A “dry socket” occurs when the blood clot is lost from an extraction site prematurely, exposing the underlying bone and fine nerve endings. The loss of the blood clot also allows continued bleeding and retards the healing process. The situation is very painful but essentially harmless, usually responding to impregnated gauze packs every 2-3 days over a two week period.  Subsequent formation of new clot allows for eventual healing to take place, usually in about two months. Rinsing with non-alcoholic fluids twice a day for two weeks after impacted mandibular third molar removal significantly reduces the incidence of alveolar osteitis or dry socket.

Dry socket occurs in about 5% of tooth extractions, but in 33% of extractions in women on oral birth control pills, when the extraction is in the first 3 weeks of the cycle. In addition, there are some activities which may increase the propensity for dry socket formation… smoking, drinking carbonated beverages in the first 24 hours after surgery, spitting or drinking through a straw in that same time period.

A dry socket is caused by the partial or total loss of a blood clot in the tooth socket after a tooth extraction. Normally, after a tooth is extracted, a blood clot will form as the first step in healing to cover and protect the underlying jawbone. If the blood clot is lost or does not form, the bone is exposed and healing is delayed.

In general, a dry socket is a result of bacterial, chemical, mechanical, and physiologic factors. Below are examples for each:

Bacterial: Preexisting infection that is present in the mouth prior to a dental extraction such as periodontal disease (or periodontitis) can prevent proper formation of a blood clot. Certain oral bacteria can cause the breakdown of the clot.

Chemical: Nicotine used by smokers causes a decrease in the blood supply in the mouth. As a result, the blood clot may fail to form at the site of a recent tooth extraction.

Mechanical: Sucking through a straw, aggressive rinsing, spitting, or dragging on a cigarette causes dislodgement and loss of the blood clot.

Physiologic: Hormones, dense jawbone, or poor blood supply are factors that prevent blood clot formation. Continue Reading