Dry Socket
Dry socket is a painful dental condition that sometimes happens after you have a tooth removed. Having a tooth removed is called an extraction. Dry socket happens when a blood clot at the site where the tooth was removed does not form, comes out or dissolves before the wound has healed.
Usually a blood clot forms at the site where a tooth was removed. This blood clot is a protective layer over the underlying bone and nerve endings in the empty tooth socket. Also, the clot contains cells that are needed for proper healing of the site.
Intense pain happens when the underlying bone and nerves are exposed. Pain occurs in the socket and along the nerves to the side of the face. The socket becomes swollen and irritated. It may fill with bits of food, making the pain worse. If you get a dry socket, the pain usually begins 1 to 3 days after the tooth removal.
Dry socket is the most common complication following tooth removals, such as the removal of third molars, also called wisdom teeth. Medicine you can buy without a prescription usually will not be enough to treat dry socket pain. Your dentist or oral surgeon can offer treatments to relieve your pain.
Symptoms of dry socket may include:
- Severe pain within a few days after removing a tooth.
- Loss of part or all of the blood clot at the tooth removal site. The socket may look empty.
- Bone that you can see in the socket.
- Pain that spreads from the socket to your ear, eye, temple or neck on the same side of your face as the tooth removal.
- Bad breath or a foul odor coming from your mouth.
- Bad taste in your mouth.
When to see a doctor
A certain amount of pain and discomfort is typical after a tooth removal. But you should be able to manage the pain with the pain reliever your dentist or oral surgeon prescribed. The pain should lessen with time.
If you develop new pain or the pain gets worse in the days after your tooth removal, contact your dentist or oral surgeon right away.
The exact cause of dry socket is still being studied. Researchers think that certain issues may be involved, such as:
- Bacteria that gets into the socket.
- Injury at the surgical site when tooth removal is difficult. This can happen with irregular wisdom tooth development or position, called an impacted wisdom tooth.
Factors that can increase your risk of developing dry socket include:
- Smoking and tobacco use. Chemicals in cigarettes or other forms of tobacco may prevent or slow healing. These chemicals can get into the wound site. Also, the act of sucking on a cigarette may cause the blood clot to come out too early.
- Birth control pills. High estrogen levels from birth control pills may cause problems with healing and increase the risk of dry socket.
- Improper at-home care. Not following home-care instructions and having poor mouth care may increase the risk of dry socket.
- Tooth or gum infection. Current or previous infections around the area where the tooth was removed increase the risk of dry socket.
Even though a dry socket can be painful, it rarely causes an infection or serious complications. But healing in the socket may be delayed. Pain may last longer than usual after a tooth removal. Dry socket also may lead to an infection in the socket.
What you can do before surgery
You can take these steps to help prevent dry socket:
- Look for a dentist or oral surgeon with experience in removing teeth.
- Practice good oral care by brushing your teeth twice a day and flossing once a day. Good oral care before surgery keeps your teeth and gums clean and removes bacteria.
- If you smoke or use other tobacco products, try to stop smoking before your tooth is removed. Smoking and using other tobacco products increase your risk of dry socket. Talk to your doctor or other health care professional about a program to help you quit for good.
- Talk to your dentist or oral surgeon about any prescription medicines, medicines you can buy off the shelf, herbs, or other supplements you’re taking. Some may cause problems with blood clotting.
What your dentist or oral surgeon may do
Your dentist or oral surgeon can take steps to help with proper healing of the socket and prevent dry socket. These steps may include recommending one or more of these medicines, which may help prevent dry socket and infections:
- Dressing with medicine to put on the wound after surgery.
- Antibacterial mouthwashes or gels immediately before and after surgery.
- Antiseptic solutions to put on the wound.
- Oral antibiotics, usually only if you have a weakened immune system.
What you can do after surgery
Your dentist or oral surgeon can give you instructions about what to expect during the healing process after a tooth removal and how to care for the site. Proper at-home care after a tooth removal helps with healing and prevents damage to the wound. To help prevent dry socket, instructions will likely include:
- Activity. After your surgery, plan to rest for that day. Follow instructions from your dentist or oral surgeon about when you can return to your usual activities. Also follow instructions about how long to avoid vigorous exercise and sports that might cause the blood clot to come out of the socket.
- Pain management. Put cold packs on the outside of your face on the first day after tooth removal. After the first day, warm packs may help. Cold and warm packs can help decrease pain and swelling. Follow instructions from your dentist or oral surgeon about putting cold or heat on your face. Take pain medicines as prescribed.
