Dry socket (alveolar osteitis) is a painful dental condition that can occur after you have a permanent adult tooth extracted. Dry socket is the most common complication following tooth extractions, such as the removal of impacted wisdom teeth. If you develop dry socket, the pain usually begins three to four days after your tooth is removed.
Normally, a blood clot forms at the site of a tooth extraction. This blood clot serves as a protective layer over the underlying bone and nerve endings in the empty tooth socket. The clot also provides the foundation for the growth of new bone and for the development of soft tissue over the clot.
Dry socket occurs when the blood clot at the site of the tooth extraction has been dislodged or has dissolved before the wound has healed. Exposure of the underlying bone and nerves results in intense pain, not only in the socket but also along the nerves radiating to the side of your face.
Over-the-counter medications alone won't be enough to treat dry socket pain. Your dentist or oral surgeon can provide treatments to relieve your pain and promote healing.
Signs and symptoms of dry socket may include:
- Severe pain within a few days after a tooth extraction
- Partial or total loss of the blood clot at the tooth extraction site, which you may notice as an empty-looking (dry) socket
- Visible bone in the socket
- Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction
- Bad breath or a foul odor coming from your mouth
- Unpleasant taste in your mouth
- Swollen lymph nodes around your jaw or neck
- Slight fever
When to see a doctor
A certain degree of pain and discomfort is normal after a tooth extraction. However, you should be able to manage normal pain with the pain reliever prescribed by your dentist or oral surgeon, and the pain should lessen with time. If you develop new or worsening pain in the days after your tooth extraction, contact your dentist or oral surgeon immediately.
The precise cause of dry socket remains the subject of study. Researchers suspect that several issues may be at play, including:
- Bacterial contamination of the socket
- Severe bone and tissue trauma at the surgical site due to a difficult extraction
- Very small fragments of roots or bone remaining in the wound after surgery
Factors that can increase your risk of developing dry socket include:
- Smoking and tobacco use. Chemicals in cigarettes or other forms of tobacco may prevent or slow healing and contaminate the wound site. The act of sucking on a cigarette may physically dislodge the blood clot prematurely.
- Oral contraceptives. High estrogen levels from oral contraceptives may disrupt normal healing processes and increase the risk of dry socket.
- Improper at-home care. Proper at-home care after a tooth extraction helps promote healing and prevent damage to the wound. Failure to follow guidelines may increase the risk of dry socket.
- Having dry socket in the past. If you've had dry socket in the past, you're more likely to develop it after another extraction.
- Tooth or gum infection. Current or previous infections around the tooth to be extracted increase the risk of dry socket.
- Use of corticosteroids. These types of medications, such as prednisone, may increase your risk of dry socket.
Make an appointment with your dentist or oral surgeon as soon as possible when you develop new or worsening pain after a tooth extraction.
Some basic questions to ask include:
- What are the likely causes of my pain?
- Do I need any tests?
- What type of treatment will I likely need to improve my symptoms?
- What can I take for the pain?
- How soon will I feel better?
- How long should I wait to eat or drink after this procedure?
- Are there any restrictions I need to follow?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can have? Are there any websites you recommend?
In addition to the questions you've prepared in advance, don't hesitate to ask questions during your appointment whenever you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you these questions:
- When did the severe pain begin?
- Does the pain happen on its own or do you need to drink or touch the area?
- How would you rate the pain on a scale of 1 to 10, with 10 being the most severe?
- Where is the pain located?
- Have you taken pain relievers? What dosage and how often?
- Have the pain relievers helped to some degree?
- Do you have any other symptoms that seem unrelated to your dental pain?
- Have you had a fever?
Severe pain following a tooth extraction is often enough for your dentist or oral surgeon to suspect dry socket. Your dentist or oral surgeon also will ask about any other symptoms and examine your mouth. He or she will check to see if you have a blood clot in your tooth socket and whether you have exposed bone.
You may need to have X-rays taken of your mouth and teeth to rule out other conditions, such as a bone infection (osteomyelitis).
Treatment of dry socket focuses on reducing symptoms, particularly pain. Dry socket treatment may include:
- Flushing out the socket. Your dentist or oral surgeon may flush the socket to remove any food particles or other debris that may contribute to pain or infection.
- Medicated dressings. Your dentist or oral surgeon may pack the socket with medicated dressings. This step provides relatively fast pain relief. You may need to have the dressings changed several times in the days after treatment starts. The severity of your pain and other symptoms will determine how often you need to return for dressing changes or other treatment.
