What is a Dry Socket (Alveolar Osteitis)?

A dry socket is a painful condition where you fail to develop a good blood clot after an extraction and this leaves a sore area of exposed bone.

It happens in about 3% of normal extractions.

The area is really sore; patients often complain that it is worse than the toothache for which the tooth was removed.

Sometimes it even gets you thinking that the wrong tooth had been taken out. So be warned carefully follow the advice given to you after having a tooth removed and the chances of getting a dry socket will be drastically reduced.

What causes a Dry Socket?

The blood clot that forms after an extraction protects the nerve endings in the bone underneath, providing the basis for the healing and infill of your tooth socket. It may not form properly or be dislodged after its formation, leaving your socket open and exposed.

It is thought a process called ‘fibrinolysis’ is responsible (fibrin is needed for the clot to be stable- ‘lysis’ is the medical term for breaking down).

Contamination from bacteria and saliva can cause this process to happen excessively, meaning the blood clot is broken down or did not form correctly to begin with.

How can I stop myself getting a Dry Socket?

If you follow the instructions given to you after the extraction to the dot, then a dry socket is unlikely. That means, if it says no smoking (and I know it does)- it means no smoking- not a cheeky one here and there.

Looking after the socket for the first few days following the extraction is absolutely key- if you get a good blood clot to develop right away, it will put you nicely on the road to healing.

What makes a Dry Socket more likely?

In addition to not following the extraction aftercare instructions carefully, there are a number of factors that make you more likely to get a dry socket:

• Big tooth

• Difficult, long extraction

• Surgical extraction (vs. simple extraction)

• Single extractions (vs. multiple ones)

• Infection already at the site (peridontal disease or periapical abcess)

• History of previous dry socket

• Lower teeth (vs. upper teeth)

• The further back the tooth

• Women- possible relationship to hormones

• Smoking

• Older patients- If you are over 40

• Oral contraceptive- due to increased oestrogen levels

• Lower wisdom teeth

• Local anaesthesia (vs. general anaesthesia) –excessive local anaesthetic containing adrenalin. (A vaso-constricter that causes blood vessels to shrink reducing bleeding may help prevent clot formation.)