How dentists treat dry sockets (alveolar osteitis). –
Tooth socket after extraction.
The fact of the matter.
What a dentist does do.
Instead, the treatment they provide is limited to what’s referred to as “palliative” care, which simply means that their efforts are directed toward the management and control of their patient’s symptoms.
What they do is take steps that: 1) Help to keep their patient comfortable and 2) Ensure that the socket’s healing environment is as favorable as possible. This page explains how both are accomplished.
Never be hesitant to ask for your dentist’s help.
As the provider of your care (your tooth’s extraction), it’s your dentist’s obligation to provide you with the follow-up assistance you require.
All dentists fully expect that a percentage of patients Incidence statistics. will develop dry sockets and require extra attention. So rather than delay and continue to suffer, you should contact them and take full advantage of the help they have to offer.
Can you treat a dry socket on your own?
Assuming that you have correctly diagnosed your condition, there are steps that you can take that can help to provide pain relief. But a self-treatment approach won’t be as comprehensive as the level of care your dentist can provide.
(For more information about the how-to’s and why-or-why-not’s of a DIY approach, use this link Self-treatment directions.)
COVID-19 / Treatment access considerations.
Due to the 2020 Coronavirus pandemic, many patients will find that their dentist’s office is not keeping regular office hours.
Some level of support should still be available.
In the case that you find yourself in need of assistance with dry socket complications, don’t overlook the fact that most offices should still be offering emergency assistance for their patients and fully expect you to take advantage of that if needed.
Home remedy solutions.
In lieu of that availability, the link above does access our page that discusses basic home remedies that are used with dry sockets. But keep in mind, even in emergencies this information is still best used in conjunction with your dentist’s direct advice (phone contact) since they are the ones most knowledgeable about your case specifics and therefore how the information we provide applies to your situation.
How do dentists treat dry sockets?
a) The initial evaluation.
As a start, your dentist will first need to establish that it’s likely that you do indeed have a dry socket.
A dry socket.
Visual inspection is a part of diagnosing a patient’s dry socket.
- They’ll quiz you about the nature of your symptoms: What are they like? Where do they seem to come from? How often do you experience them? How long do they last?
- Your dentist will also inspect your wound. (They’ll look for the situation where it appears that the socket’s blood clot has been lost and there is exposed bone tissue.)
- They’ll also want to know about the timing of the events you’ve experienced.
(In most cases, a person’s post-extraction healing will progress normally for some days before the symptoms of a dry socket See the list. begin to set in.)
b) Placement of a medicated dressing (packing).
Once your dentist determines that it’s likely that you do have a dry socket, they’ll typically proceed with the following steps.
A medicated dressing is placed in the opening of the tooth’s socket.
- First, they’ll gently flush your extraction site with sterile water, saline solution or chlorhexidine (a prescription antibacterial mouth rinse). And then gently suction the socket dry.
(The purpose of this step is to wash away any loose debris that might inhibit the healing process or possibly promote the formation of a secondary bacterial infection.)
- They’ll then smear medicated paste onto a piece of gauze, or other type of carrier such as a cotton pellet, and place it directly into your tooth’s socket.
(The insertion step is performed quickly. No anesthetic is used.)
- The packing is usually renewed (removed, the socket gently rinsed, and the packing then replaced) every 24 to 48 hours, typically for 3 to 6 days.
(The exact interval that’s used for changing the dressing simply depends on the patient’s comfort needs, with those experiencing higher levels of pain requiring more frequent replacement to remain comfortable. The replacement/reevaluation period should be at least every two days, with every 24 hours frequently used.)
- Once your symptoms have subsided, you’ll still need to return to your dentist’s office one last time so they can remove the gauze carrier that was last placed in your socket. And this is an important step to take.
(The exception to this would be if the type of carrier used is one that will dissolve away on its own. It’s fairly common for a dentist to use this type of material (Surgicel, Gelfoam, Surgifoam) instead of gauze but you’ll need to check this point with your dentist to know for sure.)
How quickly does this treatment work?
The patient may experience dramatic pain relief, possibly even immediately, once the dry socket dressing has been placed.
What ingredients do dry-socket pastes contain?
Most dry socket pastes are composed of a mixture of compounds.
Some ingredients frequently included are: Eugenol (extract of clove oil, an analgesic), Guaiacol or Balsam of Peru (compounds related to Eugenol), Benzocaine (an anesthetic), Iodophorm (an antimicrobial agent), Chlorobutanol (an anesthetic).
The problem with dressings.
While we’ve already mentioned that the use of a medication within the socket does not speed up the healing process, you might be surprised to learn that placing a dressing actually retards it somewhat.
- As an object, the dressing/packing is considered a “foreign body” by your body and as such interferes with the healing process.
- While beneficial in providing pain relief, eugenol is a known irritant to soft tissues and bone.
These issues make this treatment a trade-off. One of creating pain relief in exchange for extending the length of the healing period minimally. For someone in need of this relief, this is an easy decision to make.
