Dry socket is the most common postoperative complication of dental extraction which is commonly seen 2 to 4 days post extraction. Dry socket is also known as Localized Alveolar osteitis, Alveolitis sicca dolarsa and fibrinolytic osteitis.
In 45 percent of the extraction cases, dry socket is associated with lower wisdom tooth extraction. Females are more prone to dry socket as compared to males.
Dry socket: Mechanism
Tooth Socket is the area where tooth is firmly attached to the alveolar bone. Now after the tooth extraction, this socket is left empty which is sooner replaced by a blood clot.
But there are few activities that cause the clot to dislodge. Few of them are:
1. Brushing vigorously after extraction
2. Spitting or smoking immediately after extraction
3. Blowing too hard
4. Using straw while drinking soft drinks
As a result, the socket becomes empty, the surrounding bone is denuded and covered by yellow gray necrotic tissue layer and the surrounding gum tissues develop erythema. This leaves the bone and nerve exposed to air, food and external fluids. It is clinically characterized by a bad breath and intense pain that radiates to the ear and neck. Pain is considered the most important symptom of dry socket. It can vary in frequency and intensity, and other symptoms, such as headache, insomnia, and dizziness, can be present.
Etiological Factors for Dry Socket
Common causative factors that make a person prone to dry socket are:
1. Patient above 25 years of age are more prone to dry socket post extraction.
2. Smoking and maintaining a poor oral hygiene. This leads to the accumulation of bacteria thereby prevents the formation of blood clot.
3. Traumatic Devitalization of the socket.
4. Patient who had a previous history of dry socket has more chances of getting it again.
5. Patients’ not following the aftercare post operative instructions.
6. Infection of clot and underlying bone by Treponema Pallidum.
Symptoms with Dry Socket
Radiating Pain: Severe pain at the socket that starts normally 2-3 days after extraction and radiates to the neck and ear region.
Absence of Blood Clot: Ideally after extraction, a clot starts forming but absence of clot or an exposed bone is a sign of dry socket. Upon clinical examination, we see brown, friable clot that easily washes away.
Halitosis: Bad breath (halitosis) or foul taste from the empty tooth socket.
Gingivitis: Swelling of gums around the socket.
Trismus: Inability to open the mouth normally (Trismus). Trismus develops approximately 10days after extraction.
Tender Lymph Nodes: Swelling of regional lymph nodes can occur at the affected side
Fever, headache, insomnia and dizziness also occur in a few cases.
Treatment of Dry Socket
It is advised to go to a dentist if you develop dry socket:
Irrigation of the Socket: The dentist gently irrigates the socket with 3% hydrogen peroxide and 2% sodium iodide, at a 1:1 proportion that will clean the socket of debris followed by superficial removal of the debris.
Dressing for the Socket: Pack the socket with a dressing that contains sedative and antiseptic properties like Zinc oxide and oil of cloves that relieves pain and promotes healing. The dressing will also help prevent food debris to accumulate in the socket and thus protects the exposed bone.
Medications as Prescribed: If there are clinical signs of infection, such as fever, suppuration, antibiotics like amoxicillin 1,500 mg/day needs to be taken while for patients allergic to amoxicillin, clindamycin 1,200 mg/day. However it is always better to take medications as prescribed by the dentist.
Antibacterial Mouthwash Rinses: Gently rinse your mouth with warm salt water or other medicated mouth rinse such as 0.12% chlorhexidine digluconate 3 times daily for 14 days as they reduce pain and swelling and they also have antibacterial properties.
Dental Consultation: Take the analgesic tablets as prescribed by the dentist and if the pain persists after 48 hours, return to the dentist
Home Care Remedies for Dry Socket
Not necessarily is the dentist available when the pain due to dry socket appears. So, here we are with some home remedies to help you out:
Warm Saline Rinses: Use syringe with warm salt water to clean the wound gently.
Olive Oil Application: Cotton soaked with olive oil can be applied over the socket. It promotes healing and gets you away with the pain. Take care while applying as it may be irritating to the other soft tissues. Avoid excessive use of oil as it may prolong the healing process.
If in case you encounter swelling post extraction:
First 24 Hours After Extraction;
To get rid of immediate swelling post extraction, it is advised to apply an ice pack over the surgical site alternately 15-20 minutes on and 15-20 minutes off for 6 hours or till bedtime.
Post 24 Hours After Extraction;
If you encounter swelling after 24 hours than place towel dipped in hot/warm water and place outside of your face in the area of extraction alternately 10-15 minutes on and 10-15 minutes off.
Apply cream, ointment or tincture form of Arnica (from health food store) topically outside of your face in the area of extraction to reduce inflammation, and heal wounds.
Medications for Dry Socket
Paracetamol 0.5 - 1g or Ibuprofen 200 – 400mg taken twice daily
Paracetamol 0.5 - 1g + Ibuprofen 200 – 400mg taken every 4 - 6 hours or
Codeine + Ibuprofen 2 tablets every 8 hours or
Codeine + Paracetamol 2 tablets every 8 hours
Codeine-Paracetamol + Ibuprofen