- Pain medication. Talk to your doctor about which pain medications are best for your situation. You'll likely need a prescription pain medication.
- Self-care. You may be told how to flush the socket at home to promote healing and eliminate debris. To do this, you'll be given a plastic syringe with a curved tip to squirt water, salt water, or a prescription rinse into the socket. You'll be instructed to continue the rinse until the socket no longer collects any debris.
Once treatment is started, you may begin to feel some pain relief in just a few hours. Pain and other symptoms should continue to improve and will likely be gone within a few days.
Dry socket rarely results in infection or serious complications. But getting the pain under control is a top priority. You can help promote healing and reduce symptoms during treatment of dry socket by following your dentist's instructions for self-care after your tooth extraction. You'll likely be told to:
- Put cold packs on the outside of your face in the first 48 hours after extraction and warm packs after that, to help decrease pain and swelling
- Take pain medications as prescribed
- Avoid smoking or using tobacco products
- Drink plenty of clear liquids to remain hydrated and to prevent nausea that may be associated with some pain medications
- Rinse your mouth gently with warm salt water several times a day
- Brush your teeth gently around the dry socket area
Keep scheduled appointments with your dentist or oral surgeon for dressing changes and other care. If your pain returns or worsens before your next scheduled appointment, call your provider.
Your dentist or oral surgeon will take a number of steps to ensure proper healing of the socket and to prevent dry socket. You'll be instructed on steps you can take to prevent the complication.
What your dentist or oral surgeon may do
Your dentist or oral surgeon may talk with you about these medications, which may help prevent dry socket:
- Antibacterial mouthwashes or gels immediately before and after surgery
- Oral antibiotics, particularly if you have a compromised immune system
- Antiseptic solutions applied to the wound
- Medicated dressings applied after surgery
What you can do before surgery
You can take these steps to help prevent dry socket:
- Seek a dentist or oral surgeon with experience in tooth extractions.
- If applicable, try to stop smoking before your extraction because smoking and using other tobacco products increase your risk of dry socket. Consider talking to your doctor or dentist about a program to help you quit permanently.
- Talk to your dentist or oral surgeon about any prescription or over-the-counter medications or supplements you're taking, as they may interfere with blood clotting.
What you can do after surgery
You'll receive instructions about what to expect during the healing process after a tooth extraction and how to care for the wound. These instructions will likely address the following issues, which can help prevent dry socket:
- Activity. After your surgery, plan to rest for the remainder of the day. Resume normal activities the next day, but for at least a week, avoid rigorous exercise and sports that might result in dislodging the blood clot in the socket.
- Beverages. Drink lots of water after the surgery. Don't drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don't drink with a straw for at least a week because the sucking action may dislodge the blood clot in the socket.
- Food. Eat only soft foods, such as yogurt or applesauce, for the first day. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
- Cleaning your mouth. Following surgery, you may gently rinse your mouth and brush your teeth, but avoid the extraction site. After the first 24 hours, gently rinse your mouth with warm salt water every two hours while awake and after meals for a week after your surgery. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water.
- Tobacco use. If you smoke, don't do so for at least 48 hours after surgery. If you chew tobacco, don't use it for at least a week. Any use of tobacco products after oral surgery can delay healing and increase the risk of complications.
July 16, 2013
- Neville BW, et al. Oral and Maxillofacial Pathology. 3rd ed. St. Louis, Mo.: Saunders Elsevier; 2009:120.
- Summers A. Emergency management of alveolar osteitis. Emergency Nurse. 2011;19:28.
- Roberts JR, et al. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/das/book/body/202633129-4/0/2083/0.html#. Accessed May 27, 2013.
- Krakowiak, PA. Alveolar osteitis and osteomyelitis of the jaws. The Oral and Maxillofacial Surgery Clinics of North America. 2011;23:401.
- Cardoso CL, et al. Clinical concepts of dry socket. Journal of Oral and Maxillofacial Surgery. 2010;68:1922.
- Dodson T. Prevention and treatment of dry socket. Evidence-Based Dentistry. 2013;14:13.
- Preparing for third molar removal. NIH Clinical Center. National Institutes of Health. http://www.cc.nih.gov/ccc/patient_education/tests_procedures.html. Accessed May 27, 2013.
- Daly B, et al. Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006968.pub2/abstract. Accessed May 27, 2013.
- Fenton DA, et al. Perioperative strategies for third molar surgery. Atlas of the Oral and Maxillofacial Surgery Clinics of North America. 2012;20:25.
- Sheridan PJ (expert opinion). Mayo Clinic, Rochester, Minn. June 26, 2013.