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Removing a tooth is a routine procedure. Most patients will be sore for a day or two, and that will be that. Sometimes, however, the healing process doesn’t go as planned. The result is a “dry socket,” an empty tooth socket with some of the jawbone exposed to the outside world. Like many other dental problems, it’s not technically a big problem, but the pain can be agonizing. What can you do about the pain? Fortunately, a dentist can fix that.
What is dry socket?
“Dry socket,” also called alveolar osteitis or fibrinolytic osteitis, is the most common complication of a tooth extraction. Dry socket occurs when a blood clot—that normally covers the bottom of the empty socket—does not form or breaks down before the healing process is complete. Bone and nerves are exposed to the outside world. The pain can be excruciating when the extraction site is irritated by food debris or other particles.
Any tooth extraction can result in dry socket, but the complication most often happens when wisdom teeth are removed. About one in three wisdom tooth extractions will result in dry socket complications, but only 3% of other tooth extractions have similar problems. Dry socket is also more likely to happen when the tooth is extracted from the lower jaw than the upper jaw.
There is no consensus on why some tooth extractions result in dry socket and others don’t. The known causes of dry socket include a particularly traumatic extraction, inadequate blood flow to the injury, or the patient traumatizing the socket by rinsing too vigorously or brushing the socket.
Some patients are more likely to experience dry socket than others. Risk factors for dry socket are
- Smoking–nicotine constricts blood vessels
- Using birth control pills–oral contraceptives also constrict blood vessels
- A difficult or traumatic extraction
- A previous history of dry socket
- Poor oral hygiene
- Not following the dentist’s instructions after the extraction
How is dry socket diagnosed?
A dentist will diagnose dry socket by taking a history and visually examining the socket.
Before you visit the dentist, be prepared to answer the following important questions:
- Where is the pain?
- When did the pain start?
- Do pain relievers help settle the pain?
- Do you have other symptoms such as bad breath or fever?
The symptoms of dry socket begin about two to four days after a tooth removal. This is just about the time that the pain caused by the extraction settles down, so increased pain three days after extraction is often a clear indicator of dry socket.
Dry socket symptoms usually include:
- Dull, throbbing pain in the tooth socket that begins about three days after the extraction
- Radiation of the pain to other parts of the head such as the ears, temples, eyes, and neck
- Bad breath (halitosis)
- A bad taste in the mouth
Many patients are initially afraid that dry socket pain may be due to an infection, but dry socket typically does not include a low-grade fever or swollen lymph nodes which are both likely to occur if the socket is infected.
A dentist will closely examine the socket, often using a microscope, and may probe the socket and surrounding tissues. The presence of exposed bone and severe pain when the bone is probed are usually sufficient for a diagnosis. Even so, the dentist will probably take an X-ray of the area to determine if there is any remaining tooth fragment in the socket or to rule out more severe conditions such as osteomyelitis, an infection of the jawbone.
Dry socket treatment options
Dry socket treatment focuses on pain relief and helping the mucosal tissue heal and cover over the exposed bone. A socket is healed when it is completely covered over by a protective layer of tissue.
Pain management
In many cases, dry socket treatment can be limited to pain management with over-the-counter pain medications. Dry socket pain usually lasts for 24 to 72 hours, so pain management will require a few days of analgesics. More severe pain may require topical anesthetics.
Curettage, irrigation, and dressing
The pain is caused by irritation of the exposed bone and nerves. If pain medication does not work, which is common, a dentist will clean and dress the wound to protect the area and prevent infection. First, the dentist will anesthetize the area and scrape away (“curette”) any dead tissue on the exposed bone. The dentist will then wash out the socket with a chlorhexidine or saline rinse to remove food debris and microbes. The dentist will then “pack” the extraction site with a simple or medicated dressing. The dressing will protect the exposed bone from mechanical irritation, food debris, and bacteria for a few days to allow the healing process to advance. Dressings, however, lengthen the time a dry socket takes to heal, but they provide immediate, dramatic pain relief for three to five days.
Antibiotics
A small category of patients may require oral or topical antibiotics to prevent or treat an infection.
Surgery
Some cases may require that the dentist file down the bone so that the tissues can more quickly grow over the wound.
Other treatments
Low-level laser light therapy (LLLT), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) are increasingly used in dental surgery. All of these treatments markedly speed up the healing of dental procedure injuries. They are less commonly used to treat dry socket, but some dentists will use them to speed up the healing process.
Dry socket medications
Because dry socket heals on its own, medications are used to manage the pain and prevent or treat infections. Over-the-counter pain medications, topical anesthetics, saline or antibacterial rinses, and medicated dressings make up the standard arsenal of dry socket medications.
