Pictures of healing gums after tooth extraction

What is a Dry Socket?

A dry socket (alveolar osteitis) occurs when the bone underneath an extracted tooth becomes exposed and inflamed. Dry sockets are most common after wisdom tooth removal and can cause severe pain.

A tooth socket is a hole in the jawbone where a tooth was previously located. After a tooth is removed, a blood clot forms in the socket, similar to a scab. This blood clot gradually turns into new bone and gum tissue as part of the healing process.

A dry socket occurs when the blood clot is lost or prevented from forming. When the blood clot cannot form properly, the bone and nerves are exposed to the air, which causes severe pain and delays healing.

Dry socket occurs in approximately 1 to 5% of all extractions and up to 38% of wisdom tooth extractions. They commonly develop in:

1. The lower jaw
2. People older than 30 years
3. Females
4. Teeth that were infected before surgery

What Does a Dry Socket Look Like?

A dry socket appears as a hole where the tooth was removed. You will see the bone that once surrounded the extracted tooth. The opening where the tooth was pulled may appear empty, dry, or have a whitish, bone-like color.

The socket bone can be exposed entirely or can be covered by food debris or clumped bacterial material. When surrounded by food debris or bacteria, the socket can appear in various colors, including black, yellow, and green.

By contrast, a socket with a blood clot that is healing properly should appear dark red. As the blood clot continues to transform into new tissue, it should gradually blend in with the rest of your gums.

Medical Images of Dry Sockets

What Causes a Dry Socket?

A dry socket forms when the blood clot does not form, dissolves, or dislodges before the extraction site heals.

According to Dr. Nandita Lilly, one of NewMouth's in-house dentists, "the highest risk for dry socket is within the first 4 days after surgery."

Common risk factors for dry sockets include:

• Bacteria or an infection in the area
• Trauma due to a complicated extraction, like an impacted wisdom tooth
• Food particles that collect inside the socket
• Mechanical motions such as smoking, sucking through a straw, or aggressive rinsing and spitting
• Nicotine, alcohol, and carbonated drinks
• Changes in hormones due to menstruation or contraceptives

Symptoms of a Dry Socket

Symptoms of dry socket include:

• Throbbing pain that radiates from the socket and can extend up to the ear, eye, temple, or neck on the same side of tooth extraction
• Unpleasant taste in the mouth
• Bad breath or a smell coming from the mouth
• Slight fever

The pain from a dry socket typically begins within the first 2 to 4 days after extraction, and it can last several weeks.

If you had a tooth extracted more than a week ago and haven’t experienced this kind of pain, the clot has probably already begun to heal. This means you’re unlikely to develop a dry socket.

Dry Socket Treatment

If you begin to experience symptoms of a dry socket, contact your dentist or oral surgeon as soon as possible. 

Professional treatment for a dry socket typically consists of the following steps:

1. Clean the extraction site with sterile saline (saltwater) and scrape the socket to promote blood flow.
2. Fill the socket with medical dressings. This helps prevent any new food particles and debris from entering the tooth socket.
3. After the dressing is placed, you must visit your dentist regularly to have it changed during the healing process. 
4. Your dentist may prescribe you antibiotics, pain medications, a special mouthwash, and/or irrigation solutions to assist in healing. You can also take over-the-counter pain relievers.
5. Gently rinse your mouth with lukewarm saltwater a few times a day and after meals. Avoid alcohol-based mouthwashes, as they increase the risk of dry socket.

To care for a dry socket at home, you should:

• Take pain medicine and oral antibiotics as prescribed
• Apply ice to the jaw
• Carefully rinse the dry socket as recommended by the dentist
• Apply clove oil to the extraction site for pain relief 
• Eat soft foods until fully healed
• Refrain from smoking or drinking alcohol

Oral antibiotics do not significantly decrease the risk of dry sockets because there are hundreds of bacteria types in the mouth. For that reason, you can still develop a dry socket even if you have good oral hygiene.

How to Prevent Dry Sockets

There are a few ways to prevent a dry socket from forming. The most important things to avoid are smoking, sucking motions, and drinking through straws. Your dentist will probably also advise you to avoid strenuous exercise while the area is still healing.

You should also make sure to rinse your mouth gently because aggressive rinsing/spitting can make the blood clot fall out. Do not brush the extraction site for at least a week post-op. Only gently brush the neighboring teeth around the extraction site.

Your diet can also play a role in preventing a dry socket from forming. Until the extraction site heals, you should:

• Stick to soft foods like smoothies, eggs, soup, and mashed potatoes 
• Refrain from drinking hot liquids, carbonated drinks, alcohol, and caffeine

After having a tooth extracted, your dentist or oral surgeon will give you instructions like the ones above. These instructions are intended to help your mouth heal and prevent a dry socket from forming. Be sure to follow them carefully.

• What is a Dry Socket?
• What Does a Dry Socket Look Like?
• What Causes a Dry Socket?
• Symptoms of a Dry Socket
• Dry Socket Treatment
• How to Prevent Dry Sockets

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