This phenomenon also explains why dentists don’t place dry socket dressings as a preventive measure at the time of surgery.
c) Your dentist may write you a prescription for pain relievers.
While not a cure, pain relievers may aid in controlling dry socket discomfort.
They are typically only used as an adjunct (supplementary approach) after the placement of a medicated paste has been completed (as described above) and it’s been determined that some residual level of pain remains.
d) Taking antibiotics is not usually indicated.
Dry socket formation involves a scenario where an extraction site’s healing process has been interrupted due to the loss of its blood clot. An active bacterial infection is typically not involved. For this reason, the use of antibiotics is not usually indicated.
There can be reasons why a dentist might feel that their use is required. This could include cases where the patient is immune-compromised, or where the dentist finds strong evidence that systemic or secondary bacterial infection is involved.
Despite best-practice recommendations, it’s estimated that somewhere between 20 and 50% of dentists (a number that varies by country) continue to routinely prescribe antibiotics for their dry socket patients (Vessal).
While seemingly prescribed with the patient’s best interests at heart, the indiscriminate, purposeless usage of antibiotics instead only serves to increase the person’s risk of complications (like experiencing an allergic reaction), while offering just minimal potential for benefit.
How do you know when you’re “cured”?
As the healing process of your extraction site progresses Healing time line. and new soft tissue gradually fills in your tooth’s socket and covers over its sensitive bony walls, the amount of discomfort that you notice will gradually fade away.
Since a dentist’s treatment steps are just palliative in nature, they can be discontinued at any point where the level of your symptoms has subsided enough that they’re no longer an issue.
At this point, you can expect your extraction site to continue on and finally complete its normal healing process Healing stages..
Other than a final check that there are no dressing materials still left in your socket, there’s no special follow-up care that’s needed after your symptoms have disappeared.
Remember, treatment for dry sockets is just palliative and not a true cure.
As explained previously on our pages, a dry socket involves the situation where an extraction site’s healing process has been delayed due to the loss of its blood clot.
Over time, the wound can still be expected to go ahead and heal on its own. It’s just that it will take longer, and be more painful, than it would have been otherwise. (Related content: How long do dry sockets last?)
Placing a packing like described on this page doesn’t speed things up. Instead, it simply helps to reduce the amount of discomfort that you experience while your (now prolonged) healing process takes place.
If you think you have a dry socket, don’t hesitate to ask for your dentist’s help.
All dentists know that there’s always a chance that after an extraction a patient will develop a dry socket. And although there are risk factors See the list. that tend to influence their rate of occurrence, actually experiencing one can usually just be chalked up to bad luck.
For this reason, once you’ve asked, you’ll probably find that your dentist is quite sympathetic to your situation and will be very accommodating in providing assistance. They fully expect that some percentage of their patients will require additional attention and understand that it’s their obligation to provide this follow-up care when it’s needed.
Study: Time from first symptoms to seeking treatment.
We couldn’t help but notice the following statistics mentioned in a study by Bowe [linked above]. This paper stated that for their group of study subjects:
- The duration that elapsed between the date of extraction and the initial onset of dry socket symptoms ranged from one to three days.
- The time that elapsed between symptom onset until presenting to their dentist for treatment was four to six days.
- By the time the patients reported for treatment, all classified their pain as severe.
These numbers make one think that patients may generally be hesitant to seek post-op assistance. However, they also suggest that those who seek attention promptly will likely save themselves a day or night of severe discomfort. So don’t be hesitant to contact your dentist if you find the nature of your socket’s healing process has changed.
Our next page discusses home remedy treatment for dry sockets. ►
Page references sources:
Bowe DC, et al. The management of dry socket/alveolar osteitis.
Kolokythas A, et al. Alveolar Osteitis: A Comprehensive Review of Concepts and Controversies.
Vessal G, et al. Study of antibiotic prescribing among dental practitioners in Shiraz, Islamic Republic of Iran.
All reference sources for topic Dry Sockets.
This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.
Dry socket healing progress
Hello! I had my lower right wisdom tooth extracted three weeks ago. A week later I went back to the dentist due to dry socket which he treated by an alvogyl dressing. Then another week I went back again for a follow up and the dentist renewed the dressing. The hole in the gum is not closing and I can still see the dressing inside. I rinse my mouth with warm salt water after every meal, 3-4 times a day.
I am still only eating soft food because after eating solid food I feel a slight pain near the extraction site, otherwise I don’t feel any pain. I think the gum is slightly swollen on the outer side. I am just wondering how long the gum will take to close up.
You need to report to your dentist so they can evaluate your situation.
The alvogyl is usually placed on a dressing, that may or may not be a material that dissolves away on its own. If not, it must be removed. If it is, and now a week later you still see some type of object in your socket, the situation should be evaluated by your dentist. The presence of alvogyl in the socket beyond the time frame it is needed will delay healing.
The hole itself will fill up from the bottom, as opposed to initially closing over at the top, so it’s expected that you’ll may see some remnant of a hole for quite some time.