What is Dry Socket?
Getting a tooth extracted is far from being an enjoyable experience for anyone, and no doubt that after the extraction, one feels discomfort for some time. However, if the pain remains even after a few days, it should be seen as a tip-off of an oral condition called dry socket.
Dry socket is also called alveolar osteitis. Not everyone who undergoes tooth extraction experiences it; only a very small percentage, somewhere around two to five percent, develop the condition. Dry socket is painful, but the good news is that it can be treated.
The intensified and throbbing pain caused by dry socket begins to occur about four to five days after tooth extraction. This pain is accompanied by a foul taste in the mouth that can lead to bad breath. When this pain begins, it is clear that the natural healing process has been interrupted.
The socket referred to in “dry socket” is the hole in the gums and bone from which a tooth has been extracted. After tooth removal, a blood clot forms in the socket to protect the nerves as well as the bone present underneath. However, in some cases, the blood clot gets dislodged or dissolves after couple of days, leaving the nerves and the bones exposed to fluid, air, food, and anything else that enters the mouth. This then leads to an infection that causes severe pain and lasts for around five to six days.
What Causes Dry Socket?
Dry socket is caused by the total or partial loss of the blood clot that has formed in the socket after tooth extraction. When a tooth is extracted, a blood clot normally forms in the socket. It is the first step towards the healing of the wound, as the blood clot covers and thus protects the underlying bone from infection.
However, if the blood clot is lost for some reason, or dissolves or does not form properly, the bone becomes exposed to a variety of things entering the mouth, and the healing process is interrupted.
The causes of dry socket may be mechanical, bacterial, chemical, or physiological. Examples of each of these factors are mentioned below:
- Mechanical: Spitting, rinsing very aggressively, sucking anything through a straw, and smoking can lead to the blood clot getting dislodged and lost.
- Bacterial: Any preexisting infection present in the mouth before tooth extraction can prevent the formation of a blood clot. One infection that can lead to dry socket is periodontal disease or periodontitis. Also, certain forms of oral bacteria can lead to blood clot breakdown.
- Chemical: The nicotine present in cigarettes leads to a reduction in the supply of blood to the gums, due to which the blood clot may not form at the site of extraction.
- Physiological: An inadequate supply of blood in the mouth tissue, a deficiency in estrogen in a female patient, or a dense jawbone may contribute to a blood clot not forming after tooth extraction.
What Are the Symptoms of Dry Socket?
One will see a dry opening in the place from which the tooth was extracted, and whitish bone instead of a dark blood clot. The jawbone becomes visible in the socket, and the surrounding tissue may also appear gray due to the slow healing process.
The throbbing pain begins three to four days after tooth removal. As time passes, this pain intensifies and can start radiating toward the ear as well. Other symptoms of dry socket are bad breath and an unpleasant or foul taste in the mouth. This mostly occurs due to the accumulation of food debris and bacteria in the socket.
What Increases the Risk of Dry Socket?
Certain risk factors can lead to the complication known as dry socket. Among the risk factors are biological sex, smoking, age (being over 30 years old), and traumatic extraction, as when an impacted wisdom tooth is involved.
- Smoking is one of the biggest risk factors for the development of dry socket, and usually happens due to the nicotine in cigarettes. The supply of blood to the healing socket is reduced by exposure to nicotine. This then prevents the proper formation of a blood clot at the site of extraction.
- A preexisting infection such as pericoronitis or periodontal disease at the site of extraction increases the risk of dry socket.
- The extraction of an impacted wisdom tooth or third molar, especially if surgery is involved, is very traumatic to the jawbone and surrounding gum tissue. A correlation exists between the amount of trauma caused by a tooth extraction and the likelihood of dry socket.
- When it comes to the biological sex, females have a higher risk of developing dry socket. This is because high estrogen levels resulting from the use of oral contraceptives can negatively affect the healing process.
