What does a dry socket look like?

What does a dry socket look like

A dry socket is a common post-extraction complication resulting in severe pain in the extraction socket. The presence of certain risk factors predispose you to dry socket. In this blog, I will discuss what does a dry socket look like and the risk factors associated with it.

What is a dry socket?

A dry socket, also known as alveolar osteitis, is a debilitating, painful condition that can occur after a tooth extraction. It is usually seen at the lower wisdom tooth extraction site. You will probably experience symptoms of dry socket 24 hours the extraction, where the pain spikes from moderate to severe in intensity.

It affects 1-5% of patients undergoing tooth extractions, with the highest rate (38%) seen in the impacted lower wisdom teeth extractions. 

A dry socket is commonly perceived as an infection; however, it arises from the premature disintegration or loss of a blood clot from the extraction socket.

Why do you get a dry socket?

The dry socket occurs when the blood clot that forms after a tooth extraction dislodges or disintegrates before the wound healing, leaving the socket empty, and exposing the bone and nerves to air, food, and fluids.

Typically, a blood clot forms in the socket after tooth extraction. The blood clot attracts and recruits inflammatory cells in the socket to make new blood vessels and collagen fibers (connective tissue). The blood clot is eventually replaced by healing tissues, known as granulation tissue. In the next few weeks, the gums grow over the socket and closes the gap. The whole process takes 14-21 days.

In dry socket, premature loss of blood clots delays the normal healing process, taking longer to heal. 

What are the risk factors for a dry socket?

Several risk factors can increase the likelihood of developing dry socket after a tooth extraction. These risk factors include:

Bacterial overload 

Dry socket commonly occurs in people with poor oral hygiene or socket contamination from an infected tooth. An increased load of endotoxin producing bacteria contaminating the socket prematurely disintegrates the blood clot, leading to dry socket. 

Smoking

It is a significant risk factor for dry socket. Smoking during the post-operative period often introduces harmful substances, such as nicotine, cotinine, and carbon monoxide, in the extraction socket and inhibits the healing process. Also, nicotine delays the healing by decreasing the blood supply to the wound.

Previous history of Dry Socket

 If you have experienced dry socket in the past, you are more susceptible to it in the future extractions.

Read more: An alternative to root canal treatment

Wisdom Tooth Extraction

Lower wisdom tooth extraction shows the highest incidence of developing dry socket. You are more likely to get dry socket if you have one or more of the following conditions:

  • Impacted wisdom tooth
  • Complex anatomy, such as root dilaceration (kink in the root)
  • Fewer blood vessels in the jaw (for instance, the blood supply of the jaw decreases after head and neck radiotherapy). Also, lower jaw in the molar region has dense bone with less blood vessels and is, therefore, more prone to dry socket than upper jaw.
  • Surgical extraction — extensive tissue damage during extraction.

Read more: All about hooked tooth root

Female gender and oral Contraceptives

A few studies suggest that females have a higher risk of developing dry sockets than males, possibly due to hormonal fluctuation during the monthly cycle. Also, the frequency of dry socket is 4 times higher in women taking oral contraceptives than the ones who don’t take oral contraceptives. 

Estrogen in oral contraceptives increases plasmin concentration in the blood and prematurely disintegrates the blood clot in the extraction socket. If you’re on oral contraceptives, it is best to schedule your extraction appointment between 23-28 days of the menstrual cycle when the estrogen levels are lowest.

Moreover, young females with impacted lower third molars are advised to get them extracted before 24 years to reduce the risk of dry socket.

Damage to tissues 

Surgical extractions with extensive tissue damage have been postulated as a significant risk factor for dry socket. In tooth extractions where extensive force is applied on the socket wall, the bone-forming cells (osteoblasts) lining the socket wall undergo necrosis (dies) within 24-90 hours. The dead osteoblasts activate certain enzymes that convert plasminogen into plasmin, a compound that causes lysis (breakdown) of the blood clot, ensuing dry socket. 

The surgical and impacted lower wisdom teeth extractions are ten times more prone to develop dry socket.

