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A dry socket is a common complication that patients suffer after extractions. It can be quite painful and is something that causes a fair amount of discomfort. We outline exactly what a dry socket is, why it occurs, how it can be prevented.

Dry socket is the most common complication that patients face after extraction, especially that of their wisdom teeth [1]. Perhaps infection after wisdom tooth removal would be a close second but there is no other kind of complication that even comes close. So what is a dry socket and how can it be prevented from occurring?

What is a dry socket?

All out teeth are placed in sockets inside the bone. Once the tooth has been removed, this socket needs to be flooded with blood. The formation of a blood clot in the empty socket is a very important part of the healing process [2].

In some cases, this blood clot can get dissolved or dislodged much too quickly and that leads to the underlying bone being exposed. This is the condition that dentists refer to as a dry socket. Under certain situations, the blood clot may not form at all.

A dry socket is also more likely to form in teeth are towards the back of your mouth. The wisdom teeth, which are the furthest back teeth in your jaw, are the most likely to develop a dry socket [3].

Symptoms of a dry socket

Pain is the chief symptom that patients will experience when suffering from a dry socket. Typically, this pain begins around 2 days after the extraction has been done and will continue to get more severe as over the next few days. A lot of patients complain that the pain is worse than what they experienced immediately after the extraction [4].

A dry socket is also more likely to occur in the lower wisdom teeth than the upper wisdom teeth. One of the reasons why the lower wisdom teeth are more affected is because the lower jaw has a more dense bone with fewer blood vessels running to the socket.

Also, the more difficult an extraction has been, the more likely it is for a dry socket to occur [5].

Interestingly, planned surgical extractions where a large amount of bone cutting has been done are not at a higher risk of developing a dry socket than difficult non-surgical extractions. Women are more likely to develop a dry socket as compared to men.

Risk factors for developing a dry socket

Smoking [6] and birth control pills [7] are the two most significant risk factors that are associated with the development of a dry socket. Poor oral hygiene is another consideration that needs to be taken when planning an extraction. Patients that have poor oral hygiene harbor harmful bacteria that can lead to wisdom tooth removal infection and the development of a dry socket [8].

If you have had a dry socket develop in the past after an extraction then you could also be genetically at a higher risk than other individuals.

Treatment of a dry socket

Your dentist will prescribe you some pain medication to provide some comfort. It should be remembered that a dry socket does not automatically mean an infection has occurred and this is why antibiotics are not always prescribed.

The need for antibiotics must be decided on after evaluating the patient individually [9].

The most effective treatment method is the use of an antiseptic dressing [10]. The patient will stuff the dry socket with this dressing and may then recall you after some time to change that dressing as well. This local application of medicaments is the most effective method by which a dry socket is treated.

The use of a chlorhexidine or a povidone-iodine mouthwash is also considered to be very useful in helping minimize the symptoms.

Prevention of a dry socket

There are a few things that can be done to prevent a dry socket from occurring. The first is to maintain good oral hygiene. If a patient is found to have poor oral hygiene prior to a planned extraction then getting the teeth cleaned first is recommended.

Make sure you inform the doctor of any past episodes of difficult extractions that you may have had. This will allow the dentist to take appropriate measures during and immediately after extraction. For patients that are prone to developing a dry socket, dentists may use extraction techniques that section the tooth into little pieces and minimizes the damage to the bone surrounding the tooth.

A simple thing that can help prevent a dry socket from occurring is to avoid spitting. The blood clot should be allowed to form with minimum disturbance. Forceful spitting, rinsing out your mouth vigorously, or using a straw to drink fluids can all result in the dislodgement of the blood clot from the socket.     

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