Do I have dry socket? Also, what is dry socket?

If you have experience with extractions, you've been warned about the dreaded dry socket. Read up on what it is and what you can do to avoid it.
Did you have a tooth extraction, or have one coming up? You likely heard the nerve-wracking advice, "Whatever you do, don't get dry socket" Okay, sounds like great advice. But what on earth IS dry socket and how do I avoid it?
What is dry socket

Dry socket happens when, after a tooth extraction, the blood clot either fails to develop or dislodges before the wound heals. It's a painful situation because the blood clot protects the underlying bone and nerve ending exposed by the tooth extraction. The clot is important for the healing process as it allows your bone to regrow and for soft tissue to re-develop over the empty space.

When the bone and nerve are exposed, it causes crazy pain. Not just in the site of the extraction, but also along the jaw and the side of your face where the tooth was removed. The open space (the socket) will get irritated and may fill with food particles, which just worsens the pain.

If you get it, you're not alone. It's the most common complication people get after a tooth extraction. And if you think you have dry socket, don't fight through the pain. Call your dentist right away as they'll be able to help you address and overcome the problem.

That sounds awful! What causes dry socket and how do I avoid it?

While nobody is totally sure what causes dry socket, the common culprits seem to be bacterial contamination, or trauma during a difficult extraction. 

There are few things that could put you at higher risk of developing dry socket: 

  • Smoking and tobacco use. The chemicals in cigarettes and tobacco can interrupt the healing process and contaminate the wound. Additionally, sucking on a cigarette can physically dislodge the clot.
  • Oral contraceptives. High estrogen levels from oral contraceptives may disrupt normal healing processes and increase the risk of dry socket.
  • Not following post-op instructions. Your dentists will give you "generic" post-op instructions for at-home care, but if you don't follow it and instead embrace poor hygiene, you may increase the risk of dry socket.
  • Tooth or gum infection. Current or previous infections around the extracted tooth increase the risk of dry socket.

The good news is you can lower the chances of getting dry socket. First, seeing a dentist or oral surgeon with tooth extraction experience ensures they will be competent and confident with your tooth. If you're a smoker, stop smoking a few days before your extraction to help prepare your mouth. And discuss medications you take with your dentist - they'll know if any of them could interfere with your blood clot.

After the surgery your dentist will give you post-op instructions about the healing process and how to care for the wound. Those instructions will include the following advice: 

  • Keep your mouth clean. Gently rinse your mouth and gently brush your teeth, but avoid brushing the extraction site for the first 24 hours. For the next week (after the first 24 hours), gently rinse with warm salt water several times / day. Mix ½ teaspoon of table salt with 8 ounces of water, and warm up the water but make sure it isn't hot.
  • Decrease physical activity. Plan to take the whole day off after your surgery. Your dentist will advise when you can start your normal activities again, and when rigorous activity is safe again.
  • Pain management. Use cold packs on the outside of your face for the first 24 hours after the extraction. After that, use warm packs. These help lower pain and swelling. If your dentist prescribed you pain medications, follow the dosage.
  • Stay hydrated. You've heard it before and we'll say it again. Drink lots of water! Your dentist will let you know how long to lay off the liquids that can dehydrate you, like alcoholic or caffeinated beverages. Ask your dentist how long you should wait to drink carbonated or hot beverages. 
  • Don't suck. We can't help you if you can't solve today's crossword puzzle. But you should absolutely avoid drinking things out of a straw, smoking cigarettes, or any other activities that require a sucking motion. The vacuum you create in your mouth to suck can dislodge the blood clot. Avoid sucking on anything for the first 48 - 72 hours after the surgery. Then go gently afterward.
  • Stop tobacco use. If you smoke cigarettes or use tobacco, you'll need to kick the habit for the first 48 hours after the extraction. Period.
  • Eat soft foods. For the first 24 hours eat as though you have no teeth. Stick to yogurt, applesauce, and other foods that don't require teeth to eat. For the first three days, avoid foods with small piece (like rice) since those pieces can get stuck in the socket and cause an infection. When you're ready to upgrade to semi-soft foods, chew on the opposite side of your extraction. If you had all your wisdom teeth out, avoid chewing for a bit longer.
Now I'm super worried about dry socket. How do I know if I have it?

If you're feeling some pain and discomfort, that is  totally normal the first few days after an extraction. After all, you just yanked something out of your jaw! This should be manageable with the pain reliever your dentist prescribed, and the pain will decrease after 2-3 days.

If you're paranoid (hey, it's cool to be worried!), here are the typical symptoms of dry socket to compare what you're feeling: 

  • Pain of 5 out of 10 or higher within a few days of the extraction
  • Pain that worsens in the days after the extraction
  • An "empty-looking" socket where the tooth was removed 
  • Visible bone in the socket 
  • Pain that radiates from the extraction site out to your ear, eye, forehead, or neck on the same side of your face
  • Bad breath or a foul odor
  • Unpleasant taste in your mouth
What should I do if I think I have dry socket?

The one thing you should do if you think you have dry socket is call your dentist. Like, right now. Only your dentist can help you address dry socket and ensure you're on your road to a full recovery.

Talk to your dentist about what you're feeling. Your dentist will probably want to get a visual of the extraction site. This is where a virtual visit (video, or sending images) can be extremely helpful in getting a quick diagnosis. If your dentist determines you have dry socket, they'll work on treating it to reduce the symptoms, lower your pain level, and help you recover. They might recommend one or a few of the following options:

  • Flushing out the socket. This removes any debris, like food particles, that could be causing pain or threaten an infection
  • Medicated dressings. Your dentist might pack the socket with medicated gel or paste, and cover with medicated dressings. Your dentist can determine if this is the right treatment, and how often you'll need to change dressings.
  • Pain medication. Your dentist may prescribe a pain medication if your situation and circumstances call for it.
  • Self-rinsing at home. You may need to flush the socket at home to help with the healing process. You'll receive instructions and a plastic syringe with a curved tip to squirt water, salt water or a prescription rinse into the socket. Your dentist will inform you how long to continue the rinse, likely until the soft tissue has healed over.

Once you start treatment, you'll feel pain relief relatively quickly. The pain and any other symptoms will continue to improve and will likely be gone in a few days.

Have a concern or question? Talk to a dentist now over our chat (btw it's free!) 👉

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