Dry Socket Information
Yukon Maxillo-Facial Surgery Center
Dry Socket Information
Most of us, at one time or another, have heard the term “dry socket” and for many who are to have a tooth or teeth removed, it creates a certain fear. Tooth extraction is the most common of all surgeries and in most cases is a relatively minor operation. Few people escape this operation at sometime during their lifetime.
This sheet is designed to help you understand what a dry socket is, its possible causes, how it can be prevented, treatment, and what it means to you, the patient who may have a dry socket.
How a Normal Socket Heals
Experts can’t agree on what percentage of routine dental extractions result in a dry socket, but it can range anywhere from 2 to 6%. One thing they all agree on is that the most common area for a dry socket is the lower wisdom tooth area followed by the lower molar area in general.
Simply stated, a dry socket is a defective, abnormal healing, generally in the molar extraction site. When a tooth is removed, the empty socket fills with blood. This blood becomes the forerunner to the future permanent tissue that will eventually fill the socket.
Once the blood clots, it organizes and microscopic blood vessels penetrate it, carrying in nutrients and a variety of different cells that are part of the healing process. As time passes, the blood clot is converted to fibrous scar tissue, which then becomes calcified with conversion to bone.
An x-ray of the extraction site taken several months later shows virtually no evidence of the former tooth socket because new bone has filled the area. This is the process of normal healing of an extraction site.
What is a Dry Socket?
When a tooth is removed, a “hole” is left in the jaw. Healing normally occurs with a blood clot forming in the holes as described. New tissue forms, which is eventually converted into bone. Sometimes, however, the clot is either lost or doesn’t form properly.
A dry socket occurs when, in the early stages of clotting and clot organization, certain bacteria attack the clot and feed off of it. This happens somewhere between the third and fifth day following the extraction. These germs exist in all mouths and can prevent the blood clot from progressing to normal healing. As the bacteria begin to digest the clot, there is a typical odor and taste that is foul and characteristic of a dry socket.
Once enough of the clot has been “digested” by the bacteria, the walls of the tooth socket become exposed and inflammation sets in. This causes the pain of a dry socket and cane make the entire jaw ache, even causing an earache. The two most common signs of a dry socket, therefore, are pain in the jaw and ear and the foul taste and odor from the blood clot.
A dry socket can either be partial or complete, that is, only a portion of the blood clot is destroyed or the entire blood clot is affected. The pain often will radiate to the ear and is caused by exposed bone that is not converted by a clot or new tissue. A dry socket is neither an infection nor an ear problem.
What causes a Dry Socket?
It is believed by experts that normal surgical injury to the socket, combined with certain bacteria, and an inflammatory process are the causes of a dry socket.
Other factors that influence the incidence of dry sockets are female hormones, the birth control pill, and smoking. It has been shown that cigarette smoking can increase the incidence of dry socket by approximately four times. For this reason, we ask all our patients to refrain from smoking for at least 6 hours prior to surgery and for 7 days postoperatively.
Treatment of a Dry Socket
Should you develop an increasing amount of postoperative pain, a possible earache, and a bad taste, you have probably developed a dry socket. Treatment centers itself around replacing the missing clot with medication that will help to soothe the socket and eliminate the pain, while stimulating the formation of new healing tissue.
A dry socket is treated by gently rinsing the wound and placing an antiseptic and soothing dressing into the wound. This will greatly reduce the discomfort and foul taste. In most cases, an effective dry socket dressing will last for approximately 7 days and will no longer be needed after this time.
Most patients require no other treatment and will proceed to normal healing with the help of daily rinses by using a specially shaped plastic syringe to keep the socket cleaned. Some patients require repeated placement of dressings into the socket, if the dry socket, in fact, is 100% or without any natural clot left.
There is no surgical treatment for a dry socket, nor are antibiotics of much value. It is important for you to return to the office if the symptoms of a dry socket return.
We hope this information helps you to understand more fully this fairly common but unpleasant side effect of tooth extractions.