Dry sockets: Risk & prevention - Smoking / Oral contraceptives / Oral bacteria / Age / Tooth Position -

How and why these factors play a role. / Prevention tips and suggestions.

This page discusses the following causes and risk factors for dry sockets (alveolar osteitis). And how understanding them can help to prevent one.

Our previous page (Part 1 of this topic) explains the role of extraction difficulty, failure to follow post-op instructions and patient history as risk factors.

A) Smoking.

Studies have shown that smokers are significantly more likely to get a dry socket as compared to those who don't.

For example, after evaluating the outcome of 400 wisdom tooth extractions, Sweet (1979) determined that:

  • Patients who smoked 10 cigarettes a day experienced a more than fourfold rate of dry socket formation (12% vs 2.6%).
  • The rate for patients who smoked 20 cigarettes daily was 20% higher.
  • The rate for patients who smoked on the day of their surgery or on the first day following was 40% greater.

What's the cause?

Each of the following reasons has been given as an explanation or contributor for this relationship:

Patients shouldn't smoke after having a tooth extraction.
  • The sucking action created when a person smokes may dislodge or otherwise disrupt the blood clot that has formed in their tooth's socket.
  • The carbon monoxide that enters a person's bloodstream when they smoke limits the amount of oxygen that can be carried to (and therefore is available for) their extraction site's healing tissues.
  • Nicotine creates systemic effects that interfere with the normal healing process. (Like vasoconstriction, which reduces blood flow to tissues.)
  • At a local level, tobacco smoke may damage or be toxic to tissue cells.

Prevention guidelines.

As difficult as it may be, if you're a smoker you can lower your chances of getting a dry socket by not smoking on the day of your surgery, and then for as many days afterward as is possible.

Oral contraceptives.

B) Oral contraceptives.

Women who take birth control pills may be at greater risk for getting dry sockets.

This factor, however, may have been more of an issue in previous decades when oral contraceptives contained a larger dosing of estrogen.

What's the cause?

The correlation between oral contraceptives and dry sockets may be due to fibrinolysis activity triggered by estrogen (this process leads to blood clot disintegration).

It's possible (but still debated) that women as a group are more likely to experience dry sockets than men. If they are, one reason could be related to the use of oral contraceptives.

Prevention guidelines.

Planning the timing of your extraction may help.

Women who take birth control pills may be able to lessen their risks by scheduling their tooth extraction during those days when the estrogen dosing of their contraceptive regimen is at its lowest.

Ask your dentist for specific details. With some products, this will be those days (days 23 to 28 of your tablet cycle) when no pill, or else a placebo pill, is taken. (Cardoso 2010)

C) Oral bacteria.

Some dental research supports a view that bacteria play a role in dry socket formation.

According to this theory, having one or more of the following conditions may place a patient at greater risk.

  • A high bacterial count in the region of the extraction site (existing either before or after the extraction).
  • An active infection in the gum tissue surrounding the tooth before it's extracted. (Such as exists with pericoronitis or advanced gum disease.)
  • A habit of practicing poor oral hygiene.

Some studies have suggested that the following steps can be used to help to prevent dry sockets:

  • Having the patient rinse with an antibacterial mouthwash (chlorhexidine) before their tooth extraction.
  • Placing an antibacterial or antibiotic-impregnated packing into the tooth socket immediately following an extraction.

(Daly 2012)

Dry sockets are not usually treated with antibiotics.

Despite whatever role oral bacteria may play in causing them, most protocols for treating dry sockets do not include the use of systemic antibiotics (taking pills or capsules).

D) Patient age.

Many studies have reported a correlation between the age of a patient and their potential for getting a dry socket. But there's been a lack of agreement about which age group experiences them the most.

It seems that this complication rarely occurs in childhood. Possibly a person's risk peaks in their 30's and 40's. (Noroozi 2009)

As a general rule, it seems safe to say that comparatively younger patients are considered to be at less risk than comparatively older ones. (Thus one reason why dentists typically suggest that a patient should ideally have their wisdom teeth removed during their late teens or early 20's.)

Why does this correlation exist?

As an explanation, it's frequently pointed out that relatively older patients tend to have increased jawbone density. And with teeth like wisdom teeth, a higher incidence of full root formation. Both of these factors can increase surgical difficulty.

Additionally, relatively older people generally have a comparatively lower capacity for healing.

Prevention guidelines.

If you're in an age group that places you at somewhat greater risk, simply make sure to follow your dentist's postoperative instructions as closely as possible.

E) Tooth location.

A patient's risk for developing a dry socket is influenced by the location of the tooth that they're having extracted.

Lower wisdom tooth extractions have a higher incidence of dry socket formation.

Here are some correlations:

  • Having a back tooth pulled (especially a molar) typically poses a greater risk than a front tooth.
  • The risk of dry socket formation is 10 times higher when a lower tooth is extracted, as opposed to an upper one.
  • The greatest level of risk appears to be associated with having a lower wisdom tooth removed, especially an impacted one (see picture). The risk for these teeth may run as high as 45%.

(Cardoso 2010)

Prevention guidelines.

If the location/positioning of your tooth places you at greater risk, make sure to follow your dentist's post-op instructions as closely as possible.

Our next page discusses how dentists treat dry sockets. ▶


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