What is Dry Socket - Symptoms and Causes of Dry Socket
Tooth Extraction

What is a Dry Socket

Dry socket, also known as alveolar osteitis, is a common complication after a tooth extraction. The dental term ‘alveolar osteitis’ refers to the inflammation of the alveolar bone following the extraction of a tooth, resulting in severe pain.

Dry socket is a dental condition where the natural post-surgery healing process is delayed, characterized by symptoms such as jaw bone exposure and severe pain at the extraction site that begins about two days after extraction and worsens over time.

Problems of dry socket occur rarely, affecting only about 1% to 5% of all tooth extractions, but in certain types of extractions can be much higher. The occurence rate of dry socket symptoms after wisdom teeth extraction, especially those of lower impacted wisdom teeth, may reach 15% or more.

Dry Socket Symptoms

The pattern that dry socket symptoms appear is common, with the discomfort decreasing for the first two days after the tooth extraction when, at about the third day the discomfort starts to become progressively more intense.

The most common and disturbing of the dry socket symptoms is the intense pain. The dry socket pain is usually very intense, constant and sometimes throbbing. It cannot generally be relieved by over-the-counter painkillers. Pain may be localized to the empty tooth socket area or it may radiate up to the patient’s ear or eye, depending on the jaw of the extraction.

How long does dry socket last

The dry socket tooth pain starts about three days after the tooth extraction, by the time the tooth socket without the protective blood clot has literally got ‘dry’. The condition will eventually heal by itself with time, but the patient has to withstand the symptoms for a prolonged period of time until full dry socket healing. It might take a couple of weeks before the dry socket symptoms and pain are gone. The pain is usually very intense. Unfortunately in some cases the dry socket pain may last for over a month. Dry socket may last longer than usual in young patients that fail to follow the dentist's instructions.

There are some early signs that might warn the patient for the upcoming problem, even before the pain or other dry socket symptoms appear.

what does a dry socket look like

Visual examination of the tooth extraction area will reveal that :

  • there is partial or total loss of the blood clot from the tooth socket
  • the tooth socket appears empty and dry
  • the jaw bone is visible in the tooth socket

Other symptoms of dry socket may include:

  • Bad breath
  • Unpleasant taste in the mouth
  • Swollen lymph glands around the jaw or neck
  • Temporomandibular joint disorder related symptoms like jaw pain, ear pain etc.

The main characteristic of the dry socket symptoms is that they appear some days after the tooth has been removed, and not immediately after the procedure.

If you want to see photos of what does dry socket look like, follow this link for pictures of dry socket.

What Causes a Dry Socket

Dry sockets are associated with problems related to the blood clot that normally is forming in the extraction site. The formation of this blood clot is considered very important for the initiation of the healing process. The blood clot protects the underlying bone and nerve endings, and provides the foundation for the growth of new gum tissue and bone.

In dry socket cases, the blood clot either does not form normally or it is dislodged after its formation, leaving the socket open and exposed. The exposure of the bone and nerves to the external environment is the main cause of the intense pain. Without the blood clot, the healing of the extraction site is interrupted and becomes delayed.

Several factors are associated with increased risk of having a dry socket after a tooth extraction. These factors include:

  • Not following post-operative instructions. The instructions given by the dentist or oral surgeon after a tooth extraction procedure have to be followed carefully, in order to allow a blood clot to form and protect it. Failure to do so, increases greatly the risk of experiencing dry socket symptoms and other complications. Learn more details about post-extraction instructions.
  • Smoking. Dry sockets symptoms appear four times more often in smokers than in non smokers. The sucking action during smoking may disturb the formation of the blood clot, or draw it out of the socket. Another theory suggests that toxic chemicals in cigarettes may contaminate the wound delaying the healing process.
  • Oral contraceptives. High levels of estrogen can increase the risk of dry socket tooth by dissolving the blood clot. Women who take oral contraceptives are in 20% higher risk of developing dry sockets due to increased estrogen levels.
  • Poor oral hygiene - Tooth or gum infection. An existing or post-operative infection, and the increased bacterial count around the tooth socket is also associated with dry socket complications. Poor oral hygiene that fails to keep the bacteria concentration under control may also contribute to the problem and cause a dry socket.
  • History of dry socket. Patients who have a history of a dry socket tooth from previous tooth extraction, may have an increased tendency of having the same problem again. This category of patients must be even more careful in following the post-extraction instructions of their dentist.

Other factors that have shown a statistical correlation with developing a dry socket are :

  • Extend of extraction trauma. Traumatic tooth extractions are more likely to result in dry socket formation. Increased pressure against the tooth socket’s walls may crush and close the blood vessels in the bone preventing bleeding and blood clot formation. Generally, the more experienced the dentist, the less the trauma expected during the tooth extraction.
  • Patient’s age. Older patients seem to be in higher risk than younger ones.
  • Tooth Location / Type. There is a greater incidence of dry socket after extractions of lower teeth and molars. The highest occurence of dry socket symptoms occurs after the extraction of impacted lower wisdom teeth.

The cost of replacing extracted teeth can be significant and many patients may not afford it if they are not covered by their dental insurance. Learn how to choose a dental insurance plan that will provide the best dental treatment to you and your family.

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