Pain relievers
Dry socket will heal without intervention in about seven to 10 days, but the pain lasts for only one to three days. For many patients with moderate pain, over-the-counter pain relievers such as ibuprofen or acetaminophen provide sufficient pain relief as the healing process progresses.
Dressings
When pain relievers don’t work, the dentist will clean the socket and apply a basic or medicated dressing, called “packing.” Dressings can be simple dressings or coated in medications. The most common dressings used are SaliCept, a hydrogel, Dressor-X, made of cotton gauze, or medicated dry socket paste. Dressings are “packed” lightly into the socket and provide immediate pain relief. They typically remain in place for three to five days. Some will slowly break up in a few days, but gauze may require another trip to the dentist to be removed.
Topical anesthetics
Many dry socket dressings include a topical anesthetic such as eugenol or lidocaine, but the dentist may apply a stronger topical anesthetic such as lidocaine viscous or prilocaine in cases of severe pain. Over-the-counter clove oil (eugenol) and lidocaine can be used to numb the pain when treating dry socket at home.
Antiseptics
When the dentist cleans out the socket, the rinse will contain an antiseptic, a substance that kills microbes. The most commonly used antiseptic for rinsing dry socket is chlorhexidine, commonly found in prescription gingivitis mouthwash. The dentist may also use highly diluted hydrogen peroxide, also an antiseptic, to facilitate removal of debris from the socket.
Antibiotics
Antibiotics are only rarely used to treat dry socket. Patients with a compromised immune system or a history of dry socket may be prescribed a single-dose antibiotic when the tooth is removed to prevent infection. The most common antibiotic used to prevent dry socket is amoxicillin, but dentists may also prescribe azithromycin before a tooth extraction or apply topical clindamycin or lincomycin to the socket after a tooth extraction.
What is the best medication for dry socket?
Medications for dry socket focus mainly on pain relief, although antibiotics may be used in rare cases where the infection is a risk. There is no “best” medication for dry socket. Dentists can choose among several alternatives. In general, however, cleaning and dressing the socket along with over-the-counter pain relievers will provide sufficient pain relief as the socket heals.
| Best Medications for Dry Socket | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Advil (ibuprofen) | NSAID | Oral | One 100 mg tablet every 4-6 hours | Nausea, bleeding, heartburn, dizziness |
| Tylenol (acetaminophen) | Analgesic | Oral | Two 325 mg tablets every 4 to 6 hours | Nausea, stomach pain, loss of appetite |
| SaliCept Oral Patch (hydrogel) | Hydrogel dressing | Topical | One pledget packed into the tooth socket | None |
| Sultan Dry Socket Paste (guaiacol & eugenol) | Paste dressing | Topical | Cover the dry socket with the paste and tamp down | None |
| Xylocaine Viscous (lidocaine viscous) | Local anesthetic | Topical | 15 ml of 2% swished around in the mouth | Low heart rate, lowered blood pressure, dizziness |
| Chlorhexidine | Antiseptic | Topical | Dentist will rinse the socket with a 0.12% of 0.2% chlorhexidine solution | Irritation, bad taste, dryness |
| Amoxicillin | Antibiotic | Oral | One 500 mg capsule given at the time of tooth extraction | Low heart rate, lowered blood pressure, dizziness |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of dry socket medications?
Except for antibiotics, the side effects of dry socket medications are mild. In addition, medications are usually only required for a few days.
Pain relievers such as over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) and acetaminophen are widely available and safe. Because NSAIDs interfere with blood clotting, the most serious side effects of NSAIDs are bleeding problems, such as stomach pain, gastrointestinal pain, bleeding, and bruising.
Dry socket dressings have minimal side effects and are safe if accidentally swallowed. Medicated dressings may have side effects, but the doses in the dressing tend to be low. Eugenol, derived from cloves and available over-the-counter in clove oil, is the most common medication used in dry socket dressings. Side effects are very rare and mild. Butamben, iodoform, and guaiacol (other drugs common in dry socket dressings) may cause headaches or stomach problems when ingested, but rarely.
Anesthetics like eugenol and clove oil have few side effects but may cause sore or swollen gums in some people. Topical anesthetics containing lidocaine or prilocaine are used in small amounts for dry socket so they are relatively safe from side effects. However, exercise caution when using over-the-counter oral lidocaine medications. Overusing or swallowing the medication could cause central nervous system problems, such as confusion or dizziness, or heart problems, such as abnormal heart rhythms or chest pain.
