Do you have a dry socket? | Pictures (2023)

What is a dry socket?

A dry socket, more formally termed alveolar osteitis, is a common postoperative complication associated with having a tooth extracted.

It involves a situation where an extraction site’s healing process is interrupted (delayed) due to the loss of the blood clot that normally occupies the tooth’s empty socket.

This page’s coverage of dry sockets is broken into the following subsections:

• Usual signs and symptoms.
• Dry socket vs. normal healing.
• Pictures of dry sockets.
• How long do they last?
• How long does the pain last?
• Treatment.
• Why do they form?
• How often do they form? (wisdom teeth vs. other teeth)

Dry socket signs and symptoms.

The predominant characteristics of having a dry socket are:

1. Throbbing pain (possibly very intense pain).
2. Bad breath (a foul odor and/or bad taste coming from your extraction site).
3. Timing of these events where they first appear a few to several days following your tooth’s extraction.

How can you tell if you have a dry socket?

The key to determining if what you’re experiencing is due to a developing dry socket is to compare the symptoms you notice with those of normal post-extraction healing.

a) What’s normal healing like? What usually happens after a tooth is pulled?

• In most cases, a patient will experience some degree of discomfort from their extraction site on the day of their surgery. (Hopefully, this will just be minor.)
• And then with each day that follows, the level of pain they notice gradually tapers off until it finally disappears.
• And as each day passes, the site shows continued progress toward healing over the extraction’s wound.

b) What’s different when a dry socket starts to form?

As alveolar osteitis sets in …

• The patient will find that their initial discomfort does gradually fade over the first few days following their extraction. (Just like with normal healing.)

  But then, usually somewhere between days 2 and 4 after their procedure, their level of pain begins to intensify.

• During this same time frame, the patient may start to notice a bad taste or odor coming from their extraction site.
• On inspection, the patient will notice that their tooth’s socket appears empty. (Evidence of blood clot loss and/or disintegration.) The bony walls of the interior of the socket may be visible.

▲ Section references – Kolokythas

Here’s a recap of the above information in tabular form for comparison.

Dry socket formation vs. normal healing. – Major differences.

Further details about the symptoms of dry sockets. –

1) What does a dry socket feel like?

Pain and discomfort.

With alveolar osteitis, the discomfort from the extraction site usually starts to intensify on days 2 to 4 after the tooth was initially removed. (48 hours following the procedure, or later.)

This detail alone is an important characteristic clue that helps to confirm for your dentist that you do in fact have a dry socket.

a) What does a dry socket feel like at first?

It’s usually the gradually intensifying, frequently throbbing, pain coming from the area of your extraction site that’s the first tipoff that a dry socket is starting to form.

b) How bad does a dry socket hurt?

• The discomfort is often (almost characteristically) described as a dull throbbing pain.
• It can be moderate to severe in intensity, possibly even debilitating.
• What’s felt may be constant or intermittent. In the latter case, the frequency of onset can vary. Later on, the pain is more likely to be constant.
• The pain may remain localized to just the extraction site, radiate to other portions of the jaw, or even extend to other areas on the same side of the patient’s head such as the ear or temple, or possibly even the eye or neck. Experiencing headaches is also reported.
• The pain usually reaches its most intense level around 72 hours post-extraction (Bowe). The pain may be so debilitating that it causes loss of sleep and affects the person’s ability to function.

▲ Section references – Bowe

c) How long does dry socket pain last?

On average, the discomfort usually runs for 4 to 8 days. That means you’ll likely need attention from your dentist to stay comfortable. How dentists treat dry sockets.

At times the pain may be quite severe. Toward the end, it will just gradually taper off and finally disappear.

What does a dry socket feel like with your tongue?

You’ll be able to feel that the tooth’s socket seems empty and open. (Due to the loss of its blood clot.) You’re likely to feel the sharpness of the socket’s exposed bone surfaces.

2) What does a dry socket look like?

• The tooth’s socket will appear empty instead of being filled in with a blood clot or granulation tissue (new developing tissue) like with normal healing.

  (In many cases, the emptiness of the socket isn’t readily apparent because it’s filled with saliva, or accumulated food and debris.)

• The exposed bone of the walls of the empty socket is visible. It may be partially covered with a gray/yellow layer of necrotic tissue or other debris.
• The gum tissue immediately surrounding the extraction site shows signs of being inflamed (red, tender, puffy).

How does a dry socket’s appearance compare to normal healing?

