Dry sockets are rare in our practice! That being said, what is a dry socket? Who gets them? And how are they treated—or better yet, prevented?
A dry socket is a painful healing issue related to a tooth extraction. Pain usually starts to increase somewhat two to three days after the procedure. That part is actually normal. However, any dramatic increase could indicate a dry socket. Bacteria often cause the loss of the initial blood clot and expose the bone, which is obviously quite painful. Dry sockets may be mild or severe, and this increased pain can last another week or more and usually requires other treatment depending on the severity. In my experience, they occur more frequently in lower sockets and areas where the surgery has been more difficult to remove the tooth. Also in my experience, females are more prone to them—especially females who smoke and/or use birth-control pills. Other things that can promote a dry socket are:
- a difficult extraction;
- a patient who smokes (poor blood supply for healing);
- chronic or acute infection in the bone around the tooth;
- general health of the patient; and/or
- the patient who doesn't follow instructions, often by being too vigorous with the hygiene of a recently operated area (using a water pik or syringe too early can cause the loss of the initial blood clot that protects the bone).
What Does Dry Socket Feel Like?
From a patient standpoint, there is a dramatic increase in the level of pain over a 24-hour period of time. The medicines that you were taking to help you stay comfortable are no longer adequate, or you are having to take them more often than you should.
Dry Socket Treatment
It is better to prevent a dry socket than to treat one! Surgery in my office is always done as carefully as possible. All surgical sites are copiously washed with saline, which is the first defense against dry socket. Next, for patients who are not allergic, tetracycline powder is placed into the sockets prior to closing with sutures. Ladies are prescribed chlorhexidine rinse, which is an antibacterial rinse, which effectively helps prevent dry socket. Careful washing of the site, antibiotic powder, and chlorhexidine rinse have made recovery from wisdom teeth much easier for our patients. We also use the therapeutic (cold) laser after each removal, which helps areas to heal.
In the rare occurrence in our office that a dry socket still occurs, it usually requires local anesthesia first, to allow placement of gauze coated with a eugenol-based medicament, a substance which will sedate the bone. There are variations in the intensity of pain depending on the patient as well as their ability to tolerate treatment without local anesthesia. Treatment of dry sockets is, invariably, gently done with either no local anesthesia or local anesthesia to anesthetize the painful area. Then a sedative dressing is placed in the socket, which will stay in place for anywhere from one to three days before it's removed and possibly replaced. The placement of these dressings allow the patient to be fairly free of pain, requiring much less medication when the local anesthesia wears off. Generally, repacking with a new sedative dressing does not require the use of local anesthesia again.
A dry socket will require anywhere from one to several packings until the area is comfortable enough without being retreated. A dry socket will delay the whole healing process in the area. This can require several more visits to the office (no charge) for packing changes. After the first packing, subsequent packing rarely requires administration of local anesthesia again. If a dry socket develops, the healing of that area will not start until the dry socket runs its course. All patients have my personal cell number to reach me should they need my help!