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Causes and Symptoms of Dry Socket

Dry socket is a painful dental condition that sometimes happens after you have a permanent adult tooth extracted. Dry socket is when the blood clot at the site of the tooth extraction fails to develop, or it dissolves before the wound has healed. Usually, a blood clot forms at the site of a tooth extraction. Normally, this blood clot serves as a protective layer over the underlying bone and nerve endings in the empty tooth socket. The clot also provides the foundation for the growth of new bone and for the development of soft tissue over the clot. Exposure of the underlying bone and nerves results in i pain, not only in the socket but also along the nerves to the side of the face. The socket becomes inflamed and may fill with food debris, adding to the pain. If you develop dry socket, the pain usually begins one to three days after the tooth is removed. Dry socket is the most common complication following tooth extractions, such as the removal of wisdom teeth. Medications alone won't be enough to treat dry socket pain. Your dentist or oral surgeon should offer treatments to relieve your pain.

What Causes Dry Socket?

A dry socket is caused by the partial or total loss of a blood clot in the tooth socket after a tooth extraction. Usually, after a tooth is extracted, a blood clot will form as the first step in healing to cover and protect the underlying jawbone. If the blood clot does not form, the bone is exposed and healing is delayed as a result.

In general, a dry socket is a result of bacterial, chemical, mechanical, and physiologic factors. Below are examples for each:

  • Bacterial: Preexisting infection that is present in the mouth prior to a dental extraction such as periodontal disease can prevent proper formation of a blood clot. Certain oral bacteria can cause the breakdown of the clot.
  • Chemical: Nicotine used by smokers causes a decrease in the blood supply in the mouth. As a result, the blood clot may fail to form at the site of a tooth extraction.
  • Mechanical: Sucking through a straw, aggressive rinsing, spitting, or dragging on a cigarette causes dislodgement and loss of the blood clot.
  • Physiologic: Hormones or poor blood supply are factors that prevent blood clot formation.


The symptoms of dry socket are easy to identify. While no two cases of dry socket are the same, common symptoms include:

  • severe pain at the site of the extraction within 2-3 days
  • missing blood clot at the extraction site
  • bone visible at the extraction site
  • foul smell coming from the mouth
  • pain radiating from the tooth socket to the ear, eye, or neck on the same side

While a certain amount of pain and discomfort is normal after having a tooth pulled, worsening pain or severe pain is not quite normal. Anyone experiencing severe pain that does not improve after a tooth extraction should see their doctor immediately or dentist to rule out dry socket or other complications.

You should start to experience symptom relief shortly after treatment begins, and your symptoms should be gone entirely within a few days. If you’re still dealing with pain or swelling after about five days, you should see your dentist. You may still have debris caught in the area or another underlying condition. Having had dry socket once does put you at risk for developing dry socket again, so keep your dentist in the know. Letting them know that dry socket is a possibility with any tooth extraction can speed along the treatment process.