Dry Socket

How Do I Know If I Have Dry Sockets?

Patients who develop dry socket typically complain of pain 3-4 days after surgery that is worse than it was initially.  This can be on only one side or both. They are more common in the lower jaw.  The pain often radiates to the ear or neck or other areas in the jaw.  It can also be accompanied by bad breath.  It is not an infection and is not accompanied by swelling, redness, or fever. You often cannot see a dry socket.  Discoloration of a healing site is normal. A normal clot will often appear white in the mouth as it matures.  The pain may keep you up at night and is often not fully treated by over the counter pain medicines.  If things were getting better after surgery and suddenly worsen, it may be a sign of dry socket.

​If you think you have developed a dry socket, then you probably have. The good news is that they are easily treated in the office. Medicine can be placed that will provide nearly complete pain relief in minutes.

​Symptoms of Dry Socket: Worsening pain, bad odor, bad taste

​NOT Symptoms of Dry Socket: Swelling, redness, fever, white color in socket, or stiffness of the jaw.


What Is a Dry Socket?

A dry socket, or alveolar osteitis, is a result of loss of the blood clot in an extraction site. Exposed bone in the extraction socket is painful until the tissue grows back to cover the bone. It occurs rarely in routine tooth extractions, and up to 15% in wisdom tooth extractions.


What Causes Dry Sockets?

Bacteria: The most common cause of dry socket is bacteria in the area dissolving the clot pre-maturely.  Antibiotic use does not significantly decrease the rate of alveolar osteitis as there are hundreds of types of bacteria in the mouth.  For that reason, even if you do everything you are supposed to, you may still develop dry sockets.

Mechanical: Sucking through a straw or cigarette, or aggressive rinsing and spitting can dislodge a clot early.

Smoking: Nicotine impairs healing and decreases new blood vessel formation.

Biologic: Oral Contraceptive pills and menstrual hormones have shown to have a small increase in risk for dry sockets.  Although small, that risk can be eliminated by having surgery during your menstrual cycle and being off oral contraceptive pills.


What are Other Risk Factors for Dry Sockets?

Dry Sockets are also more common in the lower jaw, wisdom tooth extractions, patients older than thirty years, and teeth that were infected before surgery.


What is the Treatment for a Dry Socket?

In Office Treatment:

​If you think you have developed a dry socket, call your surgeon.  They are easily diagnosed and easily treated.  A medicated strip of gauze will be placed inside the extraction site.  This will numb the area and relieve the pain within about 15 minutes.  This treatment lasts 24-72 hours and will usually be repeated a few times while the socket is healing.  This treatment controls the pain while the gum tissue grows over the exposed bone. This does not delay healing or help it heal faster. Dry sockets are not infection and are not treated with antibiotics.


Are There Any Home Remedies For A Dry Socket?

If you are unable to come into the office immediately, a few drops of clove oil placed into the extraction site can temporarily relieve the pain.  This will help alleviate the pain and can be placed several times a day if necessary or until you can get into the office. Your surgeon should still evaluate the site as soon as possible. Clove oil can often be found at pharmacies, health food stores, and even grocery stores.


How Long Does A Dry Socket Last?

Most dry sockets last 7-10 days. A small minority will last longer than a week.


Do I Have to Treat it?

If you choose not to have the socket treated, it will resolve on its own in the same amount of time as would if it were being treated.  Electing to not treat it will not delay healing or worsen the outcome.


How Can I Prevent Dry Sockets?

Most of the risk factors for dry sockets cannot be prevented.  However, there are a few things you can do to help decrease the risk:

  • After extraction avoid smoking, aggressive rinsing or spitting, and use of a straw.
  • ​Discontinuing oral contraceptive use, and using a different form of birth control before surgery, may help decrease the incidence slightly.

Remember, even if you do everything you can to prevent dry sockets they may still happen. However, if they do occur, they are easily and conveniently treated.