Dry Socket- A post dental extraction complication
Dry socket is a condition which affects millions of patients around the world who undergo
tooth extraction. This painful event can be avoided in majoirty of cases by proper understanding. It will then
save unnecessary agony to patients and loss of countless hours of dentist's practice in dealing with it. We have compliled
this section in the hope of achieving this goal.
This condition occurs after tooth extraction, particularly after traumatic
extraction, resulting in a dry appearance of the exposed bone in the socket, due to
disintegration or loss of the blood clot. It is basically a focal osteomyelitis without
suppuration and is accompanied by severe pain (alveolalgia) and foul odor. It is also
called alveolar osteitis and alveolitis sicca dolorosa. (Dorland, 27th Ed)
The most common, most dreaded and most painful complication of tooth extraction.
Clinicians call it a "dry socket" a misnomer that fails to stress the importance
of infection in its etiology. Affected person complains of unbearable pain and sensitivity of
intake of food or drinks.
Dry socket usually develops after 3 to 5 post surgical days. The
pathogenesis of dry socket (also called fibrinolytic alveolitis) is a subject of debate
with two main opinions. The first one is based on the presumption that there is a absolute
absence of blood clot. According to the second opinion there is initial blood clot
formation, which subsequently gets lysed leaving behind an empty socket. Streptococci have
been implicated as causative organisms, but lysis might occur without bacterial presence
The following factors are considered important in causation of dry socket:
- Insufficient blood supply to the alveolus.
- Preexisting infection. (Granuloma, periodontal or pericoronal infection)
- Use of large amounts of local Anesthetic, leading to vasoconstriction.
- Post operative bleeding.
- Trauma to alveolus during extraction.
- Infection during or after extraction.
- Root/bone fragments or foreign bodies left in the socket.
- Excessive irrigation and curettage.
- Fibrolytic or proteolytic activity in the clot.
- Loss of clot due to patient's negligence
- Patient actions like sucking liquids, sneezing, coughing, rinsing water post extraction
- Predisposing factors in patient, eg smoking, poor general health
Dry socket is more often seen in the mandibular molars particularly the third molars.
This condition is associated with
excruciating pain, foul breath, unpleasant taste, empty socket and gingival inflammation
By avoiding all possible averse factors, risk of dry socket becomes
less. Prophylactic packing of alveolus with medicated dressing and
advising patient to use 0.2% chlorhexidine mouth rinse may be helpful to avoid dry socket in suspect cases.
Treatment of dry socket is mainly done to control pain by analgesics, advice warm saline
rinse to remove food debris, dressing the cavity to protect & heal the socket. In early stages just initiating fresh bleeding in the socket and giving a pack will resolve this condition.
Zinc oxide dressings also have been advised, commercial dressings are also available in
international market. Here are the name of some commercial products
To download a guide for these products
With these precautions and treatment the pain should reduce and granulation of the
socket should be observed. Antibiotic therapy may be used if desired. Most sockets resolve
in 4-5 days.
Always compress the socket after extraction so that chances of clot retention
Give all instructions to patient so that he does not disturb the ext wound.
Ask smoker to stop until extraction wound has healed.
Body has great healing capacity, avoid unnecessary routine irrigation of
socket with antiseptic solutions.
If dry socket develops do a simple trick it works for 99.99% cases, take a sharp
sickle scaler and scrap the gums surrounding socket, let fresh blood fill the
socket, give a pack (wet squeezed gauze)
Also as a precaution if you feel a case has more infection/ trauma during extraction, it may be
helpful to suture to socket and that would reduce/eliminate chances of dry socket.
This webpage on dry socket has been voted as one of the top pages, thanks. Funny thing is that over 80% visitors are from
USA and Europe. Why is it so, 80% extractions are being done in India, Asia, but it would appear that dry socket is more common in Western countries ?
LATEST News about Dry Socket HERE
See British Asso.Guidelines for treatment of Dry Socket
Now that you know a good deal about this condition
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