Dry Socket: not a pretty sight

Posted on by Dr. Robert Axelrad (Brampton Dentist)

Tooth Extraction

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Under normal circumstances, after a tooth is extracted (taken out), a blood clot forms and the healing process begins. But, in a small percentage of people (3-5%), the blood clot doesn’t stay in the socket…it actually comes out. This usually happens about 3-5 days after the tooth has been extracted.  This is called Dry Socket and it is not a pretty sight: The empty tooth socket that arises when the blood clot comes out looks as if there’s grayish slough coming out of it. In any case, let’s move on.

When the blood clot is no longer present, the result is pain. The reason for the pain is that the the walls of the socket have exposed bone and nerve endings present. Normally, the blood clot would be covering these nerve endings.

The resulting pain tends to ‘radiate’ up along the jaw towards the ear: An unpleasant odor usually goes hand in hand with this.

Dry socket normally appears because the ‘post-op instructions’ have not been followed. Post–Op instructions are the do’s and don’ts after getting a tooth taken out. I will discuss them in the next blog.

Negative Pressure
Usually, it’s negative pressure which pulls out a blood clot and it’s usually a blood clot that is weak and hasn’t formed properly (see below).  Negative pressure occurs when we spit out, suck through a straw or smoke; actions like that.

A weakened blood clot
If a blood clot is not stable or doesn’t form properly, then negative pressure will easily pull it out. Women tend to have a higher incidence of dry socket than men. This is because estrogen slows the healing process down. This is why it’s best to do extractions on women at the end of their cycle, when estrogen levels are lower.

Smoking also affects the stability of a blood clot because the smoke decreases oxygen levels that are needed for the blood clot to form properly.

Treatment
There are basically 2 ways to treat dry socket:

1)    First, we gently rinse out the socket to get rid of bacteria and food particles. Then we apply a sedative type of dressing which will coat and soothe the exposed bone and nerve endings in the empty socket. We do this treatment for about 3-4 consecutive days. Eventually, healing tissue known as ‘granulation’ tissue grows in and coats the sensitive and inflamed walls of the socket.

2)    The other way is a bit more aggressive. We rinse out the socket with saline and use a lot of pressure while doing so. This causes the walls of the socket to bleed, so a new clot forms.

In addition to the above, it’s common to prescribe medication such as Ibuprofen to deal with pain and inflammation, and at times an antibiotic if deemed necessary. Rinsing with warm salt water 2-3 times per day is also helpful.

Dry Socket is easy to treat, but if you follow the instructions in the next blog, it may prevent it from occurring in the first place!

Tooth Extractions need not be painful.  We can help.  Call us today (905) 791-3867 or e-mail us to book an appointment.

About Dr. Axelrad
Practicing dentistry for more than 23 years, Dr. Robert Axelrad has owned and managed his own dental practice since 1997.  He moved his practice to its current, state-of-the-art dental office in Brampton, Ontario in 2002 to accommodate his growing list of happy patients.

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