William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- What is a dry socket?
- What causes a dry socket?
- Who is at risk for getting a dry socket?
- What are the signs and symptoms of a dry socket?
- How is a dry socket diagnosed?
- What is the treatment for a dry socket?
- What is the average healing time for a dry socket?
- What is the prognosis for a dry socket?
- Can a dry socket be prevented?
- Patient Comments: Dry Socket - Symptoms
- Patient Comments: Dry Socket - Treatment
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What is a dry socket?
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.
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 causes. Below are examples for each:
- Bacterial: Pre-existing 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.
Who is at risk for getting a dry socket?
Smokers have an increased risk of 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. A dry socket occurs in 1% to 5% of routine dental extractions, but occurs in 20% to 30% for extractions of impacted third molars.
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 old 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.
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