How dentists treat dry sockets (alveolar osteitis). -

Dry-socket pastes and dressings - What medications are used? How is the packing placed? How frequently is it changed? | The role of analgesics (pain pills) and antibiotics in case management.

Topic Alveolar Osteitis logo.

Tooth socket after extraction.

The fact of the matter.

Dentists don't actually "cure" dry sockets. That's because the underlying problem associated with alveolar osteitis is one of delayed healing, and there's nothing they can really do to speed this process up.

What a dentist does do.

Instead, the treatment they provide is limited to what's referred to as "palliative" care, which simply means that their efforts are directed toward the management and control of their patient's symptoms.

What they do is take steps that: 1) Help to keep their patient comfortable and 2) Insure that the socket's healing environment is as favorable as possible. This page explains how both are accomplished.

Never be hesitant to ask for your dentist's help.

As the provider of your care (your tooth's extraction), it's your dentist's obligation to provide you with the follow-up assistance you require.

All dentists fully expect that a percentage of patient's will develop dry sockets and require extra attention. So rather than delay and continue to suffer, you should contact them and take full advantage of the help they have to offer.

Can you treat a dry socket on your own?

Assuming that you have correctly diagnosed your condition, there are steps that you can take that can help to provide pain relief. But a self-treatment approach won't be as comprehensive as the level of care your dentist can provide.

(For more information about the how-to's and why-not's of a DIY approach, use this link.)


How do dentists treat dry sockets?

a) The initial evaluation.

A dry socket.

Picture of a dry socket.

Visual inspection is a part of diagnosing a patient's dry socket.

As a start, your dentist will first need to establish that it's likely that you do indeed have a dry socket.

  • They'll quiz you about the nature of your symptoms: What are they like? Where do they seem to come from? How often do you experience them? How long do they last?
  • Your dentist will also inspect your wound. (They'll look for the situation where it appears that the socket's blood clot has been lost and there is exposed bone.)
  • They'll also want to know about the timing of the events you've experienced.

    (In most cases, a person's post-extraction healing will progress normally for some days before the symptoms of a dry socket begin to set in.)

b) Placement of a medicated dressing (packing).

Once your dentist determines that it's likely that you do have a dry socket, they'll typically proceed with the following steps.

Animation showing the placement of a medicated dressing in the opening of a dry socket.

A medicated dressing is placed in the opening of the tooth's socket.

  • First, they'll gently flush your extraction site with sterile water, saline solution or chlorhexidine (a prescription antibacterial mouthrinse). And then gently suction the socket dry.

    (The purpose of this step is to wash away any loose debris that might inhibit the healing process or possibly promote the formation of a secondary bacterial infection.)

  • They'll then smear medicated paste onto a piece of gauze, or other type of carrier such as a cotton pellet, and place it directly into your tooth's socket.

    (The insertion step is performed quickly. No anesthetic is used.)

  • The packing is usually renewed (removed, the socket gently rinsed, and the packing then replaced) every 24 to 48 hours, typically for 3 to 6 days.

    (The exact interval that's used for changing the dressing simply depends on the patient's comfort needs, with those experiencing higher levels of pain requiring more frequent replacement to remain comfortable. The replacement/reevaluation period should be at least every two days, with every 24 hours frequently used.)

  • Once your symptoms have subsided, you'll still need to return to your dentist's office one last time so they can remove the gauze carrier that was last placed in your socket. And this is an important step to take.

    (The exception to this would be if the type of carrier used is one that will dissolve away on its own. It's fairly common for a dentist to use this type of material (Surgicel, Gelfoam, Surgifoam) instead of gauze but you'll need to check this point with your dentist to know for sure.)

 Reference: 

How quickly does this treatment work?

The patient may experience dramatic pain relief, possibly even immediately, once the dry socket dressing has been placed.

Over time (usually about a day or two) the effects of the medication taper off. If the patient's symptoms still persist, the dressing can then be replaced with a new one.

What ingredients do dry-socket pastes contain?

Most dry socket pastes are composed of a mixture of compounds.

Some ingredients frequently included are: Eugenol (extract of clove oil, an analgesic), Guaiacol or Balsam of Peru (compounds related to Eugenol), Benzocaine (an anesthetic), Iodophorm (an antimicrobial agent), Chlorobutanol (an anesthetic).

The problem with dressings.

While we've already mentioned that the use of a medication within the socket does not speed up the healing process, you might be surprised to learn that placing a dressing actually retards it somewhat.

