What is “dry socket”?

Dry socket is a painful condition that occurs after a tooth removal. This is a severe pain that starts 2-3 days after the removal and lasts for upto 7 days. Although this may sound scary, dry socket occurs in a small percent of the population that undergo tooth removal. And its easily treatable!!

Why does a dry socket occur?

The teeth lie in sockets within the bone. When the teeth are removed, the socket is filled with blood from the jaw vasculature. This blood forms a clot within this socket covering the underlying bone and nerve endings. This clot provides the base to form new bone in the socket and promote healing of the area. New bone and gums are formed this way to cover the “hole” that is left behind by the tooth. If, however, for some reason the blood clot is dislodged from the socket before the healing is completed, an infection develops in the socket. This is called “dry socket”.

This condition occurs usually after a wisdom tooth removal or other complicated extractions.

Signs and symptoms of dry socket include

  • Severe pain that develops a couple of days after tooth removal
  • Missing blood clot in the extraction site, when the whitesh bone is seen
  • Pain spreading to the ear, temple or neck of the same side of the face
  • Foul odour or bad breath
  • Unpleasant taste in the mouth

You will have to see your dentist if any of these signs and symptoms persist beyond 48hours of the procedure.

Factors that increase the incidence of dry socket

  • Smoking and tobacco use: Chemicals in the cigarette or other tobacco products slow down the healing process. The act of sucking on a cigarette may physically dislodge the clot prematurely.
  • Improper home care: Not following the dentists post operative instructions and poor oral hygiene.
  • A complicated tooth removal such as a wisdom tooth extraction that causes a  greater-than-usual trauma during the tooth extraction procedure
  • Use birth control pills: High oestrogen levels from the oral contraceptive pills may disrupt normal healing process
  • A past history of dry socket after having teeth pulled
  • Tooth or gum infection around the extracted tooth

Treatment for dry socket

  • You can take over the counter pain killers.
  • If the pain and discomfort persists, contact your dentist. Your dentist may prescribe antibiotics and a mediated mouthwash or warm salt water rinses.
  • Your dentist will remove the debris and clean the socket, and then fill the socket with a medicated dressing or a paste that promotes healing. You’ll have to come back for regular dressings till the socket heals and the pain subsides..

How can you prevent dry socket?

  • Avoid cigarettes or other tobacco products at least a day or two before the scheduled procedure.
  • Discuss with your dentist about the medications you are taking. If you are on oral contraceptives or other medicines that alter the clotting of blood appropriate dosage adjustments will be recommended.
  • Your dentist will prescribe oral antibiotics, to prevent infection, anti bacterial mouthwash before and immediately after surgery. Antiseptic gels or solutions will be applied after surgery.
  • Your dentist will give you a set of post extraction instructions that have to be followed to prevent dry socket. These instructions address the following areas

Pain management: Your dentist will prescribe medication for pain and if required oral antibiotics. Medication to reduce swelling following the procedure may be given in some cases. Take all medications as instructed. Apply cold packs from the outside on the face on the day of the surgery. Subsequently, you can apply warm packs to reduce pain and swelling.

Cleaning the teeth and mouth: The first 24 hours are critical for the healing of the socket. Avoid any brushing near the extraction socket or rinsing till 24 hours are up. After the first 24 hours, you can brush gently on the side and rinse with Luke warm salt water. Mix one half teaspoon of salt in 250 ml of warm water to make the rinse. Follow the instructions of your dentist.

Activity: Plan to rest the day of surgery. Your dentist will recommend the amount of physical activity thats allowed for the day and when to resume normal activities. Rigorous exercise, swimming or sports might dislodge the clot from the socket.

Beverages: After surgery, avoid drinking through a straw and spitting for the first few days. The sucking action of the straw may dislodge the clot. Drink plenty water after surgery. Avoid caffeinated, carbonated, alcoholic or hot beverages for as long as your dentist recommends.

Food: Eat cold and soft food for the first two days. Avoid spicy and hard food that can irritate the wound and dislodge the clot. Do not try to remove any food particles that remains in the socket with your tongue. Rinse your mouth gently after every meal. Avoid chewing on the surgery side.

Care of lip and cheek: Make sure to apply pressure on the cotton gauze that your dentist places between your upper and lower teeth. Bite on it with gentle pressure till the effect of the aesthetic begins to wear off. This may take upto an hour. Be careful of biting on your lips, cheek or tongue during this phase.

Cigarettes or tobacco use: Avoid all tobacco products for the next 24-48 hours after surgery or as long you can after that. Tobacco products can delay healing and increase the risk of complications.

Visit your dentist for all the scheduled post operative appointments.