After tooth extraction, a blood clot forms in the socket left behind. This clot protects the sensitive tissue, nerves, and bone and promotes quick healing. But what happens if something delays, dissolves, or dislodges the blood clot? The result is a dry socket or alveolar osteitis.
Dry sockets can happen after tooth extraction but are most common after wisdom tooth removal.
What Does a Dry Socket Look Like?
During the normal healing process after an extraction, a deep red blood clot forms in the socket. The top of the clot sits flush with the gum line and prevents anything from entering the socket.
After a few days, the clot starts to dissolve, making way for a whitish protein called fibrin. Granulation tissue, made of collagen, white blood cells, and new blood vessels, also develops. As time passes, new gum tissue grows over the fibrin, eventually turning pink and fitting in with the rest of the gums.
When a dry socket occurs, you may only see a small black hole where the tooth used to be. This often happens when the gums are fleshy or puffy due to inflammation. Depending on where the extraction occurred, the angle may make it difficult to see the empty socket.
If the surrounding tissue and viewing angle allow, you may see directly into the dry socket. A clean, dry socket exposes the jawbone and nerve tissue to the air. The bone is white and stands out in contrast with the surrounding gums. The fibrin or granulation tissue may be visible depending on how long it has been since the extraction. Their development takes longer to happen without the protection of a blood clot. If visible, they appear milky white.
If a foreign matter has filled the dry socket, it will usually appear dark. Food particles and bacteria are the most common things to end up packing a socket. Both can increase discomfort and slow the healing process.
Moreover, bacteria will likely cause an infection, which can lead to further complications. Infected material in the socket can appear in different shades of green, yellow, or black.
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You Might Have a Dry Socket If…
Pain is the primary symptom of a dry socket – lots of pain. Because it is a surgical procedure, tooth extraction always brings some discomfort. However, a socket protected by a clot will become much less painful in 2 or 3 days. On the other hand, a dry socket will become more painful as time goes on. Furthermore, the pain often radiates outward from the extraction site to the whole jaw, neck, ears, and eyes.
Some people know they have a dry socket because they can see the exposed bone or foreign matter at the extraction site. Other symptoms include a bad taste in the mouth, bad breath, and a mild fever. These symptoms are due to an infection in the socket that probably requires treatment.
Why Do Dry Sockets Happen?
Direct Causes
Sometimes people inadvertently damage or destroy the blood clot, causing a dry socket. Creating a vacuum inside the mouth by grinding teeth or drinking through a straw can pull the clot out. Likewise, brushing or swishing mouthwash too vigorously can destroy the clot. Finally, heavy exercise can cause a rise in blood pressure and heart rate. Some doctors believe that these factors could pop the clot from the inside.
Indirect Causes
Certain habits can cause a dry socket. Food particles may enter the socket before the clot forms, potentially causing infection and preventing a clot from forming. Drinking alcohol or soda can actually dissolve the blood clot even after it has formed completely. In addition, smoking dries out the mouth and damages the clot. Finally, the nicotine from smoking can slow down healing by reducing blood vessel function.
Physiological Causes
Some preexisting medical conditions frequently cause dry sockets. Any illness that affects blood clotting can prevent a clot from forming in the first place. Hemophilia and anemia are examples of such illnesses. Preexisting infections like periodontitis can cause a dry socket when bacteria break down and consume the blood clot. These bacteria will then infect the tissue of the socket itself. Birth control pills also seem to cause dry sockets, although it is unknown how.
A paper in The International Journal of Dentistry identifies the following as the main causes for the formation of a dry socket:
- Poor oral hygiene
- Vasoconstrictors
- Reduced blood supply
In addition, the authors of a paper published in the British Dental Journal mention the following as the causes of dry sockets:
- Patient not complying with post-operative care instructions
- Fibrinolysis
- Smoking
- Oral contraceptive use
- Surgical trauma during extraction
- Infection around the extracted tooth
- History of having dry sockets
How to Fix a Dry Socket
The best cure for a dry socket is prevention. The dentist or surgeon will tell you everything you need to do to prevent a dry socket. If you follow their advice and refrain from hot food or drinks, you can increase your chances of not dealing with one.
They will also tell you to avoid alcohol and tobacco.
Finally, you should only brush very gently and avoid hard chewing. Unfortunately, a dry socket can still happen even if you follow all the doctor’s advice.
A dentist will flush out the socket to remove any debris or bacteria. Once the socket is clean, they will pack it with a medicated dressing or gauze. This dressing often comes with a local anesthetic to reduce the pain. It also prevents any more foreign matter from entering the socket.
Although the dentist may need to repack the socket a few times, your body’s healing will eventually progress, and the granulation tissue will fill the socket.
ALSO READ: The Dry Socket Healing Timeline
Good to Remember: Do not rinse your mouth within 24 hours after the extraction. It could weaken the clot and impair the healing process.
Dentistry Review on managing dry sockets: “There is no standard recommendation for treatment of dry sockets, and it is commonly missing in clinical practice guidelines in many dental centers.”
Can a dry socket heal on its own?
Dry sockets are self-healing conditions. Besides, there is no specific medication for treating a dry socket. However, the problem is that a dry socket may indicate some greater complications you may have. It is wise to contact a dentist if you believe you have a dry socket after extraction.
Dentists can help clean the socket by flushing out any food debris. They can numb the site to reduce inflammation and dress it to prevent the socket from getting infected. Based on your medical history, they may make a plan for you to accelerate the healing of your dry sockets.
Final Word
Tooth extractions are never pleasant. Luckily, when things go well and a blood clot forms, you can heal from them in just a few days. But if you refuse to follow the dentist’s advice, you might be in for a rough ride. Damaging the clot can cause a dry socket, which will be painful. But the appearance of the socket might have the clues you need to determine whether you are in the clear. It could also let you know if you are exposed to a potential infection.
Getting treatment as soon as you spot a dry socket can avoid infection and get your recovery back on track.
FAQ
Dry sockets usually occur 3 to 5 days after the extraction and can take 7 to 10 days to heal. Taking antibiotics may not be a treatment for dry sockets, as dry sockets do not result from bacterial infection. Many dentists consider dry sockets an emergency. Therefore, seeing a dentist as soon as possible is better if your tooth socket does not start healing and you experience severe pain 3 to 4 days after tooth extraction.
Extreme pain at the socket indicates that you may have a dry socket. The pain may gradually spread to your jaw, ears, and neck. You will have inflammation in the socket, which may begin to turn black. Your gums will look fleshy or puffy due to the inflammation. You may even see an exposed bone at the site of the socket.
There is no specific treatment for dry sockets. They are self-healing conditions. Dentists flush the sockets to remove food debris and dress the site with Alvogyl. Alvogyl may contain butamben, eugenol, and iodoform antimicrobial agent. It helps numb the site and reduce inflammation.
Sources
- Babatunde O. Akinbami, Thikan Godspower, “Dry Socket: Incidence, Clinical Features, and Predisposing Factors”, International Journal of Dentistry, vol. 2014 https://doi.org/10.1155/2014/796102
- Sharif, M., Dawoud, B., Tsichlaki, A. et al. Interventions for the prevention of dry socket: an evidence-based update. Br Dent J 217, 27–30 (2014). https://doi.org/10.1038/sj.bdj.2014.550
- Santhosh Kumar, Suhas Manoharan, Nabeel Nazar. Dry Socket and Its Management – An Overview. Int J Dentistry Oral Sci. 2021;08(04):2158-2161
- Cleveland Clinic. ‘Dry Socket.’
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