Dry Socket – Causes and Management

Every one of us has had undergone dental extraction at some stage in life, and we all know it is not a particularly enjoyable event, not to mention the pain experienced after the effect of anesthesia has worn off.

However, dentists say that a slight pain post-extraction is normal, and can be managed with a painkiller. However, if you feel that that the pain in your extraction socket does not go away, or has worsened or not controlled with analgesics, you should immediately consult your dentist. This is due to the possibility of a dry socket, scientifically known as alveolar osteitis.

This condition, although painful, is fortunately very rare, and develops only in 2-5% patients after undergoing dental extraction. The good news is that the condition is treatable, and recovery usually occurs quickly, provided good oral hygiene is maintained.

What is Dry Socket?

Immediately after an extraction, the dentist cleans the extraction socket, and places a gauze over the extraction site with pressure, and the patient is asked to bite on it. This is done in order promote clot formation, which later on converts into bony tissue. In certain cases, the clot gets dislodged, leaving the underlying alveolar bone and nerves exposed to the external environment, making the region vulnerable to infection.

Causes of Dry Socket

The exact cause of a dry socket has still not been identified, however there are certain factors that can enhance chances of occurrence of dry socket after an extraction:

• Disturbance to Clot – Dentists advise their patients not to disrupt the clot that forms after extraction. If the patient disturbs the clot, either manipulating the socket with tongue, fingers, or any other material, the bone gets exposed, causing a dry socket.
• Infection – The chances of development of a dry socket are greatly increased if there is already a pre-existing infection present within the oral cavity.
• Smoking – Smoking not only prevents a good clot formation, but the nicotine present in the cigarettes causes narrowing of the blood vessels (vasoconstriction), that can cause a dry socket.
• Difficult Extraction – Not all dental extractions are easy, and some require extensive manipulation and surgical intervention, which can increase the chances of developing dry socket.
• Vasoconstrictors – Dental local anesthetics contain small amounts of vasoconstrictors, in order to prolong the duration of anesthesia. However, if sufficient doses of an anesthetic are administered, the blood flow of the region is compromised, which can lead to a dry socket.
• Radiotherapy – Patients who have undergone extensive radiotherapy treatment are also at risk of developing a dry socket following extraction.

Symptoms of Dry Socket

Following signs and symptoms can be observed in case of a dry socket:

• Pain – A persistent, throbbing pain is one of the most obvious symptoms, which may also radiate to other regions. However, it must be differentiated from other causes of dental pain, such as inflammation and infection. In case of a dry socket, patients begin observing pain 2-3 days after dental extraction.
• Alveolar Bone is Visible – upon inspection, the jaw bone is clearly visible as a result of dislodgement of the blood clot.
• Malodor and Unpleasant Taste – as a result of bone exposure and accumulation of food debris and bacteria, an unpleasant smell emanates from the region, in addition to a persistently bad oral taste.

Management of Dry Socket

Management of dry socket involves symptomatic therapy as the wound heals:

• Irrigation and Cleaning of Socket –The dentist first thoroughly irrigates the region in order to wash away any contaminated food debris and bacteria.
• Dressing of Wound – After irrigation, a medicated dressing, which usually contains a naturally soothing substance such as Eugenol (e.g., alveogel), is placed over the dry socket. The dressing needs to be replaced every day after irrigation of the socket, until healing has occurred.
• Analgesics and Anti-inflammatory Drugs –To ease the pain, the dentist may prescribe the patient with a painkiller or other drug that reduces inflammation.

Prevention

The following points must be kept in mind after getting a tooth extracted:

• Follow your dentist’s instruction regarding care of the extraction socket.
• Avoid smoking.
• Avoid intake of hot foods and drinks for at least two days.
• Avoid drinking through a straw while the wound heals, as doing so may lead to dislodgement of the clot.

Prognosis

The prognosis is excellent, and this condition is completely curable, provided the dentist’s instructions are adhered to, and oral hygiene is maintained.