Dry Socket

Dry socket is a painful complication that follows the extraction of a permanent tooth. It is common after wisdom tooth extraction, and pain starts two to three days after the procedure. At times, the pain is also accompanied by a foul taste in the mouth and bad breath. This pain indicates the dry socket’s healing procedure has been interrupted.

Under normal conditions, a blood clot forms in the socket after tooth extraction. In some cases, however, the clot is dislodged or falls off the socket, revealing bone and nerves.

Pain results from the exposure of the nerve endings and bone in the socket. Treatment helps relieve pain and improve healing at the extraction site. After the removal of the tooth, an individual will have inflammation of the jawbone, which is also referred to as “alveolar osteitis”. This is one of the many complications associated with a tooth extraction.

The most common symptom of dry socket is intense pain. The pain starts two to three days after the tooth extraction and radiates from the socket to the ear, eye, or one side of the face. The socket may be empty or have a partially-removed blood clot. Bones are also visible in the socket. Gum tissue around the extraction site will be reddish and inflamed.

The empty socket often emits a foul odor and an unpleasant taste, the lymph nodes around the jaw are usually swollen, and some people experience a slight fever.

The initial discomfort after an extraction may fade gradually as the blood clot forms. But with the dislodging of the clot, which usually happens between the second and fourth day after extraction, the pain intensifies.

Partial or total loss of the blood clot from the extraction site is the cause of dry socket. Loss of the blood clot exposes the bones and delays healing. Dry socket may be caused by several factors, namely, mechanical, biological, chemical, or physiological factors.

Bacterial contamination may result in the loss of a blood clot, as some oral bacteria are involved in the dislodgement. Periodontal disease may prevent the formation of a blood clot. If there are pre-existing infections in the mouth prior to the extraction of the tooth, it can also prevent the proper formation of a blood clot.

Chemicals like nicotine reduce blood flow to the site and prevent the formation of blood clots.

Blood clots may be mechanically dislodged by sucking through a straw, spitting, or forceful rinsing.

The presence of dense jaw bone and poor blood supply to the region are some of the physiological factors that affect the formation of a blood clot.

Some of the common risk factors for dry socket formation are:

• Smoking: Due to the nicotine found in cigarettes, smoking is known to be one of the risk factors for developing dry socket. Nicotine reduces the supply of blood that is usually available for the healing of the socket, and also prevents the formation of a blood clot at the extraction site.
• Tobacco use: Similar to smoking, tobacco also prevents blood clot formation.
• Use of oral contraceptive: Women are more prone to developing dry socket than men, since it may be related to hormonal factors. These factors include the use of oral contraceptives or any changes in the hormonal cycle, which women experience during periods.
• Gum disease: Any previous infection or disease that affects the gums or periodontal disease at the extraction site can also lead to dry socket.
• History of dry socket: If an individual has previously had dry socket, it could also lead to an increase in risk of future dry socket from a tooth extraction.
• Use of corticosteroids: Certain side effects could occur from the use of corticosteroids, which would lead to the loss of blood clots and thus impact the dry socket.
• Lack of proper oral hygiene: Improper hygiene leads to the formation of bacteria or infection, which impacts the tooth and jaw, leading to a loss of blood supply to the affected site.
• Trauma: For some people, extraction of the third molar which is then impacted can cause a traumatic experience. This happens if the surrounding gum tissue and jawbone need to be removed and are adversely affected during surgery. The extraction cannot be delayed and ultimately results in trauma. This, then, leads to an increase in risk for dry socket.
• Age: Individuals older than thirty who have an impacted third molar are at a higher risk of developing dry socket. As one ages, the jawbone becomes dense and thus has a less available blood supply. When the jawbone is dense, it increases the risk of traumatic extraction and a lessened blood supply, decreasing the chances of blood clot formation and timely healing.

Diagnosis of dry socket is based on one’s dental treatment history, an oral examination, and symptoms.

Intense pain a few days after the tooth extraction is a good indicator of dry socket.

Imaging the socket using an X-ray helps rule out a bone infection.

Treatment for dry socket focuses on reducing pain and improving the healing of the socket.

