Dry Sockets -

What are they? | Signs and symptoms. | Pictures. | 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

While specifics can vary, the predominant characteristics of a dry socket are:

  1. Throbbing pain.
  2. A foul odor and taste coming from the extraction site.
  3. A timing where these events do not first appear until at least a few days after the tooth was removed.

More details 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 clot that forms immediately after an extraction is an important part of the healing process.

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.


The signs and symptoms of dry sockets.

To be able to know when a dry socket is forming, you first have to know what's normal for post-extraction healing.

a) What's the norm? What usually happens after a tooth is pulled?
  • In most cases a patient will notice some degree of pain from their extraction site on the day of their surgery. (Hopefully this will just be minor.)
  • And then with each day that follows, the level of discomfort they notice gradually tapers off until it finally disappears.

b) What happens when a dry socket starts to form?

With this scenario:

  • The patient will first find that their initial discomfort does gradually fade for the first few days following their extraction. (Just like with normal healing.)
  • But then, usually between days 2 and 4 after their procedure, their level of pain then begins to intensify.

While the exact timing of a person's symptoms will vary, 95% of dry socket cases are noticed within the first week after the patient's surgery.

More details about the characteristics dry sockets -

1) Pain.

As just stated, the discomfort from the extraction site usually starts to intensify 2 to 4 days after the tooth was initially removed. (This detail alone is an important clue to your dentist that you do in fact have a dry socket.) Other characteristics are:

  • The discomfort is frequently described as a dull throbbing pain.
  • It can be moderate to severe in intensity, possibly even debilitating.
  • What's felt may be constant or intermittent. In the latter case, the frequency of onset can vary. Later on, the pain is more likely to be constant.
  • The pain may remain localized to just 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.
  • The pain usually becomes its most intense at 72 hours post-extraction (Bowe 2017). [page references]

A dry socket.

A dry socket.

Note the loss of the socket's blood clot and exposed bone.

2) Appearance.

  • The tooth socket will appear to be empty (not filled in 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 gray/yellow layer of necrotic tissue or accumulated debris.
  • The gum tissue immediately around the extraction site shows signs of being inflamed (red, tender, puffy).

3) Other signs and symptoms.

  • It's characteristic that the patient will notice a foul odor (halitosis) or bad 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, area swelling or obvious signs of infection.

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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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 38 to 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, Bowe 2017)

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

 

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