After a tooth extraction, a blood clot naturally forms on the empty tooth socket to protect the exposed tissues, nerves, and jawbone and also to facilitate the healing process. However, there are cases where the blood clot is not properly formed or dislodged from the tooth socket, it can cause what is known as dry socket.
Dry socket, also known as alveolar osteitis or fibrinolytic alveolitis, is the most common complication of tooth extraction and causes pain or infection which usually last and felt from 3 to 4 days after the tooth has been removed. This dental problem is characterized by severe pain and delayed healing time to recover. People suffering from dental dry socket also have an increased danger of infection and can also deter the treatment required to replace the extracted tooth.
Alveolar osteitis or fibrinolytic alveolitis is the hole in the bone where a tooth has been removed, exposing the nerves, tissues, and bone to air, food, fluid, and anything that enters the mouth. This can result in severe pain and infection that can last for days. The following individuals are prone to suffer alveolar osteitis after their tooth has been extracted:
- individuals whose wisdom teeth have been removed
- individuals who use oral contraceptives
- people who do not follow good oral hygiene
- people who experienced severe tooth extraction/surgery trauma
- people with tooth or gum infection
- smokers/tobacco users
- those who have experienced dry socket in the past
- those who use corticosteroids
Signs and symptoms
It is enough for your dentist or oral surgeon to suspect dry socket after a severe pain following tooth extraction. You will be asked about other symptoms and he or she will examine your mouth to check if you have an exposed bone or a blood clot in your tooth socket. An X-ray might also be done on your teeth and mouth to determine the severity and exclude other conditions.
Signs and symptoms may include the following:
- An empty tooth socket which is partially or completely devoid of blood clot
- Bad taste in the mouth
- Exposed bone which is very painful and sensitive to touch
- Foul smell coming from the mouth
- Inflamed tissues surrounding the empty socket
- Moderate to severe throbbing pain in the socket that can spread to your neck, eyes, and ears within a few days after the tooth has been removed
- Slight fever
- Swollen lymph nodes
Causes
Dry sockets can happen in about 3-5% of tooth extractions and most common after extraction and impacted wisdom teeth. There is no accurate explanation as to what causes dry socket, but several factors may be included such as:
- Age of patient – older patients are more at risk of dry socket than younger ones
- An active infection in the gum and high bacterial count in the area of the extracted tooth due to poor oral hygiene
- History of experiencing dry sockets
- Location of the tooth
- Patient’s health condition
- Poor compliance with the dentist’s post-op instructions regarding clot formation and blood clot protection
- Severe tissue and bone trauma after a difficult tooth extraction
- Smoking and/or using tobacco after a tooth extraction
- Tiny root or bone fragments left in the wound after extraction
- Too much alcohol intake
- Use of oral contraceptives – estrogen can trigger fibrinolysis activity that leads to disintegration of blood clot
Treatment
Treatment and drugs for dry socket is mainly intended to reducing the pain and other symptoms but it won’t speed up the healing. Diagnosing a dry socket correctly is important so as not to confuse it with other dental pains like root canal issues. As soon as treatment has been done, relief will come in as little as 5 minutes, while other symptoms will go away in the next few days. Total healing usually take from 10-14 days. Several dry socket treatments include:
- Applying medicated dressings
- Flushing out the socket to remove any food particles or other debris in it that might add up to the pain or infection
- Taking pain relievers
- Self-care wherein you will be given instructions on how to continue treating dry socket at home
- Putting cold packs outside your face where there is pain to decrease the swelling and pain
- Not smoking and avoiding any tobacco products
- Keeping hydrated by drinking adequate amounts of liquids
- Using warm salt water to gently rinse your mouth several times throughout the day
- Gently brushing the teeth around the dry socket area
- Taking pain relievers as prescribed by your dentist
- Sticking to scheduled appointments with your dentist for changing of dressings or other dental care procedures
- Making a dental appointment as soon as the pain returns or worsens before the scheduled appointment
Prevention
There are several things that can be done to reduce the possibility of a dry socket after a tooth extraction. Your dentist will give you instructions to ensure the proper healing and prevention of dry socket. These guidelines may include:
- Using warm salt water, antibacterial mouth washes, rinse, or gels to keep the are clean
- Antibiotics especially if you have poor immune system
- Applying antiseptic solutions to the wound
- Applications of medicated dressings after surgery
- Avoiding rigorous activities
- Taking the recommended medications
- Avoiding caffeinated drinks, alcohol, and carbonated, and hot beverages for 1-2 days
- No smoking before and after surgery to avoid contamination
- Avoiding drinking through a straw or spitting to prevent dislodging the blood clot
- Eat only soft foods
- Take care when brushing around the area of dry socket
- Tell your dentist about any other medications your are taking to know if they are interfering with blood clotting
Summary:
Every dentist is aware that there is always a chance that their patient will have a dry socket after a tooth extraction so don’t hesitate to ask them for help if you think you are suffering from one. It is their obligation to extend assistance in providing any follow-up dental care needed to lessen the complications of dry socket and improve your dental health.
Even though dry socket is recognized as early as in the late 1800’s, medical scientists are still looking for a surefire way to prevent it other than with medications like antibiotics before and after surgery. This issue still remains debatable and there are others that argue that using antibiotics for treatment may trigger other problems especially to health issues that concerns antibiotic-resistant bacteria.
On the lighter side, knowing the signs and symptoms that can lead to dry socket is important and if you find that you are among the 3-5% that might have it, contact your dentist immediately and take all the necessary action needed to help in the prevention or treatment of it. Your dentist might have to flush out the socket to clean it of any particles and apply the necessary medicated dressings to protect the socket. He or she can also prescribe several medications to help reduce or alleviate the pain and swelling. However, your dentist can give you instructions on how to care for it at home and all will be well if you follow his or her self-care advice.