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Dry Socket: Causes, Risks Factors and Prevention

Dry socket is a painful complication that develops most commonly after extractions of particular teeth. It occurs when a blood clot that normally forms in the tooth socket after extraction does not develop or is lost. The role of the blood clot is to protect the bony socket from exposure to food particles, air and infection while it heals. The tooth extractions that most often result in dry socket are those of the lower molars, especially wisdom teeth, or premolars. Dry socket is even more likely to occur when these teeth are impacted.

The pain usually begins a day or two after a tooth extraction and can last for several weeks. It is generally impossible to relieve the pain with over-the-counter analgesics. In addition to pain, dry socket can also cause other symptoms such as bad breath, bad taste in the mouth and spasms in the jaw muscles.

Risk Factors and Causes of Dry Socket

Generally speaking, dry socket occurs more frequently in smokers, patients with diabetes and women, particularly those taking oral contraceptives. Smokers are exposed to toxic substances in tobacco smoke that interfere with normal cell function and impair healing. Diabetics have an impaired ability to heal, which increases the risk for dry socket after an extraction. The fluctuating hormonal cycles in women appear to raise the risk while the high estrogen levels associated with taking oral contraceptives have an effect on the development of dry socket. Hence, the most common factors that may influence a patient’s risk of developing dry socket following a tooth extraction include:

Extraction of lower teeth. Dry socket is more common after the extraction of teeth on the lower jaw than the upper jaw.

Extraction of wisdom teeth. Dry socket is most likely following the extraction of wisdom teeth, especially if they are impacted and/or located on the lower jaw.

Difficult tooth extractions. Extractions that are particularly difficult (e.g., fractured tooth during extraction) and/or cause increased damage to the immediate area have a higher risk of dry socket.

Gender. Women are more likely to experience dry socket than men, especially those using oral contraceptives. The degree of risk varies during particular phases of the menstrual cycle which is due to elevated amounts of certain female hormones.

Smoking. Patients who smoke are also at an increased risk of developing dry socket. Chemicals contained in tobacco smoke interfere with normal healing and contaminate the tooth socket. Smoking on the first three days after surgery greatly increases the risk. Women who smoke and take oral contraceptives are even more likely to develop this condition.

Dental and medical history. People with a history of dry socket have higher chances of experiencing dry socket following another tooth extraction. Patients with increased bone density (e.g., those with Paget’s disease) also have an increased risk of dry socket. The complication is also more likely to occur in patients with diabetes.

Dental hygiene and health. Dry socket more commonly occurs in patients with poor oral hygiene, especially in those with gingivitis or other forms of infection.

Treatment of Dry Socket

Medical treatment of dry socket by a professional is generally very effective in relieving the pain while the tooth socket heals. A dentist rinses the affected socket with a solution to remove any debris. A local anesthesia or a nerve block may be given to prevent pain and discomfort. Sometimes, the socket may need to be rinsed several times during the healing process. Once the socket is free of debris, a dressing containing analgesics and antiseptics is lightly packed into the open socket. Its role is to protect the area from food particles, irritation and infection and to help relieve pain. The dressing may be replaced daily or even several times a day, if necessary. Oral pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed. Once the socket dressing is no longer needed, the patient will be instructed in how to rinse the socket in order to keep it free of debris and improve the rate of healing.

Preventing Dry Socket

There are certain measures that can help the patient in the prevention of dry socket. A patient’s dental hygiene and dental health are important factors determining the risk of developing dry socket. If an infection such as gingivitis or periodontitis is present, it typically requires treatment before the tooth can be extracted, especially a lower wisdom tooth.

Another important aspect is a woman’s menstrual cycle. If the patient uses oral contraceptives, the risk of dry socket can be reduced if the tooth is extracted during the period when certain hormone levels are at their lowest. This is between the 23rd and 28th day of her cycle. Women who do not use oral contraceptives but have a prior history of dry socket may lower the risk by scheduling the tooth extraction during their menstrual period.

After a tooth extraction, the patients should brush their teeth gently and use mouth rinses for about a week. Patients are advised to refrain from smoking immediately before the extraction and for at least a week following the extraction. Drinking through a straw and spitting should also be avoided because these actions can cause the blood clot that protects the healing socket to dislodge.