Dry Socket: The Absolute Worst


Arianna Ritchey, RDH

DRY SOCKET: The Absolute Worst.

Last July we featured an awesome article by Becky that was all about wisdom teeth.  If you haven’t read it yet, here’s the link!  Becky touched on one of the complications following a wisdom tooth extraction, called a “dry socket.”  The technical term for a dry socket is Alveolar Osteitis, which directly translated means ‘inflammation of alveolar bone (of the jaw).’  

A dry socket is a complication which occurs after about 25% of wisdom tooth extractions, and is more common in the lower jaw than the upper jaw.  The incidence of a dry socket resulting from the extraction of any other teeth is considerably lower; only two to three percent.  The symptoms of dry socket include a bad taste in the mouth, a dry-looking socket with white-ish bone at the bottom instead of a dark red blood clot, and pain that progressively becomes more severe and can sometimes radiate to other parts of the head and neck.  Symptoms typically occur about two to three days after the extraction and are often uncontrollable with over-the-counter pain medication. If you have ever experienced a dry socket, then you already know that the pain is excrutiating.  So, what exactly is a dry socket?  Why does it happen, how can it be prevented, and most importantly, how can it be treated?

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When a tooth is pulled, what’s left behind is an empty socket site in the bone where the roots of the tooth used to be.  Following the extraction, a blot clot forms in the socket site and protects the underlying bone and nerves from exposure to the mouth.  Over time, the socket site heals and is filled in with new bone.  If this blood clot is lost prematurely, however, the underlying bone and nerves are exposed to the environment of the mouth, which is crawling with bacteria.  This exposure can lead to infection and the dreaded dry socket.  Dry socket is more prevalent in the lower jaw than the upper jaw, because the lower jaw has a poorer blood supply than the upper jaw, and food debris is more likely to become trapped in socket sites due to gravity.  

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Following an extraction, dental professionals provide post-operative instructions in the interest of preventing a dry socket.  They will advise to avoid any foods with small seeds or nuts which could get trapped in the socket site, avoid strenuous activity following surgery to prevent additional bleeding, and to avoid vigorous rinsing that could potentially dislodge the blood clot.  Instruction will be given to avoid spitting or drinking through a straw for at least two or three days.  Spitting and using a straw creates negative pressure in the mouth which could dislodge a clot.  Your dental professional will likely also tell you to avoid the use of tobacco at all costs, especially cigarette smoking.  Smoking also creates negative pressure in the mouth which could dislodge a clot, and the nicotine in the cigarette slows healing and constricts blood flow necessary for proper healing.

Besides providing helpful instructions for how a dry socket can be prevented at home, your dental health professional can also help to prevent dry socket from occurring by placing a small suture in the extraction site if necessary, and by rinsing with an antimicrobial chlorhexidine rinse immediately after the extraction.  Rinsing with chlorhexidine solution after extractions has been shown to prevent about 40% of potential dry sockets.  

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Despite dry socket being very painful, the treatment is fairly simple.  If you think you may be experiencing dry socket, call your dental provider right away.  Once they determine a dry socket is present, your dental professional will clean the socket site and apply a medicated dressing.  Your dental professional may administer a local anesthetic to the area to provide pain relief and to facilitate cleaning and medicating the site without causing further discomfort.  The medicated dressing often includes eugenol, an ingredient which is very soothing for dry socket.  Your dentist may provide a prescription for antibiotics or pain medication to assist with recovery from the dry socket.  If a dry socket is left untreated, it may resolve on its own, but the pain is likely to last for about a week.

Dry socket is a very painful complication that should be avoided with every effort.  If preventive efforts are made, and post-op instructions are adhered to, there’s a good chance you won’t experience a dry socket.  If your extraction site does start to hurt after about two or three days and over-the-counter medication isn’t controlling the pain, you may have a dry socket and should see your dentist as soon as possible!  Dry socket is easily treatable by dental professionals.

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What’s the Deal with Wisdom Teeth?


Becky Larson, RDH

What’s the Deal with Wisdom Teeth?

Everyone has them, but not everybody knows what to do with them.  “Wisdom teeth” or 3rd molars can cause a number of problems in the mouth.

Wisdom teeth are believed to be evolutionary and were helpful to our distant ancestors who frequently ate rougher foods.  Wisdom teeth would erupt as replacements for worn out or missing teeth.  Nowadays modern advancements, better hygiene, and softer diets allow us to keep most of our teeth so we really don’t need wisdom teeth at all! For most people, wisdom teeth erupt in the late teen years or early 20’s, usually earlier for females.  They are the most posterior (towards the back) teeth.  Most people have 4 wisdom teeth total, but sometimes they can be congenitally missing.  Other times people may have extra (supernumerary) wisdom teeth.

Even if there is sufficient space in the mouth and the wisdom teeth are in alignment with the other teeth, they can still cause problems.  Because of their location, wisdom teeth are extremely hard to brush and floss.  If they are not kept clean, they can cause periodontal pocketing, which can lead to tooth loss in other areas of the mouth.  Unfortunately, most people don’t have enough space and when wisdom teeth erupt, they can push on the surrounding teeth.  This can cause crowding and misalignment throughout the entire mouth.  Wisdom teeth can also be impacted – meaning they are enclosed in the gum tissue or jawbone.  When this happens they can partially erupt or even try to erupt horizontally.  When teeth are only partially erupted, it allows bacteria to enter the tooth.  This can lead to infection, pain, swelling, jaw soreness, cysts, and other systemic illnesses.

X-ray showing impacted wisdom teeth:


A dentist will usually take a panoramic x-ray to view the wisdom teeth to determine when/if they need to be extracted.  If extractions are indicated, getting them out at a younger age is preferable for recovery time.  If wisdom teeth are fully erupted and not impacted in the gums or bone, they can be extracted as easily as a regular tooth.  If they are impacted, the gums and/or bone need to be cut open in order to extract.  Wisdom teeth can be extracted with local anesthetic only, though other pain/anxiety management techniques can be used.  These include nitrous oxide, conscious sedation, and/or anti-anxiety pre-medication.

Recovering time is usually about 2 weeks.  During the recover a person may experience bleeding and facial swelling.  Pain medications and antibiotics are often prescribed as well.  Possible complications of wisdom teeth extractions include dry socket and parasthesia.  Dry socket occurs when a blood clot fails to form or falls out and is extremely painful.  A person should not drink from a straw for several days after the extractions to avoid dry socket.  During wisdom teeth extractions the nerves can sometimes become damaged or bruised.  This results in prolonged numbness or parasthesia, which can last weeks or months and can sometimes be permanent.  Parasthesia is more rare and generally the numbing sensation wears off after several hours.  Dry socket and/or parasthesia don’t always occur after wisdom teeth are extracted.

So you can see that wisdom teeth can cause many headaches (literally)!  Be wise and get your wisdom teeth extracted as soon as your dentist recommends it.

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picture from: http://www.quora.com/Do-all-humans-have-wisdom-teeth