Dry socket: Symptoms, risk factors, and treatment.

Dr. Krape Cosmetic & Specialized Dentistry knows no one likes having a tooth extracted. Developing a complication such as dry socket after a tooth extraction may be some people’s worst nightmare.

With proper care, dry socket can be avoided. If it does develop, it is only a temporary condition that will resolve quickly with appropriate treatment.

What is dry socket?

Dry socket, also known as alveolar osteitis, is a painful complication that sometimes happens after having a tooth extracted.

After a tooth has been removed, a blood clot normally forms where the tooth was. The blood clot protects the underlying bone, tissues, and nerves as the site heals.

In cases of dry socket, the blood clot does not form or is dislodged, leaving the bone and nerves exposed.

Risk factors

Not everyone who has a tooth extracted will develop dry socket. Dentists are not certain what causes dry socket, but certain factors can increase the risk of developing it.

These factors include:

  • smoking
  • using chewing tobacco
  • use of oral contraceptives or estrogen replacement therapy
  • not following care instructions after the tooth extraction
  • poor oral hygiene
  • infections in the gum or teeth around the extraction site
  • having had dry socket in the past
  • using a drinking straw after the tooth extraction

Symptoms

The symptoms of dry socket are easy to identify. While no two cases of dry socket are the same, common symptoms include:

  • severe pain at the site of the extraction within 3 days
  • missing blood clot at the extraction site
  • bone visible at the extraction site
  • foul smell coming from the mouth
  • bad taste in the mouth
  • pain radiating from the tooth socket to the ear, eye, temple, or neck on the same side

While a certain amount of pain and discomfort is normal after having a tooth pulled, worsening pain or severe pain is not normal.

Anyone experiencing severe pain that does not improve after a tooth extraction should see their doctor or dentist to rule out dry socket or other complications.

Diagnosis

A dentist or oral surgeon will likely suspect dry socket for any case of severe pain following a tooth extraction, but will also examine the person for signs of any other complications.

If necessary, the person will be sent for X-rays to rule out a bone infection, or to see if fragments of the bone or roots of the extracted tooth remain and are causing the pain.

Treatment

Hands of a man and woman holding up a dental x-ray.
In some cases, a dental X-ray may be required to diagnose the cause of pain.

The treatment for dry socket consists primarily of pain management. A dentist will likely do the following to manage the symptoms:

  • flush the socket to remove any irritating debris
  • pack the socket with medicated dressings
  • prescribe pain medication

After the dentist or oral surgeon treats dry socket in the clinic, the person will need to continue with home care for several days.

Home treatment usually includes:

  • gently flushing the socket with a saline solution or medicated rinse for several days
  • continuing to take pain medication as needed

Anyone with dry socket should keep any follow-up appointments with their dentist or oral surgeon to ensure proper healing.

Management and lifestyle changes

While medical management of dry socket will help relieve pain and promote healing, self-care at home is equally as important.

A person may need to make lifestyle adjustments while treating dry socket.

These changes include:

  • stop using chewing tobacco
  • quit smoking
  • rinse mouth gently with warm water several times a day or as directed by a dentist
  • take care when brushing teeth around the affected area
  • drink plenty of clear liquids
  • avoid foods that will irritate the area
  • avoid carbonated beverages
  • avoid drinking through a straw
  • use hot and cold packs on the jaw or cheek as directed

Prevention

Woman breaking a cigarette in half.
Quitting smoking can reduce the risk of developing dry socket.

Before surgery, a person having a tooth extraction can do the following things to reduce the risk of developing dry socket:

  • stop smoking or using other tobacco products, including chewing tobacco
  • research dentists and oral surgeons thoroughly to ensure they have sufficient experience in removing teeth
  • stop taking any medications that interfere with blood clotting as directed by a doctor or dentist

Immediately following the surgery, the oral surgeon will take several precautionary measures to prevent dry socket. These steps include:

  • packing the affected area with sterile gauze
  • prescribing antibacterial mouthwash or oral gel to use following the surgery
  • prescribing antibiotics if needed

At home, a person can take further steps to prevent dry socket after the surgery. These include:

  • resting following the surgery
  • avoiding sports and other activities that may knock the blood clot out of place
  • drinking lots of water after the surgery and avoiding carbonated, hot, and alcoholic drinks
  • eating only soft foods the day after the surgery
  • taking care when eating to avoid disturbing the wound until it has healed
  • avoiding any tobacco products for the first several days following surgery
  • practicing good oral hygiene as directed by the dentist or doctor
  • avoiding the area immediately around the healing wound when brushing teeth for the first day following surgery

Outlook

Dry socket, though very painful, usually improves soon after beginning treatment if a person follows the doctor’s instructions.

