January 22, 2007

Dry Socket (Alveolar Osteitis)


Dry socket is a complication of having a tooth extracted. Usually, after a tooth is extracted, a blood clot forms in the socket, or hole, and protects the area while it heals. When the blood clot gets washed away, the bone is exposed to air and food.

This is called a dry socket, and it can be extremely painful.
Dry socket is more common in people with diabetes, smokers and women who take oral contraceptives. It occurs following 3% to 20% of extractions and is more common after the removal of premolar or molar teeth in the lower jaw.

Dry socket causes pain in and around the site where the tooth was extracted. The pain usually starts on the third or fourth day after surgery and can radiate out from the site. Many people who have lower back teeth extracted feel pain in the ear on that side. The pain is severe and usually not relieved by over-the-counter painkillers. Dry socket can also cause bad breath and a bad taste in the mouth.

Your dentist will examine the socket to see if it is sensitive to touch. He or she will also look to see if the bone in the socket is exposed. Your dentist will check to see if you have bad breath or spasms of the muscles around your mouth. You may need to have an X-ray to determine whether fragments of the tooth or bone are in the socket.

Expected Duration
A dry socket can last from one to several weeks, although treatment can eliminate or significantly reduce the pain during this time. A tooth socket that does not heal after a few weeks of treatment may be caused by other medical conditions.

Several procedures can help to decrease your risk of dry socket:

Practice good oral hygiene.
Have your teeth cleaned before an extraction.
Do not drink through a straw or spit frequently after an extraction because this can cause the blood clot to dislodge.
If you smoke, try to stop before surgery and for at least two weeks afterward since smoking can slow healing.
If you are using oral contraceptives, try to schedule the surgery during days 23 to 28 of your tablet cycle.

Avoid vigorously rinsing your mouth for the first 24 hours after the surgery and brush and rinse gently for the next week. Your dentist may prescribe an antibacterial rinse to be used before and after surgery.

Your dentist will rinse the socket with a saline solution or an antiseptic and dislodge all debris. You may receive anesthesia during this procedure to minimize discomfort. Then the socket will be packed with a medicated dressing or paste, which will be replaced daily or as necessary until the socket heals and the pain goes away. You may also be prescribed pain relievers or told to take over-the-counter medication for pain relief. Some dentists use a dissolvable sponge soaked with an antibiotic solution.

Once your dentist decides that dressings are no longer required, he or she will instruct you in how to irrigate the socket.

When To Call A Professional
Call your dentist if you experience severe pain that starts a few days after you have a tooth pulled and that seems to originate from that site

Adapted from: Columbia University Medical Center, School of Dental & Oral Surgery