Home Dentistry Articles Dry socket
In dentistry, a dry socket is a layman's term
for alveolar osteitis, an infection of the alveolar bone surrounding
a tooth socket following extraction of the tooth.
Alveolar osteitis occurs when the blood clot
at the site of a tooth extraction is disrupted prematurely.
This leaves the alveolar bone unprotected and exposed to the
oral environment. The socket packs with food and bacterial infection
follows, typically 3-4 days following the extraction. This is
often extremely unpleasant for the patient, as symptoms include
extreme pain (sometimes worse than the toothache that caused
the extraction!), a bad taste in the mouth, bad breath, and
swelling in the infected area. There may be lymph-node involvement
leading to a palpatable submandibular lymph node.
Smokers have been shown to have a greatly increased
risk of developing alveolar osteitis after tooth extraction.
This is thought to be due to the decreased amount of oxygen
available in the healing tissues as a result of carbon monoxide
in tobacco smoke. It is advisable to avoid smoking following
tooth extraction for at least 48 hours to reduce the risk of
developing this "dry socket".
While this condition only seems to occur in
5-10% of extractions (primarily of the bottom wisdom teeth)
it seems that women are at higher risk than men for developing
dry socket. Of the women that have developed it, the majority
take an oral contraceptive. Dentists should recommend their
female patients to have extractions during the last five days
of their menstruation cycle to minimize chances of developing
dry socket because the estrogen levels are lower during that
part of the cycle.
Treatment for alveolar osteitis is mainly preventative.
Dentists encourage maintaining good oral hygiene during the
healing period. The blood clot should not be disturbed, and
a hot salt water mouth rinse is often advised 24 hours after
the extraction. Once a patient develops dry socket, treatment
is usually to debride (clean) the socket to remove debris and
pus, and encourage new clot formation. This is followed by packing
the socket with Alvogyl. Its fibrous consistency allows for
easy filling of the socket and good adherence during the entire
healing process. The active ingredients of Alvogyl include eugenol
for analgesic action, butamben for anesthetic action, and iodoform
for anti-microbial action. Sometimes analgesics are prescribed.
If the infection is severe an antibiotic such as metronidazole
may be indicated.