In most dental patients, blood fills up the open socket in the bone left after a tooth extraction. The blood hardens or clots and protects the tooth socket while the gums grow over the top of the hole. In most cases the gums completely grow over and close the tooth extraction socket within one to two weeks. Over the next year, the blood clot is replaced by bone that fills the socket.
In a patient with a dry socket, blood does not fill the extraction socket or the blood clot is lost. The most common causes are spitting, smoking, rinsing in the first few hours, or eating hard foods that dislodge the clot. With the clot missing, there is exposed bone in the extraction socket.
This open “dry” socket causes a constant dull throbbing pain that is quite uncomfortable. The more bone that is exposed, the more symptoms a patient may have. The dry socket pain can sometimes be felt in the ear or back of the head. Unfortunately, once a dry socket has formed and becomes inflamed, healing is often slower than normal.
Until the gums have healed over the exposed socket completely, the pain will continue. This typically lasts for an additional week.
The dental name for a dry socket is “acute alveolar osteitis,” which means sudden inflammation of the bone that supports a tooth.
While dry sockets are quite painful, there is no risk of long term complications. Patients who get dry sockets will ultimately heal normally and should not be concerned about any long term problems.
Causes of A Dry Socket
Dentists don’t know exactly what causes a dry socket. Dry sockets seem to occur more with lower teeth than upper teeth and more with females rather than males. Dry sockets are significantly more common with smokers. Dry sockets happen more often after difficult extractions.
Many believe the cause stems from a reduced blood supply to the healing area. For example, very dense bone and the bone around root canalled teeth tend to have fewer blood vessels which aid in healing. While Dr. Harris may be able to identify cases which seem more likely to get a dry socket, it can happen with any extraction at any time during healing.
Anything that can dislodge a forming blood clot can cause a dry socket. Forceful spitting or sucking through a straw can pull a blood clot completely out of its socket and cause a dry socket. Premature rinsing and smoking are also major causes.
Dry Socket Prevention
Dr. Harris makes every attempt to remove teeth in as conservative, atraumatic and gentle fashion as possible. In fact, dry sockets do not occur very often in our practice. It is our belief that the more trauma to an extraction site, the more chance a dry socket will develop. All of our incisions are kept to a minimum and the gum tissue is disturbed as little as possible to help keep the blood supply to the extraction socket intact.
As always, it is extremely important that the post-operative instructions are followed very carefully.
Unfortunately, Dry socket pain will typically persist until the gums have healed sufficiently to cover the painful exposed bone. There is little we can do to speed along healing. Generally, Dr. Harris recommends supportive care such as over the counter pain medications in combination with narcotic pain relievers as needed.
Many dentists pack a dry socket with eugenol based medications that help decrease the pain temporarily. However, the packing process itself can irritate the dry socket and may slow healing.
In addition, when the temporary effects wear off, the pain will likely return. Often, once begun, the application of dry socket dressing must be performed daily until healed. Generally, Dr. Harris reserves the use of dry socket packing for severe cases only. Fortunately, this is very rare.
Everyone at High Desert Oral Surgery and Implant Center understands how difficult and upsetting getting a dry socket can be. We will strive to do everything we can to aid you in quick healing and managing any post-operative pain or complications. Please let us know if you have any questions or needs.