Dry socket: Preventing and treating a painful condition that can occur after tooth extraction

Dry socket is a painful complication that can happen after you have one or more teeth pulled. It's most common after wisdom teeth removal. Fortunately, there are things you can do to reduce your risk.

What is dry socket?

Normally, after a tooth is extracted, a blood clot forms over the hole, creating a temporary shield. Dry socket can happen when the blood clot becomes dislodged and falls out, exposing bone and nerves and causing significant pain.

In an effort to prevent this from happening, your dentist will give you a list of instructions, such as not drinking out of a straw and avoiding certain foods, to help protect the clot and keep it in place. But sometimes dry socket happens despite your best efforts, explains Dr. Tien Jiang, assistant professor in oral health policy and epidemiology at the Harvard School of Dental Medicine.

"Dry socket typically happens in the lower jaw and molar area of the mouth rather than in the front, and can happen a few days after the tooth is pulled, when the pain should be getting better," she says.

Symptoms of dry socket

The most common symptom of dry socket is severe pain that occurs several days after a tooth is pulled, Dr. Jiang says. The pain can radiate from the socket to your ear, eye, or neck, on the same side where the tooth was pulled.

Other symptoms of dry socket include:

• a bad taste in your mouth
• bad breath
• low-grade fever, below 101° F (above 101° F could indicate an infection).

Why might dry socket happen after tooth extraction?

Dental experts don't fully understand why dry socket happens. But you are at higher risk for dry socket after having a tooth pulled if you:

• had a difficult tooth extraction
• had lower wisdom teeth extracted (as opposed to front or upper teeth)
• drink from a straw after a tooth extraction, or rinse and spit a lot afterwards
• smoke or chew tobacco
• use birth control pills, which may interfere with healing
• had dry socket in the past.

How is dry socket treated?

To treat dry socket, your dentist will give you an anesthetic to numb the area, clean it out with a sterile rinse, then fill the socket with a medicated paste. Your dentist also may want you to take a course of antibiotics if the dry socket was infected.

Dry socket usually goes away within days after treatment. To manage pain, Dr. Jiang recommends over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil). Because they work in different ways, they can be taken together. "Studies have shown that doing so can be more effective than taking prescription opioid medication," says Dr. Jiang.

To care for dry socket at home after in-office treatment:

• Take pain medicine and antibiotics as advised by your dentist.
• Apply a cold pack to the outside of your mouth to ease swelling and pain.
• Carefully rinse your mouth with salt water or a special mouthwash to help with healing. Lean your head over the sink and let the rinse drip out of your mouth - do not spit.
• Avoid brushing around the extraction site for at least 24 hours.
• Avoid smoking or drinking alcohol until you've healed.

Tips for preventing dry socket

The best way to prevent dry socket, Dr. Jiang says, is to avoid negative pressure in your mouth that could pull out a clot. This pressure can happen if you spit forcibly instead of drooling into a tissue or cloth for a couple of days after a tooth extraction. Drinking through a straw also can cause pressure that may dislodge a clot.

Dr. Jiang advises not eating anything too crunchy or sticky for several weeks. She suggests avoiding food with small pieces, such as rice, that could get stuck in the empty socket. Instead, seek out foods like applesauce, yogurt, smoothies (with no seeds), and thin or pureed soups.

It's important to contact your dentist after a tooth extraction if you have increased pain or pain that doesn't subside when you take pain relievers. "If you think you have dry socket," Dr. Jiang advises, "call your dentist and ask to be seen, to make sure you are healing properly."