• With normal healing, the tooth’s socket remains substantially filled. (First with the blood clot that forms and then with the developing tissues that arise from it.)
• No exposed bone is visible.
• The contours of the extraction site continually become more and more rounded as the bone and soft tissues of the wound gradually heal over.

3) Additional signs and symptoms.

• It’s characteristic that the patient will notice a foul odor (halitosis) or bad taste coming from their extraction site.
• Lymph nodes in the jaw or neck may be tender and enlarged. (A sign of the body’s inflammation response to conditions associated with the dry socket’s formation.)
• Dry sockets are typically not associated with the presence of fever, swelling of the surgical region, or obvious signs of infection (local or systemic).

▲ Primary reference sources for entire Characteristics section – Kolokythas, Bowe, Noroozi

4) Dry socket timeline.

How long does it take to get a dry socket?

Characteristically, symptoms don’t start to appear any sooner than 2 to 3 days following your extraction. 95% of dry socket cases are apparent within the week following the patient’s procedure. (Kolokythas)

How long do dry sockets last?

Once a dry socket has set in, it usually takes about 7 to 10 days for the extraction site’s healing process to get geared up again and create new granulation tissue that then starts to cover over and protect the socket’s exposed bone. As this process advances, you can expect your symptoms to begin to subside. (Noroozi)

How long does it hurt?

The pain from a dry socket usually lasts for 4 to 8 days. At times, the pain may be quite intense. But as the healing process finally manages to make progress, the discomfort will finally taper off.

How long is your wound’s healing process delayed?

In general, you can expect that the healing of your extraction siteNormal healing timeline. will be delayed on the order of a week or longer.

How do you know when a dry socket is gone?

A dry socket is a set of symptoms associated with interrupted (delayed) wound healing. As conditions within the extraction site correct themselves and get back on track, the symptoms produced by the site’s irritated tissues will gradually subside.

Once your symptoms have disappeared, it’s expected that this complication has run its course and your healing process will continue on to completion.

▲ Section references – Noroozi, Kolokythas

5) How are dry sockets treated?

Pain relievers on their own (over-the-counter pain medications and even prescription narcotics) are seldom fully effective in managing the discomfort associated with a dry socket.

Treatment.

The most effective treatment for pain associated with a dry socket is one where the patient’s dentist inserts a special paste (medicated dressing), daily if needed, directly into the woundHow that’s done.. In a pinch, there are some home remedy methodsInstructions that can be used to provide pain relief.

Then in conjunction with that treatment, over-the-counter medications (like aspirin, Advil/Motrin/ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAID)), or prescription medications if needed, are used to control whatever level of discomfort continues to persist.

6) How often do dry sockets occur?

Statistics show that experiencing alveolar osteitis is a relatively common post-extraction complication. Although, by far, it’s most common following wisdom teeth removal.

• For routine tooth extractions, the chances of experiencing a dry socket run on the order of 1 to 4%.
• They’re much more likely to occur with lower tooth extractions than upper ones.
• In general, surgical extractions (like impacted wisdom tooth removal) have a tenfold higher incidence rate.
• As many as 38 to 45% of mandibular (lower) wisdom tooth extractions (see picture) are complicated by the subsequent formation of a dry socket.
• With all tooth extractions considered collectively, a dry socket is the most common post-surgical complication.

▲ Section references – Cardoso, Bowe

Etiology – Why do dry sockets form?

Research and clinical observation have identified a number of factors that correlate with a patient’s risk for developing alveolar osteitis. Understanding these factors can be useful in preventing this condition.

Dry socket risk factors.

• Previous history of dry sockets. | Extraction difficulty. | Failing to follow aftercare instructions. Details.
• Cigarette smoking/Tobacco products use. | Taking birth control pills. | Age. | Tooth location. Details.

Following your dentist’s post-operative instructions is important.

As noted above, failing to follow your oral surgeon or dentist’s instructions (especially those that address blood clot formation and retention) places you at an increased risk of experiencing this complication.

For more information, our pages Post tooth extraction instructions – First 24 hours. Next day and beyond. cover this subject in detail.

The mechanism of dry socket formation.

The exact pathogenesis of the formation of alveolar osteitis is not fully understood but it is known that the following factors are involved.

1) The blood clot is lost.

A course of events takes place where the blood clot that normally forms in a tooth’s socket following its removal isn’t properly retained. It either:

• It disintegrates by way of a chemical process termed fibrinolysis.

  (Fibrin is a tough fibrous protein whose formation is triggered by the clotting process. Pieces join together to form long strands that then crosslink with others. As this process continues, and the web that’s formed snares platelets, it develops into what’s referred to as a blood clot.)

