Dry Socket Information
When a tooth is removed, the normal healing process involves a blood clot being formed in the socket. As time passes, the clot becomes fibrous tissue which calcifies and is converted to bone. Sometimes, between the third and fifth day following an extraction, this clot is attacked by bacteria. The bacteria, which occur naturally in the mouth, may destroy a portion or the entire blood clot. This results in an area of exposed bone called a “the socket.” Although bacteria are present, this is not considered an infection.
Several factors predispose a patient to developing a dry socket. Smoking delays wound healing and tends to breakdown the clot, which greatly increases the incidence of dry socket. Negative oral pressure, like sucking on a straw or spitting a lot, may also cause loss of the clot. Nausea and vomiting after surgery and the use of birth control pill also influence the incidence of dry socket.
Nearly everyone has experienced a tooth extraction at one time or another. A routine extraction is a relatively minor procedure which results in only a few days of discomfort. However, in 2-6% of cases, an abnormal healing pattern occurs, commonly known as a “dry socket.” This refers to the fact that there is no visible blood clot remaining in the socket. The medical term applied to this condition is a “localized osetitis”. Lower wisdom teeth or third molars are more commonly affected.
As bacteria destroy the blood clot, the tooth socket becomes exposed and inflammation sets in. Pain in the socket results. In some cases the entire jaw and ear may ache. A foul odor and taste may also be noticed around the extraction area.
There is no surgical treatment for dry socket. Since it is not an infection, antibiotics are of little value. Instead, the treatment of dry socket involves a gentle rinsing of the socket and the application of a medicated gauze dressing. This helps sooth the pain and stimulates the healing process. Generally, a dry socket dressing will be effective for about 2-3 days. In cases where nearly all of the natural clot has been destroyed, repeated dressings may be necessary. The dressings encourage secondary healing of the socket from the bottom up. As secondary healing begins, pink granulation tissue will become evident and the exposed bone will gradually be covered. The socket will begin to fill in, round off and heal with bone. During this process there may be a depression in the bone which must be kept clean. Sometimes patients need to rinse the socket daily with a special plastic syringe.
The incidence and severity of dry socket can sometimes be reduced by administering an antibiotic mouth rinse just before an extraction. Careful adherence to post operative instructions such as limiting activity, proper diet and wound care also reduce the risk of dry socket. In addition, patients should refrain from smoking for at least 5-7 days following a procedure. If you should develop pain and suspect a dry socket, contact our office immediately. Prompt treatment will have you feeling better quickly.