Dry Socket after a tooth extraction

At Parkway Family Dentistry we strongly believe that an informed patient will always make informed decisions about their health. Dry Socket is a very common and painful condition but can be completely avoided if the patient is made thoroughly about the whats and hows of it.Below is a brief description of it.

Overview:

Dry socket (alveolar osteitis) is a painful dental condition that sometimes happens after you have a permanent tooth extracted. A Dry socket happens when the blood clot at the site of the tooth extraction fails to develop, or it dislodges or dissolves before the wound has healed.

As soon as a tooth is extracted, the body responds by allowing the blood clot to form at the extraction site. It is important that this clot remains in its place and stabilizes for the next 1 week. This blood clot serves as a protective layer over the underlying bone and nerve endings in the empty tooth socket. The clot also provides the foundation for the growth of new bone and for the development of soft tissue over the clot. Any physical activity that causes the clot to dislodge from its location can cause dry socket that causes the exposure of the underlying bone and nerves resulting in intense pain. The socket becomes inflamed and may fill with food debris, adding to the pain. If you develop dry socket, the pain usually begins one to three days after your tooth is removed.

Dry socket is the most common complication following tooth extractions. Over-the-counter medications alone won’t be enough to treat dry socket pain. Your dentist or oral surgeon can offer treatments to relieve your pain.

Symptoms:

Signs and symptoms of dry socket may include:

• Severe pain within a few days after a tooth extraction
• Partial or total loss of the blood clot at the tooth extraction site, which you may notice as an empty-looking (dry) socket
• Visible bone in the socket
• Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction
• Bad breath or a foul odor coming from your mouth
• Unpleasant taste in your mouth

When to see a doctor:

A certain degree of pain and discomfort is normal after a tooth extraction. However, you should be able to manage normal pain with the pain reliever prescribed by your dentist or oral surgeon, and the pain should lessen with time.If you develop new or worsening pain in the days after your tooth extraction, contact your dentist or oral surgeon immediately.

Risk factors:

Factors that can increase your risk of developing dry socket include:

• Smoking and tobacco use. Chemicals in cigarettes or other forms of tobacco may prevent or slow healing and contaminate the wound site. The act of sucking on a cigarette may physically dislodge the blood clot prematurely.
• Oral contraceptives. High estrogen levels from oral contraceptives may disrupt normal healing processes and increase the risk of dry socket.
• Improper at-home care. Failure to follow home-care guidelines and poor oral hygiene may increase the risk of dry socket.
• Having dry sockets in the past. If you’ve had dry socket in the past, you’re more likely to develop it after another extraction.
• Tooth or gum infection. Current or previous infections around the extracted tooth increase the risk of dry socket.

Complications:

Painful, dry socket rarely results in infection or serious complications. However, potential complications may include delayed healing of or infection in the socket or progression to chronic bone infection (osteomyelitis).

Prevention:

What you can do before surgery

You can take these steps to help prevent dry socket:

• If applicable, try to stop smoking before your extraction because smoking and using other tobacco products increase your risk of dry socket.
• Talk to your dentist or oral surgeon about any prescription or over-the-counter medications or supplements you’re taking, as they may interfere with blood clotting.

What your dentist or oral surgeon may do

Your dentist or oral surgeon will take a number of steps to ensure proper healing of the socket and to prevent dry socket. These steps may include recommending one or more of these medications, which may help prevent dry socket:

• Antibacterial mouthwashes to begin one week after the extraction
• Oral antibiotics, particularly if you have a compromised immune system
• Antiseptic solutions applied to the wound
• Medicated dressings applied after surgery

What you can do after surgery

You’ll receive instructions about what to expect during the healing process after a tooth extraction and how to care for the wound. Proper at-home care after a tooth extraction helps promote healing and prevent damage to the wound. These instructions will likely address the following issues, which can help prevent dry socket:

• Activity. After your surgery, plan to rest for the remainder of the day. Follow your dentist’s or oral surgeon’s recommendations about when to resume normal activities and how long to avoid rigorous exercise and sports that might result in dislodging the blood clot in the socket.Avoid lifting heavy weights for a week.
• Pain management. Put intermittent cold packs on the outside of your face on the first day after extraction and warm moist packs after that, to help decrease pain and swelling. Follow your dentist’s or oral surgeon’s instructions on applying cold or heat to your face. Take pain medications as prescribed.
• Beverages. Drink lots of water after the surgery. Avoid alcoholic, caffeinated, carbonated or hot beverages for as long as your dentist or oral surgeon recommends. Don’t drink with a straw for at least a week because the sucking action may dislodge the blood clot in the socket.
• Food. Eat only soft foods, such as yogurt or applesauce, for the first day. Be careful with hot and cold liquids or biting your cheek until the anesthesia wears off. Start eating semi soft foods when you can tolerate them. Avoid chewing on the surgery side of your mouth for at least the first week.
• Cleaning your mouth. After surgery, avoid brushing for at least 24 hours, rinsing for at least 3 days, you may start very gentle rinsing after 3 days but we strongly recommend brisk rinsing only after 1 week of extraction. Mix 1/2 teaspoon of table salt in 8 ounces of water. Follow the instructions of your dentist or oral surgeon.
• Tobacco use. If you smoke or use tobacco, don’t do so for at least 1 week after surgery and as long as you can after that. Any use of tobacco products after oral surgery can delay healing and increase the risk of complications.

Lifestyle and home remedies

You can help promote healing and reduce symptoms during treatment of dry socket by following your dentist’s or oral surgeon’s instructions for self-care. You’ll likely be told to:

• Take pain medications as prescribed
• Avoid smoking or using tobacco products
• Drink plenty of clear liquids to remain hydrated and to prevent nausea that may be associated with some pain medications
• Rinse your mouth gently with warm salt water several times a day
• Brush your teeth gently around the dry socket area.
• Use caution with eating or drinking, avoid carbonated beverages, and avoid smoking or using a straw to prevent dislodging the dressing

Treatment

Treatment of dry socket focuses on reducing symptoms, particularly pain. Dry socket treatment may include:

• Flushing out the socket. Flushing out the socket can remove any food particles or other debris that may contribute to pain or possible infection.
• Medicated dressings. Your dentist or oral surgeon may pack the socket with medicated gel or paste and medicated dressings. These can provide relatively fast pain relief. The severity of your pain and other symptoms will determine whether you need dressing changes and how often or if you need other treatment.
• Pain medication. Ask which pain medication is best for your situation. You’ll likely need a prescription pain medication.
• Self-care. Once the dressing is removed, you may need to flush the socket at home to promote healing and eliminate debris. Typically you’ll receive instructions and a plastic syringe with a curved tip to squirt water, salt water or a prescription rinse into the socket. You’ll likely need to continue the rinse until the socket no longer collects any debris.

Once treatment is started, you may soon begin to feel some pain relief. Pain and other symptoms should continue to improve and will likely be gone within a few days. However, keep scheduled appointments with your dentist or oral surgeon for dressing changes and other care.

Dry Socket can be completely avoided by being vigilant about your oral care after the surgery.A condition which you really don’t want to experience ever in your life. Call us if you have any questions and we will be happy to discuss and answer any questions you may have.