How dentists treat dry sockets. -

Dry-socket pastes and dressings (packings). | The role of analgesics (pain pills) and antibiotics.

Topic Alveolar Osteitis logo.

Tooth socket after extraction.

There's no "cure" for a dry socket (alveolar osteitis) because there's nothing that can be done to rush its now delayed healing process along.

Active treatment is limited to the management and control of symptoms. This is termed "palliative" care.

What a dentist does is take steps that: 1) Help to keep their patient as comfortable as possible and 2) Insure that the socket's healing environment is as favorable as possible.

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

As the initial provider of your care (your tooth's extraction), it's your dentist's obligation to provide you with the follow-up assistance you require. And they fully expect that some number of patient's will need this extra attention.

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 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.

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

A dry socket.

A dry socket.

  • They'll quiz you about the nature of your symptoms (what they're 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 a loss of the socket's blood clot and 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 start 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.

A medicated paste is placed directly into the tooth's socket.

A medicated dressing is placed directly in 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) and place it directly into your tooth's socket.

    (In most cases, this 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, for 3 to 6 days.

    The exact interval that's used for changing the dressing simply depends on the patient's comfort needs. People experiencing higher levels of pain will require more frequent replacement to remain comfortable. Every 24 hours is the most common period 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 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.

How quickly does this treatment work?

A 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 common ingredients include: 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 healing, you might be surprised to learn that placing a dressing actually retards it somewhat. The object is considered a "foreign body" by your body, and as such interferes with the healing process. (Kolokythas 2010)

That makes 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.

 

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

Pain relievers.

Prescription pain relievers.

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 in conjunction (as a supplement) with the placement of a medicated paste (as described above).

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.

Your dentist may identify a reason why antibiotics should play a role in your treatment (such as the presence of a secondary bacterial infection). But on a routine basis, they are not prescribed. (Nor should they be. The over use of antibiotics helps to lead to bacterial resistance.) (Kolokythas 2010)

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 (healing time line).

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.


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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 is usually just 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.

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

 

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