Dodging the dreaded dry socket: Tips on preventing this painful possibility (2024)

The mere mention of dry socket makes dental professionals cringe. Following an extraction, dry socket is one of the most dreaded occurrences that can affect our patients. We all feel compassion for these patients, but do you know the clinical details that can help with this agonizing condition? Here's a look at potential causes of dry socket, preventive steps, and information you can share to quell your patients’ fears prior to an extraction.

The facts about dry socket

Dry socket, also known as alveolar osteitis, is a condition that develops when the blood clot in an extraction site dissolves, does not form properly, or becomes dislodged shortly after the removal of a tooth. A blood clot normally protects bone and nerve tissue in the extraction site during the healing process. When this area is exposed, contaminants may become trapped in the socket and cause problems.1

Dry socket can occur anywhere from 2% to 5% of the time with the extraction of a tooth.2 Mandibular teeth are affected by this condition more often than maxillary teeth. Dry socket is most common in molar extractions and especially in wisdom teeth, where it can occur up to 30% of the time.2

Patients with this condition typically experience a consistent throbbing pain a few days after the tooth is removed. The pain may radiate to other areas of the face and a foul odor may be present. Drinking cold water and breathing in air may also cause discomfort. Food debris commonly collect in the empty socket and aggravate the problem.

More content on dry socket:

Dry socket treatment and prevention: What to tell your patients

Alveolar osteitis: Etiology, prevention, and treatment

When dry socket is suspected, the patient should be advised to return to the dentist or oral surgeon as soon as possible. Many patients try to tough it out due to lack of knowledge about the condition.

Treatment of dry socket often consists of irrigating the area to remove food and other possible irritants and then applying a zinc oxide (ZnO) eugenol dressing to the area. Pain generally subsides quickly after treatment is provided. Over-the-counter pain medications can also provide relief as this area heals.

Addressing dry socket prevention with patients

Patients are often fearful of getting dry socket when they have teeth extracted. They may have heard about others’ terrible experiences. Patient concerns should be addressed preemptively to help prevent them from delaying treatment. You can empower patients by explaining that steps can be taken to dramatically decrease their chances of experiencing dry socket. As always, education is key!

Many of you may already know a few simple precautions that can be taken to prevent dry socket, such as avoiding the use of a straw and refraining from smoking for at least 48 hours after an extraction. Smoking limits blood supply at the extraction site, negatively affects the clot, and can delay healing.3 It is also advisable to avoid spitting and swishing vigorously during this critical period of time. Patients should refrain from drinking carbonated beverages, which can cause problems.

Many people are not aware that what they eat can affect healing after an extraction. It is recommended to eat food that does not pose a risk of leaving remnants behind. This includes nuts, popcorn, rice, and pasta. These types of foods can dislodge blood clots from extraction sites and cause dry socket. Better suggestions for your patients include soft foods such as mashed potatoes, applesauce, yogurt, and gelatin.

Proper dental hygiene is also extremely important in the prevention of dry socket. This includes gently brushing teeth that are close to the extraction site to decrease the quantity of bacteria present in the area. Rinsing with warm salt—but with limited force—can help remove food debris and keep the mouth clean.2

Another effective way to prevent the occurrence of dry socket is to reduce the number of bacteria present in the mouth by using chlorhexidine rinses. A Cochrane Review of four clinical trials published in 2014 showed that there was moderate evidence that chlorhexidine rinses before and after extractions prevented dry socket approximately 42% of the time.4 As this method of dry socket prevention is very easy to implement, most patients should be highly compliant with this suggestion.

Many patients who are smokers find it difficult to refrain from smoking after extractions. Make sure to educate your patients on how smoking dramatically increases their risk of experiencing a dry socket. In a study conducted in 2011 in Palestine, 12% of smokers experienced dry socket compared to only 4% of non-smokers.5 If your patients can discontinue smoking for 24 hours, it will make a difference—and 48 hours is even better. The frequency of smoking was also found to increase the incidence of dry socket.

