Written by Stephanie Watson Medically Reviewed by Evan Frisbee, DMD on April 02, 2022 You probably think having a tooth pulled is not a particularly enjoyable experience. And you no doubt expect to have some discomfort afterward. But that's OK, you say. You can endure it when you need to. But if the pain becomes intense and perhaps even worsen after a few days, it may be a symptom of a condition called dry socket, or alveolar osteitis. Only a very small percentage -- about 2% to 5% of people -- develop dry socket after a tooth extraction. In those who have it, though, dry socket can be uncomfortable. Fortunately, it's easily treatable. The socket is the hole in the bone where the tooth has been removed. After a tooth is pulled, a blood clot forms in the socket to protect the bone and nerves underneath. Sometimes that clot can become dislodged or dissolve a couple of days after the extraction. That leaves the bone and nerve exposed to air, food, fluid, and anything else that enters the mouth. This can lead to infection and severe pain that can last for 5 or 6 days. Some people may be more likely to get dry socket after having a tooth pulled. That includes people who: Rinsing and spitting a lot or drinking through a straw after having a tooth extracted also can raise your risk of getting dry socket. If you look into the site where the tooth was pulled, you'll probably see a dry-looking opening. Instead of a dark blood clot, there will just be whitish bone. The pain typically starts about 2 days after the tooth was pulled. Over time it becomes more severe and can radiate to your ear. Other symptoms of dry socket include bad breath and an unpleasant smell and taste in your mouth. You can take a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen, to ease the discomfort. Sometimes these over-the-counter medications aren't enough to relieve the pain. When that's the case, your doctor may prescribe a stronger drug or will anesthetize the area. Your dentist will clean the tooth socket, removing any debris from the hole, and then fill the socket with a medicated dressing or a special paste to promote healing. You'll probably have to come back to the dentist's office every few days for a dressing change until the socket starts to heal and your pain lessens. Your dentist may prescribe antibiotics to prevent the socket from becoming infected. To care for the dry socket at home, your dentist may recommend that you rinse with salt water or a special mouthwash every day. Because smoking is a big risk factor for dry socket, avoid cigarettes, cigars, and any other tobacco products for a day or so after your surgery. If you take birth control pills, ask your dentist about performing the extraction on a day when you are getting the lowest dose of estrogen. The hormone can affect the ability of the blood to clot. Also, check with your dentist about other medications you are taking that can interfere with normal blood clotting. After surgery, avoid drinking through a straw and spitting for the first few days. Also don't rinse your mouth more than your dentist recommends. If you do rinse, do so gently. Be sure to visit your dentist for all scheduled follow-up visits.
SOURCES:
American Dental Association: "Dry Socket."
Reekie, D, Downes, P, Devlin, CV, Nixon, GM, Devlin, H. British Dental Journal, 2006; vol. 200: pp. 210-213.
Roberts J, Custalow C, Hedges, J. Roberts: Clinical Procedures in Emergency Medicine, 4th ed, Elsevier, 2004.
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When a tooth is removed from the bone and gums, a blood clot forms to protect the hole in your gums as it heals. If the blood clot does not form properly or becomes dislodged from your gums during healing, it can create dry socket.
Dry socket is also called alveolar osteitis.
Dry socket can leave the nerves and bone in your gums exposed, so it’s important to seek dental care. It can be incredibly painful, and if left untreated, it can lead to complications, including:
- delayed healing
- infection in the socket
- infection that spreads to the bone
If you’ve recently had a tooth removed, you’re at risk of developing dry socket. Although dry socket is the most common complication of tooth removal, it’s still relatively rare.
Researchers in one 2016 study found that about 42 out of 2,281 observed teeth experienced some degree of dry socket. This put the incidence rate at just 1.8 percent.
The type of tooth extraction you undergo determines how likely you are to experience dry socket. While still rare, dry socket is more likely to develop after your wisdom teeth or other molars are removed compared with other teeth.
If you’ve had dry socket before, you may be more likely to experience it again. Make sure your dentist or oral surgeon is aware of your history with dry socket ahead of your planned tooth extraction.
Although your dentist can’t do anything to prevent it from occurring, keeping them in the loop will speed up the treatment process if dry socket develops.
If you’re able to look into your open mouth in a mirror and see bone where your tooth used to be, you’re probably experiencing dry socket.
