevention ...

Tooth socket, immediately after extraction.

The blood clots that form in tooth sockets are an important part of the healing process.

A) Why do dry sockets form?

The exact pathogenesis of dry socket formation (more formally termed alveolar osteitis) is not fully understood. But it is known that the following factors are involved.

1) The blood clot is lost.

A course of events takes place where the blood clot that normally forms in the tooth's socket immediately after an extraction isn't properly retained.

It either: a) Disintegrates (by way of a process termed fibrinolysis) or else b) Is dislodged (by an activity such as vigorous swishing or rinsing).

2) Healing is delayed.

The lost blood clot would have played an important role in the healing process of the extraction site. Due to its loss, the progress of the socket's healing is interrupted (delayed).

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

If the blood clot is lost, the bony socket is exposed.

3) Bone becomes exposed.

The clot would have also covered over and protected the bony walls of the empty socket as it heals. Now that it's been lost, these walls are exposed, resulting in pain and sensitivity.

B) The signs and symptoms of dry sockets.

In the case of most tooth extractions, the patient will notice some degree of discomfort from their extraction site on the day their tooth is removed (hopefully this will be just minor). And then, with each day that passes, the level of discomfort noticed gradually tapers off and finally disappears.

What happens when a dry socket develops?

With this scenario:

  • The patient will find that the discomfort they've initially experienced gradually fades for the first few days (just like with normal healing).
  • But then, usually between days 2 and 4 after their extraction, they notice that their level of pain actually starts to intensify.
  • While the exact timing of a person's symptoms will vary, 95% of dry socket cases are noticed within the first week of their surgery.

Details -

1) Pain.

  • As stated above, the discomfort from the extraction site typically starts to intensify 2 to 4 days after the tooth was initially removed.

    (This detail is an important clue to your dentist that you do in fact have a dry socket.)

  • It's frequently described as a dull throbbing pain. It can be moderate to severe in intensity.
  • The discomfort can be constant or intermittent (it's frequency can vary).
  • The pain may remain localized in the area of the extraction site. Or it may radiate to the patient's ear (earache) or eye (on the same side of their face). Headaches are frequently reported too.

2) Appearance.

  • The tooth socket will appear to be empty (not filled with a blood clot or granulation tissue like with normal healing).
  • 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.

  • It's characteristic that the patient notices 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, swelling or obvious signs of infection.

C) How long do dry sockets last?

Healing time frame.

Once the conditions of a dry socket have set in, it usually takes about 7 to 10 days for the healing process to get geared up again and create new granulation tissue that then starts to cover over and protect the socket's exposed bone. (Noroozi 2009)

How long will the pain last?

On average, the discomfort from a dry socket usually runs for 4 to 8 days. (That means, you'll likely need attention from your dentist to stay comfortable.)

At times the pain may be quite severe. Towards the end, it will just gradually taper off and disappear.

How long is the healing process delayed?

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.

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D) How often do dry sockets occur?

Lower wisdom tooth extractions have a higher incidence of dry socket formation.
  • For routine tooth extractions, the chances of experiencing a dry socket run on the order of 1 to 4%.
  • They're much more likely to occur with lower tooth extractions than upper ones.
  • 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 45% of the cases involving the removal of mandibular (lower) impacted wisdom teeth (like the tooth show in our illustration).
  • For all to extractions collectively, a dry socket is the most common post-surgical complication.

(Cardoso 2010)

Our next page discusses dry socket risk factors and prevention. ▶


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