Read more: All about the local anesthesia for wisdom teeth

Age 

Dry socket is frequently seen in people over 40-45 years. Approximately 1-4% of simple, uncomplicated extractions are likely to develop dry socket with 10 times more risk associated with lower molars than the upper molars. 

What does a dry socket look like?

Dry socket presents with certain visible signs and symptoms. However, all of these features maynot be present in every case. You will likely to experience one or more signs and symptoms if you suffer from dry socket:

Empty or Partially Empty Socket

The blood clot that usually forms after a tooth extraction is missing or partially dislodged, leaving the extraction site empty. On examination, the empty socket appears white and dry.

Exposed socket bone

 In some cases, you may see the underlying bone in the socket, contributing to the term “dry socket.”

Severe Pain

Intense and throbbing pain is a hallmark of dry socket, typically extending beyond the usual discomfort associated with tooth extractions.

You will experience improvement in pain in the first 24 hours, with worsening, debilitating pain in the next 48 hours. The pain continues through the night and is most intense 72 hours post-extraction. The pain may last from 10 to 14 days. Moreover, the pain is unresponsive to the prescribed painkillers. 

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Bad Breath

Occasionally, the socket may be filled with saliva and food debris. The rotting food debris and dead tissues in the socket contribute to foul odor. 

Read more: 8 Signs of poor oral hygiene

Pain Radiating to Ear

The pain associated with dry socket may radiate to the ear on the extracted side.

Swollen gums

The gums around the extracted tooth may appear red and swollen. 

Delayed socket closure

Normally, the socket begins to close a few days after tooth extraction. However, premature loss of blood clots delays the healing in dry socket, and the socket remains open longer than expected. 

What Is the Treatment for Dry Socket?

The treatment of dry socket involves socket debridment followed by placemet of a medicated dressing. The socket is cleaned with normal saline to remove the dead and rotting tissues and pricked with a probe (sharp instrument) to allow bleeding and healthy blood clot formation. The socket is finally packed with a eugenol-based dressing that has numbing and healing properties.

Your dentist will prescribe you pain relievers to manage discomfort. Avoid smoking and drinking with a straw to prevent further delay in healing.

Read more: Can you brush your teeth olive oil

How to avoid dry socket?

After an extraction, you must follow the following post-extraction instructions to faciliate the healing and reduce the risk of dry socket:

  • Ensure that your dentist or oral surgeon is experienced with the type of surgery you require. Surgical extraction, impacted wisdom tooth extraction, or teeth with curved roots, etc., are complicated procedures and require an experienced dentist or oral surgeon.
  • Bite on the dampened gauze for 30-60 minutes to allow the blood clot to form. Biting on a dry guaze can also dislodge the clot.
  • Don’t use a straw for at least 24-48 hours after the surgery.
  • Avoid vigorous spitting for 24-48 hours after the extraction. Passively empty your mouth if required.
  • Avoid beverages or mouthwash containing alcohol for the first 24 hours to reduce dislodging clots. Alcohol has an anticoagulant effect and can increase the risk of bleeding.
  • Avoid smoking and use of all tobacco products for at least 72 hours after the procedure.
  • Start gentle toothbrushing from day 2.
  • It is recommended to rinse with warm saline 4-5 times daily. 
  • Eat a soft, nutritious diet such as soups, eggs, milkshakes, chicken, and smoothies. Avoid crunchy, hard foods for at least two weeks and slowly add solids back into your diet.
  • Limit strenuous activity for the first 24 hours after the extraction to avoid excessive bleeding from the socket. 

When to report to the dental office? 

If you’re suspecting a dry socket or experiencing severe pain after a tooth extraction, call your dentist’s office for evaluation and timely treatment.

Summary 

Dry socket pain is a common post-extraction complication. It occurs due to premature disintegration or loss of blood clot from the socket. The main characteristics and what does a dry socket look like are summarised below: 

  • Severe pain is the most common symptom that brings you to the dentist.
  • Bad breath from the mouth.
  • Empty socket with exposed bone can be seen in the mirror. 
  • It is more common in people with poor oral hygiene, surgical extractions, female gender, and smokers.
  • Mostly seen after the lower wisdom tooth extraction.

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