Another tell-tale sign of dry socket is an unexplained severe pain in your jaw. It’s typically felt on the same side as the tooth extraction site 2 to 3 days after the procedure. However, dry socket can occur at any time during the healing process.
Other possible symptoms include bad breath and an unpleasant taste that lingers in your mouth.
If you’re experiencing any of these symptoms, you should see your dentist right away.
What does it feel like?
Dry socket typically causes steady, throbbing pain. The pain can be severe and is often not fully helped by over-the-counter or prescription pain medications. It may lead to being unable to work or focus on other things.
Pain from dry socket may radiate from the extraction site to your:
If you have dry socket, you may also feel pain when you drink something cold or breathe in cold air.
Diagnosis
If you’re experiencing symptoms of dry socket, your dentist will want to see you to look at the empty socket and to discuss next steps.
In some cases, your dentist may suggest X-rays to rule out conditions other than dry socket. This includes bone infection (osteomyelitis) or the possibility that bone or root fragments are still present in the extraction site.
Dry socket can develop if after a tooth is removed, a protective blood clot doesn’t form in the open space.
Dry socket can also develop if this blood clot becomes dislodged from your gums.
Researchers aren’t sure what prevents this blood clot from forming. It’s thought that bacterial contamination, whether from food, liquid, or other things that enter the mouth, can cause dry socket.
Trauma to the area may also lead to dry socket. This can occur during a complicated tooth extraction or during aftercare. For example, accidentally poking the area with your toothbrush may disrupt the socket’s healing.
Risk factors
You’re more likely to develop dry socket if:
- You smoke cigarettes or use other tobacco products. Not only can the chemicals slow healing and contaminate the wound, but the act of inhaling can also dislodge the blood clot.
- You take oral contraceptives. Some birth control pills contain high levels of estrogen, which may disrupt the healing process.
- You don’t care for the wound properly. Not following your dentist’s instructions for at-home care or not practicing good oral hygiene can cause dry socket.
If you have dry socket, your dentist will clean the socket to make sure it’s free of food and other particles. This may alleviate any pain and can help prevent infection.
Your dentist may also pack the socket with a medicated dressing or paste to help numb the pain.
If the dressing needs to be removed, you’ll have to return to your dentist after a few days. The dressing may need to be replaced if the pain is still severe. Otherwise, you may be instructed to remove it at home and clean the socket again afterward.
Your dentist will likely recommend a saltwater or prescription rinse. They may also prescribe antibiotics to prevent infection in the area.
Managing pain
Over-the-counter pain medication may help relieve any discomfort. Your dentist will probably recommend a specific nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin IB, Advil), or acetaminophen (Tylenol).
It’s best to avoid taking aspirin, as it’s an NSAID that may cause more bleeding in the area.
A cold compress may also provide relief.
If your pain is more severe, your dentist may recommend a prescription pain reliever.
You’ll likely have a follow-up appointment about a week after your extraction. Your dentist will look over the affected area and discuss any next steps.
Buy ibuprofen to help relieve discomfort.
You can reduce your risk of dry socket by taking the following steps before surgery:
- Ensure that your dentist or oral surgeon is experienced with this type of procedure. You should check out their credentials, read online reviews, and ask around about them — whatever you need to do to know that you’re in good hands.
- After selecting a care professional, talk with them about any over-the-counter or prescription medications that you’re currently using. Some medications can prevent your blood from clotting, which can cause dry socket.
- If you smoke, limit or avoid smoking before and after your extraction. Smoking can increase your risk of dry socket. Talk with your dentist about using nicotine management options, such as the patch, during the healing process. They may even be able to provide guidance about quitting.
After the procedure, your dentist will provide you with information about recovery and general guidelines for care. It’s important that you follow these directions. If you have any questions, call your dentist’s office. They can clear up any concerns that you may have.
Your dentist may recommend one or more of the following during recovery:
- antibacterial mouthwashes
- antiseptic rinses
- medicated gauze
- medicated gel
- pain medication
Your dentist may also suggest an antibiotic, especially if your immune system has been compromised.
While it can be very painful, dry socket is a highly treatable condition. You should start to feel better shortly after treatment begins, and your symptoms should be gone entirely within a few days.
If you’re still dealing with pain or swelling after about 5 days, call your dentist. You may still have debris caught in the area or another underlying condition.
Having had dry socket once does put you at risk of developing dry socket again, so be sure to tell your dentist about your dental history if you ever need to have another tooth removed.