What is it?
After a tooth is taken out, a blood clot forms in the socket. This clot covers the bone and the nerve endings and prepares the ground on which healing will be built. In dry socket the clot breaks down early or comes away; the bone surface is left open to the mouth and pain appears.
The pain typically starts two or three days after the extraction, just when it would be expected to be easing. It is deep and throbbing, and it can spread to the ear, the temple and the neck on the same side. The socket looks empty and may have a greyish covering over it; there is a bad taste and a bad smell in the mouth. A fever and swelling of the face do not usually go with it.
Dry socket is a hold-up in healing rather than a spreading infection. That is why the absence of a fever and swelling matters; it is what separates it from an abscess. It has been reported more often after lower wisdom teeth are taken out. As the socket closes, the symptoms are expected to ease; the aim of care is to control the pain during that time.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Losing the clot early
Spitting on the first day, drinking through a straw, rinsing the mouth vigorously and anything that creates suction can lift the clot out of place. Smoking makes healing harder both through that suction and because of what it contains.
- 02
A difficult, long extraction
Removing impacted teeth surgically, taking bone away and sectioning the tooth all put strain on the blood supply in the area. Dry socket is seen more often after extractions of this kind.
- 03
Inflammation already present in the area
Inflammation around a wisdom tooth, advanced gum disease and poor oral hygiene disturb the stability of the clot. That is why this inflammation is brought under control before a planned extraction.
- 04
Factors that depend on the person
Smoking, having had dry socket before, hormonal factors and conditions that affect the clotting of the blood have been reported as risks. These factors are talked through before the extraction.
How does it progress?
- Days 0–1
Expected healing
A clot forms in the socket; the pain is at its most noticeable on the first day and can be controlled with a painkiller. Dry socket is not spoken of at this stage.
- Days 2–4
The pain coming back
Pain that should be easing increases, spreads to the ear and the temple, and a bad taste starts in the mouth. This is the window in which dry socket is most often noticed.
- Care
Cleaning the socket and dressing it
Once the socket is rinsed out and a medicated dressing is placed, the pain is expected to ease noticeably within hours. The dressing is renewed as often as it is needed.
- Weeks 1–2
Closing over
The bone surface is covered by granulation tissue and the symptoms settle. If there is no improvement in this time, other causes are looked into.
How is it treated?
What is done at the clinic is first to rinse the socket gently with sterile saline to clear away debris, and then to place a medicated dressing that reduces the pain. The dressing is renewed, or removed, as the symptoms settle. Making the socket bleed again or scraping it out is not a route used in every patient; the decision is made according to the findings.
Because there is no spreading infection, antibiotics are not regarded as a routine treatment in this condition; if there is a fever, swelling of the face or something that affects your immunity, the assessment changes and the decision is for your dentist to make. The choice of painkiller is made with your dentist too. At home you are asked to keep away from smoking, not to rinse your mouth on the first day, and to rinse gently with warm salty water after the time your dentist has described.
If the pain carries on beyond the expected time, the diagnosis is looked at again. A root fragment left in the socket, infection in the bone, osteonecrosis in people with a history of bone medication or of radiotherapy to the head and neck, nerve injury and, after upper back teeth are taken out, an opening between the sinus and the mouth are each considered separately. That is why pain that does not go is dealt with by a fresh examination.
- A fever, swelling of the face or the neck and difficulty swallowing
- Pain that does not ease at all with painkillers and keeps you awake at night
- Numbness in the lower lip or the tongue lasting for days
- Exposed bone in the socket that does not close over for weeks
How is it prevented?
- Do not smoke in the first days after an extraction; smoking is one of the main things that raise the risk of dry socket.
- For the first 24 hours do not spit, do not use a straw and do not rinse your mouth vigorously.
- Bite on the gauze for as long as your dentist tells you, and avoid very hot food and drink on the first day.
- Have any gum inflammation treated before a planned surgical extraction; tell your dentist if you have had dry socket before.
Frequently asked questions
- Are antibiotics needed for dry socket?
- In dry socket there is most often no spreading infection; the problem is the loss of the clot and the bone being left exposed. Antibiotics therefore do not take the pain away on their own and are not given routinely. If findings such as a fever, swelling of the face and feeling unwell are added, or if you have a condition that affects your immunity, the assessment changes; that decision is made by your dentist.
- Does dry socket clear up on its own?
- As the socket heals, the symptoms are expected to ease; but during that time the pain can be bad enough to make daily life difficult. The purpose of the rinsing and dressing done at the clinic is less to speed up healing than to control the pain in that period. Having it assessed, rather than waiting for the pain to pass on its own, is also useful so that another cause is not missed.
- Does dry socket happen after every extraction?
- No; it is seen after a small proportion of extractions and is reported more often in certain situations. Surgical removal of lower wisdom teeth, smoking, inflammation already present in the area and having had dry socket before are among the things that raise the risk. Following the advice given after the extraction, especially on the first day, is aimed at reducing the risk.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.