Dry Socket

Question: What is dry socket and why is it so painful?

Explanation: Dry socket, or alveolar osteitis, occurs when the blood clot in an extraction socket dislodges or dissolves prematurely, exposing bare bone and nerve endings. It typically begins two to four days after extraction, just as post-operative pain should be improving. The pain is severe, deep, radiating to the ear or temple, and poorly relieved by ordinary painkillers. A foul taste and odour are common. The socket appears empty with visible greyish bone. Treatment involves gentle irrigation and packing the socket with a medicated dressing. It is not an infection.

Related Questions:

What increases the risk of dry socket?

Smoking is the single largest factor, both chemically and through the suction of inhaling. Lower wisdom tooth extractions, traumatic extractions, oral contraceptive use, prior dry socket, and vigorous rinsing or spitting in the first 24 hours all raise risk. Rates after routine extractions are around 2 to 5 per cent.

How long does dry socket last?

Untreated, seven to ten days as the socket slowly granulates. With a medicated dressing, pain typically improves within an hour and the dressing is changed every few days. Most cases settle within a week of treatment beginning.

Is dry socket an infection that needs antibiotics?

No. It is a failure of clot organisation, not a bacterial infection, and antibiotics do not treat it. Management is local. Irrigation to remove debris, followed by an obtundent dressing containing eugenol, provides symptomatic relief while healing proceeds.