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How to Prevent Dry Socket

Watch this video explaining what an abscessed tooth is and when treatment is necessary.
American Dental Association

From baby teeth to wisdom teeth, what's in our mouths marks our passage from infancy into adulthood. Tooth loss is a normal part of childhood, but there is no tooth fairy for adults. While many Americans lose teeth as they age, it's not inevitable. Instead of the fairy tale tooth-for-cash exchange, adult tooth loss centers around decay and injury.

Tooth decay is the leading cause of missing teeth and tooth extractions, but tooth extractions may also be needed due to other reasons, such as impacted wisdom teeth or accidental injury.

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Sometimes, when a tooth is unhealthy and cannot be repaired, your dentist may recommend removing it to avoid complications, such as infection. A tooth extraction is a dental procedure performed by either a dentist or oral surgeon, and as with any surgery, there are risks of side effects. The most common side effect of a tooth extraction is dry socket.

Before we can understand dry socket, let's first look at what a tooth socket is.

Each of your teeth has two basic parts: a crown and a root. The crown is the part of the tooth visible inside your mouth, while the root is what anchors the tooth in the jawbone. The root is embedded in a tooth socket, which is a hole in the jawbone, covered by cementum (hard, calcified connective tissue) and attached to the periodontal ligament (the flexible tissue that attaches the root to the alveolar bone).

When a tooth is extracted, the body naturally forms a blood clot in the empty tooth socket. This blood clot is essential for protecting the exposed jawbone, tissue and nerves and promoting healing. When the blood clot does not properly form (for example, if it's too small to cover the wound), or if the clot becomes dislodged from the socket, this is a condition known as dry socket.

While it's normal to experience pain and discomfort immediately after a tooth is extracted, this discomfort should begin to lessen, generally, after the second day of healing. When pain persists or worsens after the first two to three days after an extraction, and when it's accompanied by bad breath or a bad taste in your mouth, you may be developing dry socket. If you were to look at the wound it would appear empty, and you may be able to see bone.

Luckily, while dry socket is painful, it's easily treatable. Let's find out tips for prevention, and discuss the treatment options if it develops.

Some people are at greater risk for dry socket. People with poor oral hygiene habits, and people with a prior history of dry socket after a tooth extraction, are at an increased risk for developing the condition. So are patients who are having their third molars (their wisdom teeth) pulled, or who have more trauma than usual during extraction surgery.

If you're a woman and you're taking birth control pills your risk also rises -- women who take oral contraception have a 30 percent higher chance of developing dry socket after a tooth extraction during the first 22 days of their monthly cycle than women who are not on the pill [source: Academy of General Dentistry]. It's the estrogen -- high levels of estrogen circulating through the body affect the blood's ability to clot, so plan your extraction surgery during the last week of your cycle to give yourself the best odds against dry socket.

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Some personal habits may also increase your odds of dissolving or damaging the blood clot. Smoking has poor oral health ramifications, including increased risks for gum disease, bone loss and oral cancer, among other health concerns. And now, smokers have one more thing to worry about -- an increased risk of dry socket after a tooth extraction. Smokers should stop smoking for at least 24 hours after an extraction, since smoking can decrease the blood supply to the wound and delay healing.

In addition, coughing, sneezing, spitting and sucking through a straw also increase your odds of dry socket. While your wound is healing, and especially during the first 24 hours, it's best to avoid any activities or habits that may damage the blood clot.

After your tooth extraction surgery, your dentist will pack the empty socket with gauze to help stop the bleeding -- sometimes, you may also need stitches. You'll be sent home with a few at-home care tips, including instructions to take over-the-counter nonsteroidal anti-inflammatory drugs to relieve pain, and advisement not to touch your wound -- not with your fingers, your tongue, or anything else, for that matter. Keep bacteria away, and you'll help keep infection away.

It's also important to understand the best practices for rinsing. To avoid damaging the blood clot forming in your empty tooth socket, it's best not to rinse your mouth during the first 24 hours after your tooth is extracted. Beginning the day after your surgery, though, a gentle rinse with warm salt water several times a day will help keep the wound clean, and will also help to reduce pain and inflammation.

Despite following preventative care instructions to the best of their abilities, it's estimated that between 2 and 5 percent of patients will develop dry socket anyway [source: MedicineNet].

Treatment usually includes a combination of cleaning and packing the wound. Your dentist will rinse and clean out any debris that has become lodged in the socket, and pack the empty socket with medicated dressings which will be changed every day or two. Some patients may also need antibiotics if the socket has become infected, or as a preventative measure.

With treatment, the pain of dry socket will begin to subside after about four or five days and is normally healed in less than two weeks.

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More Great Links

Sources

  • Advanced Dental Care of Norton. "How to Avoid Dry Socket After a Tooth is Removed." (Oct. 14, 2011) http://www.adcofnorton.com/adc_dry-socket.pdf
  • American Dental Association. "Dry Socket." (Oct. 14, 2011) http://www.ada.org/2980.aspx?currentTab=1
  • American Dental Association. "Tooth Extractions." (Oct. 14, 2011) http://www.ada.org/2926.aspx
  • American General Dentistry -- Know Your Teeth. "Avoid Dry Socket With Wisdom Tooth Extractions." 2008. (Oct. 14, 2011) http://www.knowyourteeth.com/infobites/abc/article/?abc=a&iid=340&aid=1364
  • American General Dentistry -- Know Your Teeth. "Check Menstrual Calendar for Tooth Extraction." 2008. (Oct. 14, 2011) http://www.knowyourteeth.com/infobites/abc/article/?iid=340&aid=1365#abc_result
  • Catellani, JE; Harvey S.; Erickson, SH; and D. Cherkin. "Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis). Journal of the American Dental Association. Vol. 101, no. 5. Pages 777-780. 1980. (Oct. 14, 2011) http://www.ncbi.nlm.nih.gov/pubmed/6935267
  • Colgate Oral and Dental Health Resource Center. "Tooth Extraction." (Oct. 14, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Checkups-and-Dental-Procedures/Tooth-Removal-Extraction/article/Tooth-Extraction.cvsp
  • Mayo Clinic. "Dry socket." 2010. (Oct. 14, 2010) http://www.mayoclinic.com/health/dry-socket/DS00778
  • MedicineNet.com. "An Overview of Dry Socket." 2011. (Oct. 14, 2011) http://www.medicinenet.com/dry_socket/article.htm
  • National Institute of Dental and Craniofacial Research. "Tooth Loss." 2011. (Oct. 14, 2011) http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/ToothLoss/
  • SimplyTeeth.com. "The Anatomy of Teeth and Jaws." 2004. (Oct. 14, 2011) http://www.simplyteeth.com/category/sections/adult/aboutteeth/anatomy.asp?category=adult&section=1&page=1
  • WebMD. "An Overview of Dry Socket." 2011. (Oct. 14, 2011) http://www.webmd.com/oral-health/dry-socket-symptoms-and-treatment
  • WebMD. "Pulling a Tooth (Tooth Extraction)." 2009. (Oct. 14, 2011) http://www.webmd.com/oral-health/pulling-a-tooth-tooth-extraction

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