Alveolar osteitis or, colloquially, a dry socket, is a complication of wound healing following extraction of a tooth. The term alveolar refers to the alveolus, which is the part of the jawbone that surrounds the teeth, and osteitis means simply "bone inflammation".
Signs and symptoms
Dry socket is characterized by detritus, grayish slough, severe pain and foul odor. The foul odor, in particular, is a result of the disintegration of the blood clot by putrefaction rather than by orderly resorption.
Multiple types of alveolar osteitis can result from disturbances in the healing process. The type that is commonly referred to as dry socket is one in which the disturbance is from the time a blood clot forms immediately after tooth extraction to the initiation of healing in the 4-5 day period after extraction occurs. The healing tissue that is supposed to replace the blood clot, known as granulation tissue, may fail to grow or be disrupted after beginning to grow, leading to the well known symptoms of dry socket.
Wound healing is a complex process and can be positively and negatively affected by many factors. Alveolar osteitis is the most common healing disturbance of extraction sockets.
Suppurative osteitis results when the disturbance of extraction socket wound healing occurs later, during the third stage of healing from day 14-16 after extraction, and is a manifestation of the disruption of connective tissue development. This form usually results from an infection and exhibits a purulent discharge (pus) from the extraction socket.
Disruption of the extraction socket during an even later stage of healing might result in necrotizing osteitis in which encapsulated shards of bone (bony sequestrae) will be noted alongside inflammatory cells.
Who Is Likely to Get Dry Socket?
Some people may be more likely to get dry socket after having a tooth pulled. That includes people who:
have poor oral hygiene
have wisdom teeth pulled
have greater than usual trauma during the tooth extraction surgery with dental supplies.
use birth control pills
have a history of dry socket after having teeth pulled
Rinsing and spitting a lot or drinking through a straw after having a tooth extracted also can increase your risk of getting dry socket.
How Is Dry Socket Treated?
You can take a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen to ease the discomfort. Sometimes these over-the-counter medications aren't enough to relieve the pain. When that's the case, your doctor may prescribe a stronger drug or give you a nerve block.
Your dentist will clean the tooth socket, removing any debris from the hole, and then fill the socket with a medicated dressing or a special paste to promote healing. You'll probably have to come back to the dentist's office every day for a dressing change until the socket starts to heal and your pain lessens.
Your dentist may prescribe antibiotics to prevent the socket from becoming infected. To care for the dry socket at home, your dentist may recommend that you rinse with salt water or a special mouthwash every day.