You probably think having a tooth pulled is not a particularly enjoyable experience. And you no doubt expect to have some discomfort afterward. But that's OK, you say. You can endure it when you need to. But if the pain becomes intense and doesn't go away after a few days, it may be a sign of a condition called dry socket or alveolar osteitis.

Only a very small percentage -- about 2% to 5% of people -- develop dry socket after a tooth extraction. In those who have it, though, dry socket can be very uncomfortable. Fortunately, it's easily treatable.

What is dry socket?

The socket is the hole in the bone where the tooth has been removed. After a tooth is pulled, a blood clot forms in the socket to protect the bone and nerves underneath. Sometimes that clot can become dislodged or dissolve a couple of days after the extraction. That leaves the bone and nerve exposed to air, food, fluid, and anything else that enters the mouth. This can lead to infection and severe pain that can last for five or six days.

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:

• smoke
• have poor oral hygiene
• have wisdom teeth pulled
• have greater than usual trauma during the tooth extraction surgery
• 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.

What are the symptoms of dry socket?

If you look into the site where the tooth was pulled, you'll probably see a dry-looking socket. Instead of a blood clot, there will just be bone. The pain typically starts about two days after the tooth was pulled. Over time it becomes more severe and can radiate to your ear.

Other symptoms of dry socket include bad breath and an unpleasant smell and taste in your mouth.

How is dry socket treated?

You can take a nonsteroidal antiinflammatory 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 medication 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 piece of gauze 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.

Your dentist will wait until the dry socket has healed -- which can take up to two weeks -- before placing dental implants.

What can I do to prevent dry socket?

Because smoking is a big risk factor for dry socket, avoid cigarettes, cigars, and any other tobacco products for a day or so before your surgery. If you take birth control pills, ask your dentist about performing the extraction on a day when you are getting the lowest dose of estrogen because the hormone can affect the ability of the blood to clot. Also, check with your dentist about other medications you are taking that can interfere with normal blood clotting.

After your surgery, avoid drinking through a straw and spitting for the first few days. Also don't rinse your mouth more than your dentist recommends. If you do rinse -- do so gently. Be sure to visit your dentist for all scheduled follow-up visits.

WebMD Medical Reference

Sources:

American Dental Association: "Dry Socket."

Reekie, D, Downes, P, Devlin, CV, Nixon, GM, Devlin, H. British Dental Journal, 2006; vol. 200: pp. 210-213.

Roberts J, Custalow C, Hedges, J. Roberts: Clinical Procedures in Emergency Medicine, 4th ed, Elsevier, 2004.

Reviewed by Matthew Hoffman, MD, on July 10, 2008

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