You can recommend some type of nicotine replacement therapy during this timeframe if your patient has trouble tolerating their nicotine cravings.6 Patches, inhalers, or sprays work best in this situation, as they do not involve the oral cavity. Lozenges or gum are not advisable, as they are placed directly in the mouth and may only cause more complications after extractions. Hopefully, successfully refraining from smoking for a few days can help your patient consider quitting smoking on a permanent basis.

Other factors to consider with dry socket

Women tend get dry socket more often than men. In fact, according to the Academy of General Dentistry, women who take oral contraceptives are twice as likely to get dry socket due to increased estrogen levels.7 It is recommended that these women wait until the last week of their menstrual cycle, if possible, to have extractions done, as estrogen levels will be inactive at that time.

Another factor to consider is that dry socket occurs more frequently in surgical extractions versus non-surgical extractions.5 This is one of the reasons that dry socket occurs more with the extraction of wisdom teeth. The 2011 Palestinian study previously mentioned above showed that dry socket occurred in only 1.7% of the time with the less involved non-surgical extractions.6 If your patient is in the higher risk group, stress to them how seriously all preventative measures should be taken to avoid dry socket.

Treating patients with ozone is another possibility being researched as a method to prevent dry socket. In a pilot study published in the European Journal of Dentistry, 30 people with bilateral impacted third molars of mandible were treated with surgical extractions.8 This group was at a high risk for dry socket in accordance with the type of extractions needed. With the experimental group, ozone gas was administered for 12 seconds to the intraalveolar area after the extractions. Patients were reevaluated 48 hours and seven days post-treatment, and dry socket was present in 16.67% of the control group and in 3.33% of the treated group. This treatment method needs further research, but it looks promising in the prevention of dry socket, especially in high-risk groups.

Final thoughts

The more tools we can find to prevent dry socket, the more comfortable and confident patients will feel when they have extractions performed. Patients may often delay their treatment out of fear, and as time passes their condition will likely become only more complicated. When dry socket occurs, the idea of pain being associated with dentistry is only further promoted. If we can help to prevent this complication through education and the use of simple preventative measures, we can allay this fear and instill continued confidence in the dental profession.

Originally posted in 2018 and updated regularly

References

1. Dry Socket. Columbia College University of Dental Medicine website. https://www.dental.columbia.edu/patient-care/dental-library/dry-socket.

2. Akinbami B, Godspower T. Dry Socket: Incidence, Clinical Features, and Predisposing Factors. Int J Dent. Published online: June 2, 2014 (doi: 10.1155/2014/796102).

3. Avoid Dry Socket with Wisdom Tooth Extractions. Know Your Teeth website. http://www.knowyourteeth.com/infobites/abc/article/?abc=a&iid=340&aid=1364. Updated January 2012.

4. Dodson T. Prevention and Treatment of Dry Socket. Evidence Based Dent. 2013 March; 14 (1): 13-4. https://www.ncbi.nlm.nih.gov/pubmed/23579300

5. Younis M and Hantash R. Dry Socket: Frequency, Clinical Picture, and Risk Factors in a Palestinian Dental Teaching Center. Open Dent J. 2011; 5: 7-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3089956/

6. Using Nicotine Replacement Therapy. https://smokefree.gov/tools-tips/medications-can-help-you-quit/using-nicotine-replacement-therapy

7. Know Your Teeth Infobites: Check Menstrual Calendar for Tooth Extraction-Who is at Risk for Dry Socket. http://www.knowyourteeth.com/infobites/abc/article/?abc=c&iid=340&aid=1365

8. Ahmedi J, Ahmedi E, Sejfija O, et al. Efficiency of Gaseous Ozone in reducing the development of dry socket following surgical third molar extraction. Eur J Dent. 2016 July-Sep; 10(3): 381-5. https://www.ncbi.nlm.nih.gov/pubmed/27403058

Dodging the dreaded dry socket: Tips on preventing this painful possibility (2024)

FAQs

Dodging the dreaded dry socket: Tips on preventing this painful possibility? ›

Do not use a straw for at least three days. Focus on Soft Foods- Soft, easy to eat foods are best after a tooth extraction. Avoid foods that leave particles in the mouth, like rice or nuts. Medications- Some medications can increase your risk of dry socket.