- Beverages. Drink lots of water after the surgery. Avoid alcoholic, caffeinated, carbonated or hot beverages for as long as recommended. Do not drink with a straw for at least a week. The sucking action may cause the blood clot to come out of the socket.
- Food. Eat only soft foods, such as yogurt or applesauce, for the first day. Be careful with hot and cold liquids or biting your cheek until the numbness wears off. When you feel ready, start eating foods that do not need a lot of chewing. Avoid chewing on the surgery side of your mouth.
- Cleaning your mouth. After surgery, you may gently rinse your mouth and brush your teeth, but avoid the site where the tooth was removed for the first 24 hours. After the first 24 hours, gently rinse your mouth with warm salt water several times a day for a week after your surgery. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water. Follow the instructions from your dentist or oral surgeon.
- Tobacco use. If you smoke or use tobacco, do not do so for at least 48 hours after surgery and as long as you can after that. Using tobacco products after oral surgery can slow healing and increase the risk of complications.
Severe pain following tooth removal is often enough for your dentist or oral surgeon to suspect dry socket. You’ll likely be asked if you have any other symptoms. Your dentist or oral surgeon can check your mouth to see if you have a blood clot in your tooth socket or if you have lost the clot and have exposed bone.
You may need X-rays of your mouth and teeth to rule out other conditions, such as a bone infection. The X-rays also can show if you have small pieces of tooth root or bone remaining in the site after surgery.
Treatment of dry socket focuses on reducing symptoms, especially pain. Treatment may include:
- Flushing out the socket. Your dentist or oral surgeon may flush out the socket to remove any food bits or other loose materials that may add to pain or possible infection.
- Dressing with medicine. Your dentist or oral surgeon may pack the socket with medicated gel or paste and a dressing. These can provide quick pain relief. Whether you need dressing changes and how often and whether you need other treatment depends on how severe your pain and other symptoms are.
- Pain medicine. Ask which pain medicine is best for you. You’ll likely need a prescription pain medicine.
- Self-care. Once your dentist or oral surgeon takes out the dressing, you may need to flush the socket at home to keep it clean and improve healing. Your dentist or oral surgeon can give you instructions. You may get a plastic syringe with a curved tip to squirt water, salt water or a prescription rinse into the socket.
Once treatment starts, you may begin to feel some pain relief. Pain and other symptoms should continue to improve and will likely be gone within a few days. Even when you’re feeling better, keep scheduled appointments with your dentist or oral surgeon for dressing changes and other care.
References
- Daly BJM, et al. Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database of Systematic Reviews. 2022; doi:10.1002/14651858.CD006968.pub3.
- Chow O, et al. Alveolar osteitis: A review of current concepts. Journal of Oral and Maxillofacial Surgery. 2020; doi:10.1016/j.joms.2020.03.026.
- Ghosh A, et al. Aetiology, prevention and management of alveolar osteitis — A scoping review. Journal of Oral Rehabilitation. 2022; doi:10.1111/joor.13268.
- Adekunle AA, et al. Effectiveness of warm saline mouth bath in preventing alveolar osteitis: A systematic review and meta-analysis. Journal of Cranio-Maxillofacial Surgery. 2021; doi:10.1016/j.jcms.2021.09.001.
- dos Santos Canellas JV, et al. Intrasocket interventions to prevent alveolar osteitis after mandibular third molar surgery: A systematic review and network meta-analysis. Journal of Cranio-Maxillofacial Surgery. 2020; doi:10.1016/j.jcms.2020.06.012.
- Buttaravoli PM, et al. Dental pain, postextraction alveolar osteitis (dry socket, septic socket, necrotic socket, localized osteitis). In: Minor Emergencies. 4th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed March 30, 2023.
- Hupp JR, et al., eds. Postextraction patient management. In: Contemporary Oral and Maxillofacial Surgery. 7th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed March 30, 2023.
- Postextraction problems. Merck Manual Professional Version. https://www.merckmanuals.com/professional/dental-disorders/dental-emergencies/postextraction-problems?query=postextraction%20problems. Accessed March 30, 2023.
- Medical review (expert opinion). Mayo Clinic. April 28, 2023.
- Azher S, et al. Antibiotics in dentoalveolar surgery, a closer look at infection, alveolar osteitis and adverse drug reaction. Journal of Oral and Maxillofacial Surgery. 2021; doi:10.1016/j.joms.2021.04.019.
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