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How to recognise, treat and prevent a dry socket

Firstly, just what is a dry socket? Alveolar osteitis or dry socket is a painful condition that occurs following tooth extraction in adults. Usually, a blood clot forms at the site of the tooth extraction and protects the bone and nerve endings and aids recovery. Where a blood clot doesn’t develop or becomes dislodged this is known as a dry socket.

Without the protection of the blood clot, the empty tooth socket will become inflamed and the bone and nerve endings will be exposed to saliva, air, food and bacteria causing pain and discomfort.

Symptoms of a dry socket

The main symptom of dry socket is intense pain which usually begins between 1 and 4 days following your tooth extraction. The pain usually radiates from the socket and can spread to your neck, temple, ear or eye on the side of the tooth removal. Other symptoms of a dry socket include:
• Bad breath or smell coming from your mouth
• Unpleasant taste in your mouth
• Visible bone in the mouth socket

Between 2 and 5% of tooth removals result in a dry socket and while some may be down to just bad luck there are some factors that can increase your risk of developing a dry socket. These risks are:

Smoking – As with most oral healthcare advice smoking is not good for your mouth. Cigarettes and tobacco can prevent healing of your tooth removal site and can increase the risk of dislodging the blood clot prior to healing.

Tooth or gum infection – Infection close to the site of the extraction can lead to an increased risk, even if the infection has been previously treated.

Oral contraception – The high oestrogen levels from oral contraceptive pills can disrupt the healing process and cause the blood clot to dissolve before your wound has healed.

Treatment

If you do find yourself with a dry socket, then you need to book an emergency appointment with your dentist. They will then flush out the socket to remove any food particles and bacteria before packing the socket with a medicated gel, paste or dressing. Your dentist will also be able to advise on pain medication write you a prescription if necessary.

Prevention of dry socket

Prevention is better than cure, and one of the best ways to prevent dry socket is with a self-managed care routine to help promote healing and stop bacteria, food and air getting to the wound. The following are things that you should do following a tooth removal:

Pain management – Having a tooth removed can be painful and leave your face feeling bruised and tender. Cold packs can be used on your face to reduce swelling while prescribed pain medication can help you manage the pain. Heat packs can also be used after the first couple of days to promote better blood flow and ease the pain.

Drinks – Drinking lots of water will help keep you hydrated and keep your mouth feeling fresh. Avoid alcohol, fizzy, hot and caffeinated drinks for at least a couple of days. Also, don’t use a straw for drinking as this can dislodge the blood clot.

Put your feet up – On the day of the tooth extraction, you should plan to rest for at least 24 hours. Avoid strenuous activities while your extraction site is healing as these can dislodge the blood clot causing a dry socket.

Eat soft food – For the first couple of days only eat soft and semi-soft foods and completely avoid chewing on the side of your mouth where you have had a tooth removed. Try to avoid hot and cold foods for the first 24 hours.

Gently clean your mouth – The temptation can be to vigorously rinse your mouth out following an extraction, but this is not a good idea. Instead, focus on gently rinsing out your mouth with warm saltwater mixture and gently brush teeth around the removal site being careful not to disrupt the blood clot.

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