  It’s hypothesized that the compounds responsible for this fibrinolytic activity may come from the socket’s bone itself, either as a consequence of infection or as a result of trauma created during the extraction process. (Noroozi)

• It is dislodged by an event or activity.

  (Common scenarios involve loss of the clot as a result of vigorous swishing, rinsing, spitting, or the creation of a sucking action, like when drinking using a straw.)

▲ Section references – Noroozi

2) Healing is delayed.

The lost blood clot would have played an important role in the healing process of the extraction site. However, due to its loss, the progress of the socket’s healing is interrupted (delayed).

3) The socket’s bone tissue becomes exposed.

The clot would have also covered over and protected the bony walls of the tooth’s empty socket as it heals. Now that it’s been lost, the walls are exposed and become irritated, resulting in (possibly intense) pain and sensitivity.

Our next page outlines how dentists treat dry sockets. ►

Video transcription.

Hello, and welcome to Animated Teeth.com and our page that discusses dry sockets, their signs and symptoms, and appearance. Using this video, we’ll highlight some of the primary points we cover that we feel you should know about when sorting through this subject.

This page’s coverage is divided up into a few subsections.

Since it’s usually the timing of the patient’s symptoms that leads to making a diagnosis, we cover that first. And compare what’s experienced to normal post-extraction healing.

Then, while less diagnostic, we discuss the appearance of a dry socket, and compare that to what’s seen with normal healing.

This page also explains why dry sockets form, how often this complication tends to occur, and how long it usually lasts.

We should point out that this isn’t our primary page that discusses treatment for this condition. We instead have two companion pages that cover that. One explains how dentists treat alveolar osteitis, the formal name for a dry socket. The other discusses the possibility of self-treatment.

As far as signs and symptoms go, what’s reported by the patient, and especially their mention of the timing of events, is usually the cornerstone on which a dentist bases their diagnosis.

The standout characteristics of a dry socket are throbbing pain, which can be very intense, and possibly a foul breath odor. But the most important point is this. These symptoms don’t start to appear until some days, usually 2 to 4, following your procedure. That’s the key, the timing.

To recap that point, with normal post-operative healing, the patient can expect that as each day passes, the discomfort they notice from their extraction site will continually, gradually diminish.

With a dry socket, pain levels will start to subside for a few days but then start to ramp up. And associated halitosis may be noticed. And if the person can see in their tooth’s socket, they will probably discover that it seems empty. The blood clot that was noticed previously now seems at least partially missing.

Here’s a comparison of normal vs. alveolar osteitis in tabular form.

In regard to discomfort, the classic description of dry socket pain is “dull and throbbing.” It may be constant or intermittent. Its intensity can vary but at times may be debilitating. The pain may seem focused at your extraction site or can extend into portions of your head and face.

Unfortunately, there is no cure for a dry socket, it simply needs to run its course, which typically takes 4 to 8 days. In the meantime, the most effective means of controlling your discomfort comes from treatment from your dentist, so let them know you need help.

If you can see into your extraction site, the classic description of a dry socket is one where the socket looks empty. If it doesn’t, it may still contain a portion of the blood clot that had formed or it may be full of food and debris.

If you can see the socket’s bony walls, they may be covered with a gray-yellow layer of necrotic debris. Your gum tissue around the opening will be red and puffy, which are signs of inflammation.

With normal, uneventful healing, no exposed bone will be visible. The tooth’s socket will appear substantially filled in.

At this point, you’re probably wondering why dry sockets form. They’re a situation where the extraction site’s healing process is interrupted and therefore delayed.

The crux of the problem lies in the fact that the blood clot that formed immediately following your extraction has become compromised, either disintegrated by chemical mediators or dislodged. And since it provides the scaffolding for the continued progress of the healing process, your socket finds itself back at square one, although now with exposed irritated tissues.

While developing a dry socket isn’t routine, it’s certainly not uncommon. Comparatively more difficult or involved extractions tend to be more frequently associated with their formation, especially removing lower impacted wisdom teeth.

There are other risk factors too, including a previous history of having a dry socket, tobacco product use, possibly increased age and taking oral contraceptives, and, drum roll please, not following your dentist’s aftercare instructions. Look for our supplemental page, shown here, that discusses these issues in more detail.

There’s a lot more information on this page than we’ve covered in this video, so make sure to read through it. However, as advice to you if you’re currently experiencing a dry socket, by far it’s your dentist’s care that will be most effective in controlling your pain. So, as your extraction provider who is also obligated, and probably very eager, to provide you with postoperative assistance, be sure to take advantage of their services. Good luck.

Comments.

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