September 3, 2015
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Dry Socket

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What is a dry socket?

The typical scenario for dry socket is the occurrence of throbbing pain about two to four days after the tooth is extracted. Dry socket pain is often accompanied by bad breath and a foul taste in the mouth. It is obvious that healing has been interrupted.

Dry socket is a condition in which there is inflammation of the jawbone (or alveolar bone) after a tooth extraction. It is also referred to as "alveolar osteitis" and is one of the many complications that can occur from a tooth extraction. The occurrence of dry socket is relatively rare, occurring in about 2% of tooth extractions. However, that percentage rises to at least 20% when it involves the removal of mandibular impacted third molars (lower wisdom teeth).

What causes a dry socket?

A dry socket is caused by the partial or total loss of a blood clot in the tooth socket after a tooth extraction. Normally, after a tooth is extracted, a blood clot will form as the first step in healing to cover and protect the underlying jawbone. If the blood clot is lost or does not form, the bone is exposed and healing is delayed.

In general, a dry socket is a result of bacterial, chemical, mechanical, and physiologic factors. Below are examples for each:

  • Bacterial: Preexisting infection that is present in the mouth prior to a dental extraction such as periodontal disease (or periodontitis) can prevent proper formation of a blood clot. Certain oral bacteria can cause the breakdown of the clot.
  • Chemical: Nicotine used by smokers causes a decrease in the blood supply in the mouth. As a result, the blood clot may fail to form in the site of a recent tooth extraction.
  • Mechanical: Sucking through a straw, aggressive rinsing, spitting, or dragging on a cigarette causes dislodgement and loss of the blood clot.
  • Physiologic: Hormones, dense jawbone, or poor blood supply are factors that prevent blood clot formation.

What are risk factors for getting dry socket?

Smoking is a risk factor for developing a dry socket due to the use of nicotine. Exposure to nicotine reduces the blood supply available to the healing socket and can prevent the proper formation of a blood clot at the extraction site.

Extraction of impacted third molars (wisdom teeth) can be traumatic as some surrounding gum tissue and jawbone may need to be removed or may be adversely affected during surgery. Although the extraction is necessary, the resulting trauma can increase the chances of dry socket.

Previous infections such as periodontal disease or pericoronitis at the site of the extraction can predispose an individual to dry socket.

Women have been found to develop a dry socket more so than men. This may be related to hormonal factors such as use of oral contraceptives or normal hormonal changes during a woman's cycle.

Patients older than 30 years of age with impacted third molars have an increased risk of dry socket. With age, the jawbone becomes more dense and has less blood supply available. A dense jawbone increases the risk of a traumatic extraction and less blood supply decreases the chances of blood clot formation and healing.

Medically Reviewed by a Doctor on 4/21/2015

Source: MedicineNet.com
http://www.medicinenet.com/dry_socket_overview/article.htm

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