- Any patient who is above the age of 30 and has an impacted wisdom tooth has increased chances of developing dry socket. As one ages, the jawbone becomes denser and less blood is supplied to the area. Denser jawbones tend to increase the trauma caused by an extraction. Also, the lower blood supply reduces the possibility of proper blood clot formation and delays the healing process.
Apart from the above, poor oral hygiene and a history of dry socket are also risk factors.
Diagnosis of Dry Socket
A dentist can diagnose dry socket based on the dental history, symptoms, and clinical examination of the patient. He or she will ask about the timing of the onset of symptoms relative to a tooth extraction.
In the normal healing process, discomfort after tooth removal is reduced over time. But if the pain increase instead, it is a clear indication of a delay in the healing process, which in turn is probably due to dry socket. The symptoms of dry socket typically arise within the first week after tooth extraction.
What Is the Treatment for Dry Socket?
The average time for dry socket to heal is seven to nine days, this being the amount of time it takes for new tissue to grow over the exposed socket.
Symptomatic support during the healing of the socket is the usual form of treatment for dry socket. Once the condition is confirmed, the dentist will carefully irrigate the socket to clear it of food and other debris.
Once the cleaning part is done, the dentist will pack analgesic-medicated dressing into the socket. This is done to provide immediate relief to the intense pain and cover the exposed bone and nerves. Whether this dressing needs to be replaced and how often, and whether other treatment is needed, will be determined by the severity of pain and other symptoms experienced by the patient.
The medicated paste or gel smeared on the dressing and packed into the socket is usually made with pain-relieving ingredients such as clove oil or eugenol. To provide additional relief from pain, the doctor may also prescribe non-steroidal medication such as Aleve (naproxen), ibuprofen, aspirin, or acetaminophen.
Home Remedies for Dry Socket
One may also begin taking care of dry socket through some home remedies if one cannot see the dentist right away. These home remedies will provide temporary pain management until the conventional treatment method can be had from the dentist.
The various home remedies for pain relief include using over-the-counter painkillers and applying cold compresses or insulated ice packs on the affected side of the face for a few minutes on and a few minutes off.
Saltwater rinse is good for helping to remove food and other debris from the socket.
Clove oil has been proven very beneficial for any kind of oral problem. Place one or two drops of clove oil on a clean wad of cotton and place it gently on the affected area. Alternatively, use a cotton swab to apply clove oil gently to the area. The pain should gradually fade away.
One should remember that these home treatments just provide temporary relief. It is a must to visit the dentist as soon as possible, as any length of delay can lead to extending the pain and recovery time.
Once new tissue begins forming over and covering the exposed bone, healing will begin to progress normally.
Prevention of Dry Socket
The dentist or dental surgeon performs certain dry socket preventive measures after tooth extraction. The first preventive measure is packing the wound or surgery site after the tooth removal process. The packing is done either with or without using an antibiotic such as tetracycline. A second preventive measure that can be done is the placement of sutures to protect the blood clot. Prior to the extraction process, the individual can discuss these details with the dentist or the surgeon.
Once the tooth has been removed, the dentist or dental surgeon advises the patient about certain routine activities that the patient should take care in doing or avoid altogether if possible. These activities include sucking drinks through a straw, smoking, and aggressively rinsing and spitting. After tooth removal, try to eat only soft foods. One should ensure that the area from which a tooth has been removed is kept as clean as possible. Gently rinse out the mouth with an antibacterial solution and take care to spit gently with minimal force. Check with the dentist as to which oral mouthwash or rinse can be used. Ensure that you comply with and stay mindful of the post-extraction care instructions your dentist or dental surgeon gives you.
Women who use birth control pills should, prior to tooth extraction, check with the dental practitioner whether the removal can be done when there are low levels of estrogen in the body. The hormone is known to impact the ability of blood to clot. Also check with the doctor with regard to any medicine you are taking as some drugs can interfere with the normal blood clotting process.