Dry Sockets (Alveolar Osteitis)

Dry sockets, termed alveolar osteitis by dentists, are a fairly commonplace complication associated with having a tooth extracted. While the exact pathogenesis of dry sockets has not been thoroughly explained, their occurence is associated with a situation where the blood clot normally expected to occupy the extraction site and initiate its healing has instead been lost. The net result is that the healing of the socket becomes delayed.

The symptoms of a dry socket are pain, foul odor and foul taste emanating from the tooth extraction site. These symptoms characteristically do not appear until some days after the tooth has been removed. Clinical experience and dental research have identified a number of factors that seem to place dental patients at greater risk for experiencing dry sockets. If the dentist and dental patient keep these factors in mind when planning for and then proceeding with a tooth extraction they may help to minimize the risk for dry socket formation.

The use of analgesics (pain pills), either non-prescription or prescription, is typically not the most effective solution for controlling the pain and discomfort associated with dry sockets. In most cases the best treatment involves a dentist inserting a medicated dressing, daily if needed, into the dry socket. The idea is that this treatment dressing helps to control the level of pain the dental patient experiences until the (delayed) healing process is able to progress and resolve the symptoms of the dry socket.

What are dry sockets?

A dry socket, more formally referred to as alveolar osteitis by dentists, is a fairly common complication associated with tooth extractions. The formation of a dry socket involves a scenario where the blood clot which forms in the tooth socket's after the extraction isn't properly retained (either it disintegrates by way of fibrinolysis or becomes dislodged). Since this blood clot is an important factor in protecting the boney socket and initiating the healing process, the healing of the extraction site is interrupted and becomes delayed.

What are the symptoms of a dry socket?
With most tooth extractions a dental patient will experience some level of discomfort at the extraction site (no matter how minor) on the day the tooth has been removed and then, with each day that passes, less and less pain as the healing process progresses. In those cases where a dry socket forms, the patient typically notices that their level of discomfort does progressively diminish for the first few days but then, between three and five days after the extraction, pain from the extraction site begins to intensify.

Dry socket signs and symptoms ...

The pain associated with a dry socket can be moderate to severe in intensity and often has a throbbing component. The pain can be just localized to the extraction site or it may radiate from the extraction site to the patient's ear or eye (on the same side of their face). Additionally, the dental patient may notice a foul odor or taste emanating from the tooth socket. Upon visual inspection (when possible) the tooth socket will appear to be empty (minimal or no blood clot or granulation tissue present) and when looking down into the socket exposed bone is visible. The term "dry socket" is derived from this empty socket appearance. The lymph nodes in the patient's jaw or neck may become enlarged.

How often do dry sockets occur?

The frequency of occurrence for dry sockets, when considering for all tooth extractions collectively, is roughly on the order of 1 to 3%. Extractions involving lower teeth, especially molars, are statistically more likely to result in dry socket formation. Dry sockets may occur in as many as 20% of the cases involving the extraction of mandibular (lower) impacted wisdom teeth.

What causes dry sockets?

• Dental patients who don't follow their dentist's postoperative instructions have a greater incidence of dry sockets.
• Dental patients who have experienced dry sockets with past tooth extractions are at greater risk for developing a dry socket with future tooth extractions.
• Traumatic tooth extractions are more likely to result in dry socket formation.
• Patients who smoke tend to have a greater incidence of dry socket formation.
• Women who take oral contraceptives are at greater risk for dry sockets.
• The presence of bacteria may play a role in dry socket formation.
• The age of the dental patient may be related to the risk for experiencing dry sockets.

How do dentists treat dry sockets?

The focus of the protocol that a dentist follows when providing treatment for a patient who has a dry socket is usually only supportive and palliative. A dry socket is a situation where the extraction site's healing has been delayed. With time the extraction site will still go ahead and heal on its own, it will just take longer than it would otherwise. Dry socket treatments do not speed up the healing of the wound, they simply help to mitigate the discomfort the patient experiences while the (now prolonged) healing process takes place.

It's typical that the discomfort associated with a dry socket is difficult to control with analgesics (pain pills) alone (either non-prescription or prescription). Usually the best treatment solution involves returning to your dentist's office so they can wash out the extraction site and then place a medicated dressing into the socket.

The dressing that is selected for placement into the tooth socket will vary from dentist to dentist depending upon their previous experiences with different products. Some of the more common ingredients incorporated into dry socket dressings are eugenol (an extract of clove oil) and benzocaine (an anesthetic). Usually the dressing is changed (depending on the patient's comfort requirements) every 24 to 48 hours for 3 to 6 days. A patient can experience dramatic relief, even within an hour, once a dry socket dressing has been placed.