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Alveolar osteitis, more commonly known as a “dry socket”, is a documented complication following tooth extraction.  As the name implies, this is an inflammatory condition of the alveolar bone, which is that part of our jaw bone that houses our teeth.  Dry socket is a fitting nickname as in essence the problem is the loss of the blood clot which forms immediately following the tooth extraction, leaving the alveolar bone exposed leading to severe pain.

It is estimated that a dry socket may develop in as many as 2-5% of cases of tooth extraction.  Males are more prone to developing a dry socket than females.  The affected age range is wide, with an average at age 35.  The lower jaw is more commonly affected than the upper jaw, and the molar area is much more common than any other region with the third molar region being most affected.

There are several well-documented preoperative risk factors for development of a dry socket.  Smoking tobacco is a well-known risk factor both in the preoperative and postoperative settings.  People who have a history of smoking develop changes in their smaller blood vessels which can lead to impeded healing and protection from infection.  The use of oral contraceptives is also a minor risk factor historically associated with development of a dry socket.  Elevated estrogen levels, such as the condition created by oral contraceptives, have been linked with disruption of normal healing processes and formation of dry socket.  Improper oral hygiene also has a well-documented association with dry sockets.

The mechanism of development of a dry socket involves the improper initial formation of a postsurgical clot or the premature dissolution of that clot, both of which lead to exposure of the alveolar bone and the very sensitive nerve endings to numerous pain inducing stimuli.  One cause of the loss of clot is the physical act of smoking or use of straws, both of which require a sucking motion which creates a negative pressure in one’s mouth and may lead to loss or dissolution of clot.  The greater amount of time and the greater difficulty associated with tooth extraction has shown to correlate with development of dry socket.  Some studies have also pointed to a higher incidence of dry socket formation in patients treated by less experienced clinicians.

The signs and symptoms of a dry socket are somewhat abstract.  A dry socket usually develops and elicits symptoms 48-72 hours following tooth extraction.  The typical symptoms include moderate to severe pain in the region of treatment, which may radiate, and bad breath.  It is the lack of fever, swelling, and other symptoms which is most consistent with dry socket.  Visually the surgical site may appear greyish in color, and does not display any drainage or excessive soft tissue redness.

The symptoms of dry socket are self-limiting and will normally resolve on their own in a matter of 3 days.  Your surgeon may also very easily treat this condition with the application of a dressing in the area of extraction.  This dressing is normally coated with a Eugenol solution which is immediately soothing for the pain in the area.  This dressing is then normally removed in a matter of 2 or 3 days when symptoms have completely resolved.  Antibiotics have not proven to be helpful in the treatment of dry socket.

Ultimately, dry sockets can not necessarily be prevented, though eliminating some of the risk factors such as smoking cessation and avoidance of straws on the part of the patient can drastically improve one’s risk.