However, a person being treated for dry socket should follow up with their doctor or dentist to ensure no other complications have developed.

After developing dry socket once, a person is at higher risk to develop it again following another tooth extraction.

Last reviewed Sun 2 July 2017 By Jenna Fletcher Reviewed by Christine A. Frank, DDS

 

Diabetes causes shift in oral microbiome that fosters periodontitis, Penn study finds.

Doctor Krape Cosmetic & Specialized Dentistry continues to keep you informed as to the new studies, trending techniques and medical advances that can affect or change the way Dentistry is practiced, which can affect the overall health of not just your teeth but your entire body! Diabetes continues to have ill effects on much more than previously understood. Please read!

A new study led by University of Pennsylvania researchers has found that the oral microbiome is affected by diabetes, causing a shift to increase its pathogenicity. The research, published in the journal Cell Host & Microbe, not only showed that the oral microbiome of mice with diabetes shifted but that the change was associated with increased inflammation and bone loss.

“Up until now, there had been no concrete evidence that diabetes affects the oral microbiome,” said Dana Graves, senior author on the new study and vice dean of scholarship and research at Penn’s School of Dental Medicine. “But the studies that had been done were not rigorous.”

Just four years ago, the European Federation of Periodontology and the American Academy of Periodontology issued a report stating there is no compelling evidence that diabetes is directly linked to changes in the oral microbiome. But Graves and colleagues were skeptical and decided to pursue the question, using a mouse model that mimics Type 2 diabetes.

“My argument was that the appropriate studies just hadn’t been done, so I decided, We’ll do the appropriate study,” Graves said.

Graves co-authored the study with Kyle Bittinger of the Children’s Hospital of Philadelphia, who assisted with microbiome analysis, along with E Xiao from Peking University, who was the first author, and co-authors from the University of São Paulo, Sichuan University, the Federal University of Minas Gerais and the University of Capinas. The authors consulted with Daniel Beiting of Penn Vet’s Center for Host-Microbial Interactions and did the bone-loss measurements at the Penn Center for Musculoskeletal Diseases.

Graves co-authored the study with Kyle Bittinger of the Children’s Hospital of Philadelphia, who assisted with microbiome analysis, along with E Xiao from Peking University, who was the first author, and co-authors from the University of São Paulo, Sichuan University, the Federal University of Minas Gerais and the University of Capinas. The authors consulted with Daniel Beiting of Penn Vet’s Center for Host-Microbial Interactions and did the bone-loss measurements at the Penn Center for Musculoskeletal Diseases.

“We were able to induce the rapid bone loss characteristic of the diabetic group into a normal group of animals simply by transferring the oral microbiome,” said Graves.

With the microbiome now implicated in causing the periodontitis, Graves and colleagues wanted to know how. Suspecting that inflammatory cytokines, and specifically IL-17, played a role, the researchers repeated the microbiome transfer experiments, this time injecting the diabetic donors with an anti-IL-17 antibody prior to the transfer. Mice that received microbiomes from the treated diabetic mice had much less severe bone loss compared to mice that received a microbiome transfer from untreated mice.

The findings “demonstrate unequivocally” that diabetes-induced changes in the oral microbiome drive inflammatory changes that enhance bone loss in periodontitis, the authors wrote.

Though IL-17 treatment was effective at reducing bone loss in the mice, it is unlikely to be a reasonable therapeutic strategy in humans due to its key role in immune protection. But Graves noted that the study highlights the importance for people with diabetes of controlling blood sugar and practicing good oral hygiene.

“Diabetes is one of the systemic disease that is most closely linked to periodontal disease, but the risk is substantially ameliorated by good glycemic control,” he said. “And good oral hygiene can take the risk even further down.”

The study was supported by grants from the National Institute of Dental and Craniofacial Research (DE017732 and DE021921) with assistance from Penn Vet’s Center for Host-Microbioal Interactions and the Penn Center for Musculoskeletal Disorders.

Article: Diabetes Enhances IL-17 Expression and Alters the Oral Microbiome to Increase Its Pathogenicity, Dana T. Graves et al., Cell Host & Microbe, doi: 10.1016/j.chom.2017.06.014, published 12 July 2017.