Dry Socket- A post dental extraction complication

Dry socket is a condition which affects millions of patients around the world who undergo tooth extraction. This painful event can be avoided in majoirty of cases by proper understanding. It will then save unnecessary agony to patients and loss of countless hours of dentist's practice in dealing with it. We have compliled this section in the hope of achieving this goal.

This condition occurs after tooth extraction, particularly after traumatic extraction, resulting in a dry appearance of the exposed bone in the socket, due to disintegration or loss of the blood clot. It is basically a focal osteomyelitis without suppuration and is accompanied by severe pain (alveolalgia) and foul odor. It is also called alveolar osteitis and alveolitis sicca dolorosa. (Dorland, 27th Ed)

The most common, most dreaded and most painful complication of tooth extraction. Clinicians call it a "dry socket" a misnomer that fails to stress the importance of infection in its etiology. Affected person complains of unbearable pain and sensitivity of intake of food or drinks.

Dry socket usually develops after 3 to 5post surgical days. The pathogenesis of dry socket (also called fibrinolytic alveolitis) is a subject of debate with two main opinions. The first one is based on the presumption that there is a absolute absence of blood clot. According to the second opinion there is initial blood clot formation, which subsequently gets lysed leaving behind an empty socket. Streptococci have been implicated as causative organisms, but lysis might occur without bacterial presence also.

The following factors are considered important in causation of dry socket:

Insufficient blood supply to the alveolus.
Preexisting infection. (Granuloma, periodontal or pericoronal infection)
Use of large amounts of local Anesthetic, leading to vasoconstriction.
Post operative bleeding.
Trauma to alveolus during extraction.
Infection during or after extraction.
Root/bone fragments or foreign bodies left in the socket.
Excessive irrigation and curettage.
Fibrolytic or proteolytic activity in the clot.
Loss of clot due to patient's negligence
Patient actions like sucking liquids, sneezing, coughing, rinsing water post extraction
Predisposing factors in patient, eg smoking, poor general health

Dry socket is more often seen in the mandibular molars particularly the third molars. This condition is associated with excruciating pain, foul breath, unpleasant taste, empty socket and gingival inflammation and Lymphadinopathy.

By avoiding all possible averse factors, risk of dry socket becomes less. Prophylactic packing of alveolus with medicated dressing and advising patient to use 0.2% chlorhexidine mouth rinse may be helpful to avoid dry socket in suspect cases.

Treatment of dry socket is mainly done to control pain by analgesics, advice warm saline rinse to remove food debris, dressing the cavity to protect & heal the socket. In early stages just initiating fresh bleeding in the socket and giving a pack will resolve this condition.

Zinc oxide dressings also have been advised, commercial dressings are also available in international market. Here are the name of some commercial products :
Alvogyl
Dressol-X
D.S. Dressing/paste
To download a guide for these products CLICK HERE

With these precautions and treatment the pain should reduce and granulation of the socket should be observed. Antibiotic therapy may be used if desired. Most sockets resolve in 4-5 days.

USEFUL Tips:

Always compress the socket after extraction so that chances of clot retention are better.

Give all instructions to patient so that he does not disturb the ext wound.

Ask smoker to stop until extraction wound has healed.

Body has great healing capacity, avoid unnecessary routine irrigation of socket with antiseptic solutions.

If dry socket develops do a simple trick it works for 99.99% cases, take a sharp sickle scaler and scrap the gums surrounding socket, let fresh blood fill the socket, give a pack (wet squeezed gauze)

Also as a precaution if you feel a case has more infection/ trauma during extraction, it may be helpful to suture to socket and that would reduce/eliminate chances of dry socket.

This webpage on dry socket has been voted as one of the top pages, thanks. Funny thing is that over 80% visitors are from USA and Europe. Why is it so, 80% extractions are being done in India, Asia, but it would appear that dry socket is more common in Western countries ?