INFORMATION AND MANAGEMENT ADVICE FOR PATIENTS
A dry socket is a painful condition that commonly occurs after having a tooth removed. It happens most often after having a lower wisdom tooth removed, but they can occur at any locations in the mouth.
A dry socket is a painful slow healing wound that typically presents 2-4 days after having a tooth removed.
A dry socket is not dangerous, but they can be extremely painful. It is important to distinguish a dry socket from other more dangerous post operative complications, such as infections.
It is normal for patients to experience some amount of pain and discomfort after having a tooth removed. Distinguishing between 'normal' post operative pain and a dry socket is important, but not always easy.
The main difference between 'normal' post operative pain, and a dry socket is the charecteristics of the pain.
Normal post operative pain:
is usually manageable and doesn't keep patients awake at night
should be significanly improving by day 2-3
typically present as an escalation in pain on day 2-4
can cause be very severe, it often radiates throughout the entire side of the face and head
it is often worse at night, disturbs sleep and often wakes patients at night
often causes a foul smell or taste coming from the wound
Note: swelling that increases after 48hrs is not typical of a dry socket or normal healing wound. This is more likely related to an infection and you should seek urgent assessment and advice if you are experiencing increasing swelling 24 - 48 hours after a tooth extraction.
WHAT CAUSES THEM?
There has been considerable research into the cause of dry sockets. However we are not 100% sure why they occur. Premature loss of the blood clot in the healing wound seems to play a part in the development of a dry socket.
Smoking is a significant risk factor for the development of dry socket, but many non-smokers also get dry sockets. To some degree getting a dry socket is just bad luck.
Once the blood clot is lost from the wound, it creates an exposed area of 'raw bone' at the bottom of the wound that becomes inflamed and painful during the healing proccess. The technical name for this is alveolar osteitis.
You can think of it as an ulcer in the jaw bone at the bottom of your healing extraction wound.
Just like normal mouth ulcers, they can be very painful, but are not dangerous. And just like ulcers the pain will go away once it heals. But it can be very painful during the healing proccess
Also like a normal mouth ulcer, a dry socket is not an infection, and thus antibiotics will not help and are not reccomended as part of the treatment.
Disclaimer: this advice is general in nature is based on how Dr Andrew Chan at Adelaide Tooth Removals often manages dry sockets at his practice. It is not intended to be used as a guideline without professional dental assessment and advice.
If you think your are developing a dry socket seek prompt advice and treatment from your treating dentist. It is important dry sockets are differentiated from other more serious post operative complications such as an infection.
Once it is established that you have a dry socket Dr Andrew Chan will usually numb the area with an injection, rinse the wound with sterile salt water and then dress the wound with a special dressing called Alveologyl. This is a special dressing that smells strongly of cloves, and is often helpful in alleviating the pain.
After that, the most important aspect of dry socket management is effective pain relief. Dr Andrew Chan will often recommend a combination of paracetamol, ibuprofen, and tapentadol (or oxycodone). Your recommended pain relief regime will be tailored to you based on your other medical conditions.
Patients are often advised to use laxatives and anti-nausea medication to counteract the constipation and nausea cased by the tapentadol (or oxycodone)
AFTER A DRY SOCKET
The recovery after a dry socket is variable.
The majority of dry sockets are 'mild', and are relatively easily managed with good pain relief. Mild dry sockets normally subside after approximately 1 week.
A severe cases of a dry socket can be very painful. And even with good pain relief medication, patients can still experience considerable discomfort during the healing period. In rare cases a severe dry socket can take 3-4 weeks to fully resolve.