Dry socket is a very common debilitating, painful complication of tooth extraction. It arises anytime between one to 3 days.
The incidence of dry socket ranges from 0.5-5% for all routine extractions but reaches up to 38% for the removal of lower wisdom teeth hidden under the bone (impacted teeth).
A dry socket is often misunderstood as an infection. However, it arises from the disintegration of a blood clot from the socket or failure of blood clot to form, leaving the bone exposed.
What are the risk factors for Dry socket
Bacteria are thought to play a role in the breakdown of a clot because of the high frequency in people with poor oral hygiene or the increase bacterial load in the socket area from the infected extracted tooth
Dry socket is more common in smokers. Smoking may introduce harmful substances at the extraction site that act as contaminators to the surgical wound.
Nicotine, cotinine, carbon monoxide, among others, acts as toxins for several types of cells and inhibit the healing process. Moreover, nicotine also decreases the blood supply to the wound and delays the healing.
The frequency of dry socket pain is higher among women taking oral contraceptives with its incidence 4 times more than those not taking oral contraceptives.
Surgical removal of impacted mandibular third molars should be carried out before the age of 24 year for female patients to reduce the risk of post-operative complications like dry socket.
Damage to the tissues
The difficulty of extraction and damage to the tissues has been postulated as a major causative factor. Surgical extractions and removal of impacted wisdom teeth are 10 times more prone to developing dry sockets.
Dry socket is observed in people over 40-45 years. The prevalence of 1% to 4% after teeth extraction, with an incidence 10 times greater for lower teeth than for upper teeth and reaching 45% for lower wisdom teeth.
How to tell if you have dry socket?
The most common symptom of dry socket is pain.
You might experience an initial improvement over the first 24 hours and then subsequently go on to develop a severe, debilitating, constant pain. The pain continues through the night, becoming most intense at 72 hours post-extraction.
You may also experience a foul taste and bad breath. Moreover, the pain responds poorly to the painkillers prescribed.
An empty socket with no blood clot and exposed bone indicate that it’s a dry socket pain.
The socket may be filled with a mixture of saliva and food debris. Moreover, the adjacent gums tend to be red, painful, and swollen.
What is the treatment for a dry socket:
Irrigation and placement of a dressing
Dry socket resolves on its own but due to the severity of the pain, you may need a symptomatic treatment to resolve the pain.
Your dentist irrigates the socket with an antibacterial solution to remove all the food particles, bony or tooth fragments and dead cells that interferes with the clotting process and cause infection.
The socket is then packed with a medicated gel or dressing that has an antibacterial and anti-fungal action and eases the pain of a dry socket.
You are asked to return if the pain persists. The whole procedure may have to be repeated until the pain subsides.
The dentist will prescribe you non-steroidal anti-inflammatory painkillers for pain relief.
Self-care at home to keep the socket and mouth clean is critical:
• Once the dressing is removed, you need to flush the socket at home to promote healing and eliminate debris. You will receive instructions and a plastic syringe with a curved tip to squirt water into the socket.
• Regular gentle warm salt water mouth or Chlorhexidine 1% (diluted with water) at least 4-5 times a day.
• Maintain good oral hygiene.
• Avoid smoking and using tobacco products.
• Drink plenty of clear fluids.
How do you prevent a dry socket?
To prevent dry socket, it is important that to strictly follow the tooth extraction aftercare measures. here are the list of instructions:
• Ensure that your dentist or oral surgeon is experienced with the type of surgery you require. Surgical extraction, impacted wisdom tooth extraction or tooth with twisted roots, etc,. require an experienced dentist or oral surgeon.
• Bite on the dampened gauze for 30-60 mins to allow a blood clot to form.
• Do not use a straw for at least 24-48 hours after your surgery.
• Avoid spitting vigorously after rinsing for 24-48 hours after the extraction. Passively empty your mouth if required.
• Avoid beverages or mouthwash containing alcohol for at least 24 hours to reduce the likelihood of the clot becomes dislodged. Alcohol has an anticoagulant effect and can increase the risk of bleeding.
• Don’t smoke or use oral tobacco for 72 hours after the procedure.
• Start gently brushing your teeth by day 2 but make sure not to injure the tissues at the site of surgery.
• Rinse your mouth with warm saline 4-5 times a day.
• Eat a soft nutritious diet such as soups, eggs, milkshakes, chicken, and smoothies. Avoid crunchy, hard, and tough foods for at least 2 weeks. After about 7-10 days, you can switch back to your regular diet.
• You should limit strenuous activity for the first 24 hours after the extraction to reduce bleeding and help the blood clot form.
Dry socket is the most common post-extraction complication resulting in pain. It arises from the breakdown of a blood clot from the socket or failure of the clot to form, leaving the bone exposed.
Traumatic extractions, smoking, use of oral contraceptives and poor oral hygiene are risk factors for the development of dry socket.
Irrigation of local area with an antibacterial solution and placement of a medicated dressing by the dentist remove all the foreign particles and accelerate healing.