The first step is to clean the socket and remove any debris or food particles that aggravate the pain. The socket is then covered with medicated dressings to reduce pain. The dressing needs to be replaced every few days during the healing process. It is usually coated with dry socket paste made of various ingredients, such as eugenol (clove oil), and is loaded with pain-relieving properties.

Prescription pain medication is also recommended to alleviate throbbing pain. There are certain nonsteroidal anti-inflammatory drugs, such as Advil or Aleve, or other narcotic medications, such as Vicodin, acetaminophen, or hydrocodone, which can also be prescribed for pain relief.

The socket may be rinsed and cleaned at home using a syringe with a curved tip. Rinsing the socket keeps debris off.

Prognosis

Dry socket takes an average of seven to ten days to heal. This is usually the amount of time required for the growth of new tissues and for the exposed socket to be covered. Generally, there are no long-term consequences. Once the new tissue covers the bone, the healing will progress normally.

Certain precautionary measures can be performed before and after the extraction to prevent dry socket formation. These include:

• Antibacterial mouth washes, gels, and antibiotics to prevent infection
• After the surgery, apply a medicated dressing to prevent dry socket formation.
• Smoking and tobacco use increase the risk of dry socket.
• Quitting smoking aids in the healing of the socket.

Sutures can be placed to protect the clotting of blood. This can be discussed with the dentist if such preventive methods are recommended.

One should avoid vigorous rinsing or spitting, as well as drinking through straws.

Include soft foods that do not put too much strain on the teeth in your diet.

Maintain good oral hygiene and keep the area as clean as possible by gently rinsing with a good antibacterial solution, which can be recommended by the doctor.

There have been cases where the incidence of dry socket in women decreased when the tooth extraction was performed during their menstrual period. Hence, the dentist can pre-plan the extraction are the menstrual period. This helps eliminate the risk of dry socket due to hormonal changes.

A few alternative and homeopathic remedies for dry socket are:

• Clove oil improves healing. It can be directly applied to the dry socket by using a clean cotton swab. First, reduce the sting of the clove; this can be done by soaking the cotton ball in water and then dipping it in the clove oil. Now the swab can be applied to the dry socket. Apart from the affected tooth, clove oil can also be applied to the neighboring teeth. This should be carried out at least once or twice a day to best relieve pain.
• Yogurt is used as a natural antibiotic.
• Ice packs and cold tea bags help reduce pain in the region.
• Gargling a turmeric and saline solution provides pain relief. One can also gargle with a simple warm water and salt mixture.
• Lemon juice prevents further infections. Salt and lemon juice are considered natural antiseptics and prevent further infection in the dry socket. A mixture of salt and lemon juice can be applied on the gums. Apart from this, one can also drink lemon juice, which is equally beneficial; lemon is known to be rich in vitamin C, which speeds up the healing process.
• Increase fluid intake and keep yourself hydrated at all times. This will prevent pain and giddiness, which can be caused by dry socket.
• Valerian root and a hydrogen peroxide rinse alleviate pain. Valerian root is also considered a natural tranquilizer; it is known to prevent anxiety and stress, as well as provide relief from excruciating pain caused by dry socket. Valerian root is known to speed up the healing process.
• Cold tea bags are also known to be helpful in healing dry socket. Take a cold tea bag and place it on the affected area, then press it down with the help of your teeth. Tea bags contain tannic acid, which helps provide relief from excruciating pain. This is one of the known and effective home treatments for dry socket.
• One can also prepare an herbal solution in the form of a paste made of dry salt, mustard oil, and turmeric. This paste can be directly applied to the affected region. It provides immense relief, and thus is also considered an excellent home remedy. The solution is also known to help maintain good dental health.
• To prevent direct saliva and air exposure on the dry socket, one can nibble a damp piece of gauze. Exposure of air and saliva is known to intensify the pain in dry socket.

Lifestyle modifications are necessary in order to cope with dry socket.

Avoid rigorous activities that will dislodge the blood clot from the socket after an extraction. Keep well-hydrated and avoid alcoholic and carbonated drinks.

Aggressive cleaning of the mouth, particularly the extraction site, should be avoided after the procedure.

Opt for soft foods like yogurt and apple sauce, which don’t require much chewing.

Infection of the socket is the major complication associated with dry socket.