Wednesday, November 5, 2014

What is a Dry Socket?




Hopefully none of us ever ever experience a dry socket (localized alveolar osteitis). A dry socket can be extremely painful.

What the heck is a dry socket? It's a phenomenon that can occur after having a tooth pulled. During the healing process, the blood clot can become dislodged and will leave exposed denuded bone which has many pain receptors. When these nerves are exposed, the unfortunate person will experience pain.

How does a dry socket occur? Typically the clot becomes dislodged in several ways. It can become dislodged physically with a tongue, a finger, an instrument or even food. It can become dislodged when there is negative pressure in the mouth like when sucking on a straw or a cigarette. Also, alcohol can cause the clot to dissolve. The mechanism is different, but the result is the same.

Who is most likely to experience a dry socket? Smokers! I've already briefly mentioned one reason--negative pressure from taking a drag off of the cigarette can dislodge the clot. In addition, smokers do not heal very well because of a compromised immune system.

Where are they likely to occur? On teeth pulled from the bottom jaw--especially posterior teeth. We often give instructions after extractions of all teeth. However, I have only seen this occur on a bottom posterior tooth. I have never seen a case of dry socket on an upper extraction site.

When does this occur? This will occur around the third day after the extraction. You may have minimal or tolerable pain for the first couple days following an extraction, but on that third day, the intensity of pain will dramatically increase. This is a tell tale sign of a dry socket.

So, how the heck do we avoid a dry socket? We give verbal and written instructions. Basically, the idea is to keep the clot from dislodging or dissolving. So we instruct patients to avoid sucking on cigarettes, straws or anything else. We also instruct them to avoid alcohol. This doesn't only mean alcoholic beverages, but also mouth rinses that contain alcohol. Visit the following link for more detailed post surgical instructions: LINK

Let's say we get a dry socket even after diligently following instructions. What the heck do we do now? We basically have two options:
  • The first option is to place some medication (eugenol which is derived from clove oil) in the extraction site. The advantage of this option is that there is immediate relief. The disadvantage is that this medication is placed in the extraction site with gauze which is a foreign body. It delays healing. It must also be removed and replaced on a daily basis. This can be inconvenient since you may have to visit the office multiple times. Another issue is that the medication we use for this is somewhat toxic.
  • The second option is to control the pain with oral medications such as NSAIDS and narcotics. The advantage here is that we eliminate the need for multiple visits and the healing time is much quicker. The disadvantage is that the medications do not provide immediate relief. However, once the medication kicks in, there is some relief.
Fortunately dry sockets can be avoided. Follow your dentist's instructions and you should be just fine.


Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com. 

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