Signs and Symptoms
- Common location of dry socket: socket of an extracted mandibular third molar (wisdom tooth)
- No pyrexia (fever) or cervical lymphadenitis (swollen glands)
- Minimal edema (swelling) and erythema (redness) in surrounding soft tissues
- Empty socket, partially or totally devoid of blood clot
- Exposed bone visible or socket filled with food debris revealing exposed bone
- Extremely painful and sensitive exposed bone
- Surrounding inflamed soft tissues may hide dry socket
- Denuded (bare) bone walls
- Dull, aching, throbbing pain in socket area, may radiate to other parts of head
- Pain starts 2nd to 4th day after extraction, may last 10-40 days
- Strong pain that even strong analgesics don't relieve
- Intraoral halitosis (oral malodor)
- Bad taste in the mouth
Causes
- Cause(s) of dry socket not completely understood
- Blood clot forms after tooth extraction
- Clot replaced by granulation tissue, fibroblasts, and endothelial cells
- Factors like poor blood supply, excessive mouth rinsing, or fibrinolysis may prevent clot formation
- Bacteria can colonize socket and dissolve clot
- Localised inflammatory reaction in exposed bone walls
- Necrotic bone slowly separated by osteoclasts, fragmentary sequestra may form
- Bones of jaws have evolutionary resistance to this process
- Healing is delayed, tissue grows from surrounding gingival mucosa
- Some patients may develop short-term halitosis
Extraction site and Infection
- Dry sockets more common in mandible than maxilla
- More common in posterior sockets (molar teeth)
- Inadequate socket irrigation associated with increased risk
- Food debris tends to gather more in lower sockets
- Dry socket more likely with pre-existing infection in mouth
- Necrotizing ulcerative gingivitis or chronic periodontitis increase risk
- Oral microbiota may have fibrinolytic action, predisposing individuals to dry socket
- Dry socket can have secondary infection
Risk factors
- Smoking and tobacco use increase risk of dry socket
- Nicotine's vasoconstrictive action on blood vessels may contribute
- Smoking can dislodge blood clot during healing process
- Difficult tooth extraction increases risk
- Vasoconstrictors in local anesthetics associated with increased risk
- Radiotherapy decreases blood supply to jaw bones
- Menstrual cycle may affect frequency of dry socket, higher risk in middle of cycle and in women taking oral contraceptives
Prevention, Treatment, Prognosis, Epidemiology, and Etymology
Prevention:
- Rinsing with chlorhexidine or placing chlorhexidine gel in the sockets reduces the frequency of dry socket.
- Preventative antibiotics reduce the risk of dry socket following third molar extractions.
- Antifibrinolytic agents applied to the socket after extraction may reduce the risk of dry socket.
- Debriding the bony walls of the socket does not have evidence to support its effectiveness in preventing dry socket.
- Dental extractions in females taking oral contraceptives should be scheduled on days without estrogen supplementation.
Treatment:
- Treatment for dry socket is usually symptomatic, focusing on pain management.
- Debris from the socket is removed by irrigation with saline or local anesthetic.
- Medicated dressings are commonly placed in the socket to alleviate pain.
- There is not enough evidence to determine the effectiveness of any specific treatments for dry socket.
- Curettage of the socket may increase pain and its overall benefit is debated.
Prognosis:
- Dry socket prolongs the total healing time.
- Postoperative pain is worse than normal discomfort after minor surgical procedures.
- The pain from dry socket may last for seven to forty days.
Epidemiology:
- The rate of dry socket is about 0.5-5% for routine dental extractions.
- Impacted mandibular third molars have a higher risk, with a rate of about 25-30%.
- Females using oral contraceptives are more frequently affected.
- Dry sockets are more common in individuals aged between 20 and 40.
- Other risk factors include periodontal disease, bone diseases, and inadequate oral hygiene.
Etymology:
- Alveolar refers to the alveolus, the alveolar processes of the mandible or maxilla.
- Osteitis is derived from osteon, meaning bone, and -itis means inflammation.
- Alveolar osteitis is considered synonymous with dry socket.
- Dry socket is named because the socket appears dry after the blood clot is lost.
- Other types of osteitis include focal sclerosing/condensing osteitis.
Alveolar osteitis, also known as dry socket, is inflammation of the alveolar bone (i.e., the alveolar process of the maxilla or mandible). Classically, this occurs as a postoperative complication of tooth extraction.
| Alveolar osteitis | |
|---|---|
| Other names | Dry socket, fibrinolytic alveolitis |
 | |
| Alveolar osteitis of a socket after extraction of all maxillary teeth; note lack of blood clot in socket and exposed alveolar bone | |
| Specialty | Dentistry  |
Alveolar osteitis usually occurs where the blood clot fails to form or is lost from the socket (i.e., the defect left in the gum when a tooth is taken out). This leaves an empty socket where bone is exposed to the oral cavity, causing a localised alveolar osteitis limited to the lamina dura (i.e., the bone which lines the socket). This specific type is known as dry socket and is associated with increased pain and delayed healing.
Dry socket occurs in 0.5% to 5% of routine dental extractions, and in about 25–30% of extractions of mandibular (lower) wisdom teeth that are impacted (buried in the bone of the lower jaw, erupting during adulthood).