How can I make my dry socket less painful? ›

Lifestyle and home remedies
  1. Take pain medicines as prescribed.
  2. Do not smoke or use tobacco products.
  3. Drink plenty of clear liquids. ...
  4. Rinse your mouth gently with warm salt water several times a day.
  5. Brush your teeth gently around the dry socket area.
  6. Be careful with eating or drinking.
Jul 18, 2023

When can I stop being scared of dry socket? ›

Depending on your oral hygiene, age, and other health factors, it could take you longer than 10 days to recover from a tooth extraction or less than 7 days. The moment you notice the blood clot getting tucked under a layer of your gums, that's when you can finally stop worrying about a dry socket.

How do you swallow to prevent dry socket? ›

Ditch the straw and opt for gentle sips from a cup or mug. Spice-less Smoothies: Spicy, crunchy, or acidic foods can irritate the healing socket. Stick to soft, lukewarm, and smooth foods like mashed potatoes, yogurt, or smoothies for the first few days.

Is dry socket pain unbearable? ›

But the pain with dry socket can be intense. It may start a few days after the extraction. If you have dry socket you may have: severe persistent, throbbing pain within 1 to 5 days of the tooth extraction — the pain may extend to your ear or eye on the same side of the face.

What do dentists use to fill dry socket? ›

After flushing the socket to remove food and debris, your dentist will pack it with a medicated dressing in the form of a paste. One of the ingredients in dry socket paste is eugenol, which is present in clove oil and acts as an anesthetic. Eugenol also has anti-inflammatory and antibacterial properties.

What is the highest risk day for dry socket? ›

The highest risk for this condition is between days 2-3 after tooth extraction. After day 4, the risk of dry socket is passed.

Does drinking water help prevent dry socket? ›

Brush teeth very gently. Drink plenty of fluids. Avoid food, beverages, and activities that threaten your blood clot. Rest from strenuous work as long as possible.

What are the odds of getting a dry socket? ›

Dry socket can occur anywhere from 2% to 5% of the time with the extraction of a tooth. Mandibular teeth are affected by this condition more often than maxillary teeth. Dry socket is most common in molar extractions and especially in wisdom teeth, where it can occur up to 30% of the time.

Should I be paranoid about dry socket? ›

If you take proper care, you can avoid the development of dry socket. Dry socket is not something you should be afraid of or worried about. It is a temporary condition that needs proper treatment.

Why is dry socket an emergency? ›

When this condition occurs, the underlying nerves and bones are exposed in the area where a protective blood clot should develop. An empty socket is also at a higher risk of accumulating food particles and bacteria, which can eventually lead to an infection.

Is it OK to swallow blood after tooth extraction? ›

You can just swallow this normally and have a sip of water if required. Remember that a little bit of blood mixed with your saliva will look a lot but in fact it is probably minimal. Soreness around the area may persist for a day or two after the procedure. If needed you may take your normal painkillers.

Does slurping cause dry socket? ›

Avoid using straws or carrying out any activities that may require suctioning air after teeth removal procedures. While at it, you should avoid consuming soup with the regular sucking motion, which can dislodge the protective clot leading to a dry socket.

What is the best home remedy for a dry socket? ›

Home Remedies for Dry Socket
  1. Warm Saltwater Rinses. Gently rinsing the mouth with warm salt water may help lower bacteria and swelling while clearing out food bits that might bring infection. ...
  2. Cold and Heat Therapy. ...
  3. Natural Oils.
Feb 12, 2024

What painkillers are good for dry sockets? ›

Aspirin or ibuprofen can help relieve some pain. Still, you may need a prescription medicine from your dentist or oral surgeon. If you believe the clot over your extraction site has become dislodged, call your dentist.

How long is dry socket a risk? ›

The first five or so days after extraction are the most critical, and it is during this time that the risk for a dry socket is the highest. A dry socket can be very painful! If you think you have this condition, contact your dentist immediately.

How long should dry socket packing stay in? ›

If the non-resorbable packing is placed you will need to return to the office in the next two to four days to have the dressing removed and possibly replaced depending on how fast the site heals. Sometimes a dry socket requires multiple dressing change appointments until it has healed adequately.

References

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