Dry Socket

Dry socket (alveolar osteitis) can happen after you get a tooth pulled. Normally, a blood clot forms in the empty space (called a socket) where the tooth used to be. This clot protects the area and helps it heal.

If the clot doesn’t form — or if it comes out too soon — the bone and nerves underneath can get exposed. That can cause a lot of pain and slow down healing.

Dry socket affects about 2% to 5% of all tooth extractions. It’s more common after wisdom teeth removal.

How do I know if I have a dry socket?

A dry socket looks like an empty hole where your tooth was, with a whitish layer at the bottom. That white part? It’s exposed bone. That’s why you’re feeling so much pain.

Dry socket vs. blood clot

After your dentist pulls the tooth, a blood clot forms in the socket — that’s a good sign. It looks like a dark scab and protects the area while it heals. If you notice the clot, leave it alone and don’t try to touch or remove it. If you don’t see a clot — or if you see bone instead — you might have a dry socket.

Symptoms of dry socket

Dry socket symptoms may include:

• Mouth and/or facial pain
• Radiating nerve pain from your jaw to your head and neck
• Tooth/gum infection
• Unpleasant taste and/or bad breath

Dry socket causes

A dry socket happens when a blood clot at the site of a tooth extraction breaks down too soon or doesn’t form properly. This clot is essential — it protects the bone and nerves underneath as the area heals. But in some cases, the clot dissolves or dislodges early, exposing the bone and causing pain.

Researchers still don’t know exactly why this happens in some people and not others. However, they’ve identified several risk factors that can increase your chances of developing a dry socket.

Risk factors

These things can raise your risk for dry socket:

• Hormonal birth control. Birth control pills with estrogen can slow down healing and make dry socket more likely.
• Poor oral hygiene. Not keeping your mouth clean can let bacteria in, which raises your risk.
• Smoking. People who smoke are over three times more likely to develop dry socket than those who don’t.
• Using a straw. Suction from drinking through a straw can dislodge the blood clot. Skip the straw for at least a week.
• Vigorous rinsing. Swishing mouthwash too hard can also knock the clot loose. If your dentist recommends rinsing, tilt your head and let the liquid soak the area instead.

How doctors diagnose dry socket

Dentists usually suspect dry socket when severe pain follows a tooth extraction. They confirm it by checking the empty socket where they removed your tooth.

In some cases, your dentist may also take X-rays to check for any tooth fragments left behind in your jaw.

How is dry socket treated?

Dry socket treatment may include:

• Antibiotics. If your dentist thinks you might have an infection, they can prescribe antibiotics.
• Irrigation. Your dentist may gently flush out the socket with salt water or antibacterial mouthwash.
• Medicated dressings. Your dentist might place numbing medications like lidocaine or eugenol in the empty socket.
• Pain medicine. Over-the-counter medications like acetaminophen (Tylenol^®) or ibuprofen (Advil^®) can help reduce discomfort.

Recovery time

With proper care, a dry socket usually heals within seven to 10 days. In that time, new tissue forms to cover the exposed area. Brushing and flossing regularly helps keep your mouth healthy and lowers your risk of infection.

When should I see my healthcare provider?

Let your dentist know if you’re having pain that keeps you up at night or doesn’t improve with medication. If you can’t reach the provider who did the extraction, head to the nearest urgent care or emergency room.

Can dry socket be prevented?

You can’t always prevent dry socket, but you can lower your risk. Here’s how to protect the healing spot after a tooth extraction:

• Don’t smoke or use tobacco.
• Skip warm or fizzy drinks while you heal.
• Avoid straws — they create suction that can dislodge the clot.
• Stick to soft foods and steer clear of anything hard, crunchy or chewy.
• Follow all post-op instructions from your care team.

Taking these steps helps your mouth heal and keeps discomfort to a minimum.

What can I expect if I have a dry socket?

Most dry sockets heal on their own, but the pain can be intense. If you’re dealing with moderate to severe discomfort, it’s a good idea to see your dentist. Prompt treatment can help relieve the pain and speed up healing.

Dry socket usually develops within the first three days after your dentist removes a tooth. If you haven’t had symptoms by day five, you’re likely in the clear.