Dry Socket

Alveolar osteitis or dry socket as it is commonly known is a post-operative complication, that usually occurs after a complicated tooth extraction.

What is a Dry Socket

Dry socket or alveolar osteitis is a potential postoperative complication that may occur after a tooth extraction.  Dry socket causes delayed healing but is not associated with an infection. Patient can experience moderate to severe pain.  However, usually symptoms associated with an infection, such as fever and swelling, are not present.  The term “dry socket” describes the appearance of the tooth extraction socket when the pain begins. In a usually clinical course, pain begins  on the third or fourth day after removal of the tooth. Upon examination the socket appears to be empty, wth a partially or completely lost blood clot, and the bone surfaces of the socket are exposed. The exposed bone is extremely sensitive and is the source of the pain.  The moderate to severe pain is dull in nature, usually throbbing is present, and frequently radiates to the patients ear.  The extraction socket is a source of bad odor and taste.

The cause of alveolar osteitis is not absolutely clear, but it appears to be  the result of high levels of fibrinolytic activity in and around the extraction socket. The fibrinolytic activity results in loss of the blood clot, which leads to exposure of underlying bone. The occurrence of a dry socket is very low with simple extractions, about 2 percent of extractions.  Incidence of the complication is much higher after removal of impacted lower third molars., about 20 percent of extractions.

Prevention of the dry socket syndrome requires that the surgeon minimize trauma  and bacterial contamination in the area of surgery.  The incidence of dry socket can also be decreased by preoperative and postoperative rinses with antimicrobial mouthiness, such as chlorhexidine.

Treatment of a Dry Socket

Alveolar Osteitis
Treatment of a dry socket consists of control of the symptoms until the socket has closed

The main focus of treatment for alveolar osteitis (dry socket) is pain control.  Treatment will not expedite the healing process.  Any therapy the dentist provides is geared towards reducing the level of pain while the socket is healing.  Current treatment consists of gentle irrigation with saline and placement of a medicated dressing. The medication used in the dressing consists of eugenol, which makes the pain less intense.  Topical anesthetic, usually benzocaine and a caring agent such as balsam of Peru.  The medicated dressing is gently inserted into the socket and the patient usually experiences profound relief from pain within a few minutes. The dressing can be changed as often as once per day for 3 to 6 days but is usually dictated by the patient’s level of pain after the initial placement.  The socket is gently irrigated with saline at each dressing change.

In cases of severe  pain, managing the discomfort associated with a dry socket can be difficult. Patients have reported that even with the use of controlled substances there is little and short lived pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs), like Ibuprofen, Advil, Motrin, are usually more effective. The reason behind poor effectiveness of controlled substances  as compared to NSAID is because the main cause  of pain is localized inflammation at the extraction site.  The NSAIDs work locally to reduce inflammation, or swelling of the surrounding tissue.  Controlled substances usually block pain signals from reaching the brain and do not reduce the inflammation.  Due to the nature and severity of pain associated with a dry socket, pain control by means of oral medication is not very effective.

If you had an extraction and experience pain that gets progressively worse about 3 days after the extraction, contact your dentist.  The complication can be effectively managed during the healing process.