Dry socket is a markedly painful healing problem that arises when the clot in the socket is lost early or breaks down after tooth extraction; it is most often reported after lower wisdom tooth extractions (Blum, 2002; Hupp, 2014, Chapter 11).

Symptoms

• Pain that gradually increases a few days after extraction
• A socket that looks empty or bone that is visible
• Bad odor or taste in the mouth

Risk factors

Difficult extractions, smoking, poor oral hygiene and previous infection are counted among the risk-increasing factors (Blum, 2002).

Prevention and management

Antimicrobial mouthwashes before and after surgery have been shown to reduce the risk (Caso et al., 2005; Hupp, 2014). In treatment the aim is to relieve pain: the socket is gently irrigated and, if needed, a medicated dressing is placed; scraping the bone is not recommended (Hupp, 2014). The level of evidence for local interventions has been evaluated in a systematic review (Daly et al., 2012).

Why is dry socket painful?

The clot in the socket normally protects the bone and nerve endings. When the clot is lost early, the bone surface is left exposed and pain increases markedly; pain can radiate to the ear or temple. The timing of the pain matters: dry socket pain mostly becomes marked on days 2–4 after extraction, which coincides with the period when normal post-extraction pain is expected to decrease (Blum, 2002).

Telling dry socket apart from other problems

Infection, a retained root fragment or injury can also cause pain after extraction. Therefore, when pain increases, it is important to go for a check-up instead of self-diagnosing. The dentist examines the socket and requests an X-ray if needed. Symptoms such as fever, swelling of the face or difficulty swallowing may suggest a different problem and require urgent evaluation.

What may help prevent it

• Not smoking or using a straw
• Avoiding strong rinsing and spitting in the first days
• Using antimicrobial mouthwash if the dentist recommends it (Caso et al., 2005)
• Checking for calculus and infection before extraction

What does treatment do?

Treatment aims to relieve pain by gently irrigating the socket and, if needed, placing a medicated dressing; treatment does not speed up healing but increases comfort (Hupp, 2014, Chapter 11). The level of evidence for local methods used for dry socket has been evaluated in a Cochrane review (Daly et al., 2012); the dentist decides which method is suitable.

Frequently asked questions

Does dry socket go away by itself?

It heals over time; however, a dentist’s check is recommended for pain management.

Does it happen with every extraction?

No; it is seen relatively rarely.

What should I do if pain increases?

Contact your clinic; do not wait. For details see our care after extraction article.

How long does dry socket last?

It heals over time; duration varies from person to person and a check-up is recommended for pain management.

Does dry socket recur?

The same socket is not expected to dry out again; risk factors are re-evaluated for later extractions.

Is it more common in women?

Hormonal factors have been discussed in some studies; an individual evaluation is needed for each patient.

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References

• Hupp, J. R., Ellis, E., III, & Tucker, M. R. (2014). Contemporary oral and maxillofacial surgery (6th ed.). Elsevier Mosby.
• Hupp, J. R. (2014). Prevention and management of extraction complications (Chapter 11). J. R. Hupp, E. Ellis III, & M. R. Tucker (Eds.), Contemporary oral and maxillofacial surgery (6th ed., pp. 174–187). Elsevier Mosby.
• Blum, I. R. (2002). Contemporary views on dry socket (alveolar osteitis): A clinical appraisal of standardization, aetiopathogenesis and management: A critical review. International Journal of Oral and Maxillofacial Surgery, 31(3), 309–317. PubMed ↗
• Caso, A., Hung, L. K., & Beirne, O. R. (2005). Prevention of alveolar osteitis with chlorhexidine: A meta-analytic review. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 99(2), 155–159. PubMed ↗
• Daly, B., Sharif, M. O., Newton, T., Jones, K., & Worthington, H. V. (2012). Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database of Systematic Reviews, (12), CD006968. PubMed ↗

Note: Book chapter references follow the page ranges of the publisher’s edition; article links open the matching PubMed record.

This article is for information only and is not medical advice. See your dentist for diagnosis and treatment; no outcome is guaranteed.

This page was reviewed by Dr. Dt. Mehmet Fuat Bozaba, periodontist.