Alveolar Osteitis (commonly called as Dry Socket) is the inflammation/irritation of the alveolar bone below the socket where the tooth has been extracted. It is seen in around 5-10% of extractions. This condition occurs because of any disturbance that causes the stoppage of blood clot formation in the extraction socket. Due to improper clot formation and damage, the bone gets exposed to air, food and the liquids and the patient presents with an offensive odor, a few days after the extraction. The bone along with the nerve endings get exposed due to the break/dislodgement of the blood clot, and the healing process is not possible after the present clot is disturbed.
How is the dry socket formed? In whom?
- It is seen mostly in mandibular areas where the 3rd molar is extracted, as the blood supply is poor in this area and it is seen 2 days after extraction, and can last for around 5-6 days. It occurs due to fibrinolytic activity, leading to lysis of blood clot.
- Smoking after tooth extraction – People who smoke soon within a few days after a tooth is extracted, leads to delayed healing, decreases the blood supply to the blood clot, apart from irritation to the gums due to the toxic products from the cigarette smoke.
- Poor oral hygiene and failure to follow the instructions given by the dentist, after the extraction.
- Actions like sucking liquids, sneezing, coughing, rinsing water soon after the extraction.
- In women who use oral contraceptives/birth control pills, formation of dry socket is more incidental.
Signs and symptoms of Dry Socket
- Dry looking socket
- Sharp and sudden pain in the socket area, and usually couple days after extraction. The pain can radiate to the ear
- Exposed bone is highly susceptible to pain
- Foul odor and taste
Prevention of Dry Socket
- Avoid smoking for a few days after extraction
- Avoid drinking liquids using a straw
- Vigorous movements of mouth to disturb the clot should be avoided
- Extraction at the end week of menstrual cycle is advisable, and not during the menstrual period, because higher estrogen levels delay the healing process
- Try to make the patient chew on the other side of the mouth, and rinse the mouth gently for the first 24 hours after extraction
- Discourage spitting of saliva as it creates negative pressure, and affects the clot formation
Treatment of Dry Socket
- Main aims include relieving the pain, and healing the tissue around the bone.
- Irrigation of the socket, and then a gauge with certain medication is placed. Medication includes a topical anesthetic like Benzocaine, obtundant and eugenol. The gauge is replaced every 3-4 days.
- Antibiotics are advised to reduce any risk of infections, and gentle mouthwash is advised.