  • As an object, the dressing/packing is considered a "foreign body" by your body and as such interferes with the healing process.
  • While beneficial in providing pain relief, eugenol is a known irritant to soft tissues and bone.

 Reference: 

Kolokythas A, et al. Alveolar Osteitis: A Comprehensive Review of Concepts and Controversies

Bowe DC, et al. - Linked above.

These issues make this treatment a trade-off. One of creating pain relief in exchange for extending the length of the healing period minimally. For someone in need of this relief, this is an easy decision to make.

This phenomenon also explains why dentist don't place dry socket dressings as a preventive measure at the time of surgery.

 

c) Your dentist may write you a prescription for pain relievers.

Picture of prescription pain relievers.

While not a cure, pain relievers may aid in controlling dry socket discomfort.

Beyond placing a dressing, your dentist may also write you a prescription for an analgesic (pain pills), or explain the use of a non-prescription (over-the-counter) alternative.

Analgesics are seldom effective in controlling the (possibly extreme) discomfort from a dry-socket on their own.

They are typically only used as an adjunct (supplementary approach) after the placement of a medicated paste has been completed (as described above) and it's been determined that some residual level of pain remains.

d) Taking antibiotics is not usually indicated.

Dry socket formation involves a scenario where an extraction site's healing process has been interrupted due to the loss of its blood clot. An active bacterial infection is typically not involved. For this reason, the use of antibiotics is not usually indicated.

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Legitimate considerations.

There can be reasons why a dentist might feel that their use is required. This could include cases where the patient is immune compromised, or where the dentist finds strong evidence that systemic or secondary bacterial infection is involved.

Common practices.

Despite best-practice recommendations, it's estimated that somewhere between 20 and 50% of dentists (a number that varies by country) continue to routinely prescribe antibiotics for their dry socket patients (Vessal).

While seemingly prescribed with the intent of providing a benefit, the indiscriminate, purposeless usage of antibiotics instead increases the risk of complications, including allergic reaction and the development of bacterial resistance.

 Reference: 

How do you know when you're "cured"?

As the healing process of your extraction site progresses and new soft tissue gradually fills in your tooth's socket and covers over its sensitive bony walls, the amount of discomfort that you notice will gradually fade away.

Since a dentist's treatment steps are just palliative in nature, they can be discontinued at any point where the level of your symptoms has subsided enough that they're no longer an issue.

At this point, you can expect your extraction site to continue on and finally complete its normal healing process.

Other than a final check that there's no dressing materials still left in your socket, there's no special follow-up care that's needed after your symptoms have disappeared.

Remember, treatment for dry sockets is just palliative and not a true cure.

As explained previously on our pages, a dry socket involves the situation where an extraction site's healing process has been delayed due to the loss of its blood clot.

Over time, the wound can still be expected to go ahead and heal on its own. It's just that it will take longer, and be more painful, than it would have been otherwise. (Related content: How long do dry sockets last?)

Placing a packing like described on this page doesn't speed things up. Instead, it simply helps to reduce the amount of discomfort that you experience while your (now prolonged) healing process takes place.


If you think you have a dry socket, don't hesitate to ask for your dentist's help.

All dentists know that there's always a chance that after an extraction a patient will develop a dry socket. And although there are risk factors that tend to influence their rate of occurrence, actually experiencing one can usually just be chalked up to bad luck.

For this reason, once you've asked, you'll probably find that your dentist is quite sympathetic to your situation and will be very accommodating in providing assistance. They fully expect that some percentage of their patients will require additional attention and understand that it's their obligation to provide this follow-up care when it's needed.

Study: Time from first symptoms to seeking treatment.

We couldn't help but to notice the following statistics mentioned in a study by Bowe [linked above]. This paper stated that for their group of study subjects:

  • The duration that lapsed between the date of extraction and the initial onset of dry socket symptoms ranged from one to three days.
  • The time that lapsed between symptom onset until presenting to their dentist for treatment was four to six days.
  • By the time the patients reported for treatment, all classified their pain as severe.

These numbers make one think that patients may generally be hesitant to seek post-op assistance. However, they also suggest that those who seek attention promptly will likely save themselves a day or night of severe discomfort. So don't be hesitant to contact your dentist if you find the nature of your socket's healing process has changed.

Our next page discusses home remedy treatment for dry sockets. ▶

 

Last revision/review: 9/26/2018 - Reviewed. Content added.


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