Antiseptics like chlorhexidine are administered in small amounts for dry socket in a clinical setting and should have no side effects. The most common side effects of chlorhexidine are irritation, dryness, and bad taste.
Antibiotics usually are prescribed for dry socket in a single dose or for only a few days, so side effects will be limited. The most common side effects of antibiotics are gastrointestinal problems such as stomach pain, intestinal problems, loss of appetite, and stomach upset. However, drug allergies are common to antibiotics and could be severe.
What is the best home remedy for dry socket?
The best home remedy for dry socket is to prevent it in the first place by following the dentist’s instructions after having a tooth extraction:
- Rinse the mouth lightly with warm salt water three or more times a day to rinse out debris
- Do not brush the tooth socket
- Do not smoke
- For the first day after a tooth extraction, do not use a straw to drink liquids
- Try to keep food away from that side of your mouth for two to three days
- Don’t probe or irritate the empty socket.
Once dry socket occurs, the job is to manage the pain and give the socket a chance to heal:
- Rinse gently with warm salt water
- Brush carefully around the socket or dressing
- Take over-the-counter pain medications
- Use cold compresses to numb the pain
- Use clove oil or an over-the-counter oral anesthetic to numb the pain
- Do not use tobacco products.
Frequently asked questions about dry socket
How serious is a dry socket?
Dry socket usually heals in seven to 10 days without serious complications. In rare cases, the most serious complication could be a jawbone infection that may require antibiotics or surgery.
Is dry socket treatment painful?
Dentists use a local anesthetic to clean and pack a dry socket. Patients will usually experience immediate pain relief after a medicated dressing has been packed into the extraction site.
Is dry socket dangerous?
Dry socket typically resolves in seven to 10 days without any issues other than pain. During the healing process, however, the exposed bone is vulnerable to infection, so long healing times may result in osteomyelitis, a potentially dangerous infection of the jawbone. The standard treatment for dry socket involves rinsing the socket with an antiseptic and using a medicated dressing that also includes an antimicrobial medication. For vulnerable individuals, dentists will prescribe an antibiotic to prevent infection.
Is honey good for dry socket?
Honey has mild antibacterial and anti-inflammatory properties, so in some countries, it is occasionally used with wound dressings to speed the healing process. One group of researchers has shown that dressing a dry socket every day with a cotton wound dressing soaked with honey sped up dry socket healing with no side effects. However, there is no evidence that eating honey or rinsing with it is good for dry socket.
Is dry socket a dental emergency?
Dry socket itself is not a medical emergency, but the pain can be severe and debilitating. If the dentist who extracted the tooth is unavailable, patients with dry socket can get help at emergency dental clinics, urgent care clinics, or a hospital emergency room. All of these facilities have emergency dentists who can treat dry socket.
Does dry socket need antibiotics?
Dry socket is not caused by bacteria, but by the loss of the blood clot that normally forms over the exposed bone in the extraction site. Antibiotics are only used to prevent infection after tooth removal in patients with compromised immune systems or who have a history of dry socket. Otherwise, antiseptics are used to prevent infection of the exposed bone and tissues.
Will dry socket heal itself?
Dry socket heals in seven to 10 days. The pain itself usually resolves in one to three days.
Will antibiotics help dry socket?
Researchers generally agree that bacterial infection does not “cause” dry socket, so antibiotics do not help prevent dry socket or speed up the healing process unless there’s an active infection. For dry socket, dentists use antibiotics either to treat an active infection or to prevent infection in vulnerable patients, such as people with compromised immune systems.
What do they pack dry socket with?
Dentists will pack a dry socket with simple or medicated dressings made of cotton, paste, hydrogel, or other materials.
What happens if the dry socket is not treated?
Untreated dry socket usually heals in seven to 10 days, and the pain usually subsides in one to three days. However, untreated dry socket carries a risk of prolonging both the pain and healing process. Infections are a potentially serious hazard if the wound isn’t properly cared for.
What can I eat with a dry socket?
Eat soft foods for the first few days. Try to avoid hot or cold foods. Protect the socket by keeping food away from it as you eat.
How do you treat a dry socket at home?
Dry socket will heal by itself, so the central goal of home treatment is to weather the pain. Take over-the-counter pain relievers, use over-the-counter topical anesthetics, like clove oil, with moderation, apply a cold compress to the area several times a day, and rinse the area with warm salt water a few times a day to keep the socket clean of debris.
How long does dry socket take to heal after packing?
Dry socket typically takes seven to 10 days to heal. The pain, however, usually only lasts for one to three days. Packing lengthens the amount of time a dry socket takes to heal but provides immediate and substantial pain relief for three to five days during the peak pain period.