After a tooth extraction, a normal socket will develop a blood clot that stays in place while the wound heals, while a person’s pain will steadily improve. In a dry socket, the blood clot will partially or fully detach from the wound, which can worsen the pain.
Dry socket, or alveolar osteitis, is a common complication of tooth extraction. It develops when the blood clot that protects the wound disintegrates or breaks loose, leaving the nerves and bone in the socket exposed.
This article will look in more detail at the differences between dry sockets versus normal healing sockets. It also explores what causes dry socket, as well as treatments and recovery time. We will also look at whether it is possible to experience this condition with no pain.
Following a tooth extraction, an empty socket will usually heal on its own, while any pain from the procedure will gradually improve.
In contrast, with a dry socket, the pain will improve and then suddenly get worse, which could be more painful than the extraction procedure.
The pain of a dry socket may throb and radiate across a large area of the jaw or up towards the ear.
The following table shows the differences between a dry socket versus a normal socket:
| Dry socket | Normal socket |
| Pain that improves, but then gets worse | Pain that continues to improve |
| No visible blood clot, or a blood clot that has partially disintegrated | Visible blood clot that stays in place until the wound heals |
| Visible exposed bone or tissue, which may have increased since the time of surgery | No visible exposed bone or tissue |
| Bad taste in the mouth | No change in taste |
| Bad smells coming from the wound, which may lead to bad breath | No noticeable change in how the breath smells |
Most cases of dry socket develop within 3–5 days after surgery. The risk of this condition decreases over time, so the longer the wound heals, the lower the likelihood.
For standard tooth extractions, complete recovery takes a couple of weeks. However, wisdom tooth extractions can take much longer to heal. Once the wound fully heals, there is no risk of dry socket.
After a tooth extraction, the body creates inflammation. This causes mild swelling around the affected area. Platelets in the blood clump together to form a clot, which protects the wound by sealing it.
If this clot disintegrates, becomes dislodged, or does not form, the empty tooth socket is unprotected. This increases the risk of intense pain due to the exposed nerves in the socket.
Certain risk factors increase the likelihood of developing a dry socket, including:
- Pressure on the wound: Chewing or biting down on the empty socket can dislodge the blood clot. Similarly, using straws, sucking on foods, and blowing the nose can create negative pressure inside the mouth, increasing the risk of the blood clot detaching.
- Location and type of extraction: Dry socket is more common in wisdom tooth removal and tooth extractions from the lower jaw. It is also more prevalent if the extraction is complicated or traumatic, as well as depending on the surgeon’s experience level.
- Preexisting infection: People with bacterial infections in the mouth before undergoing tooth extraction have a higher risk for dry socket. Those with preexisting infections should speak with their dentist about antibiotics.
- History of serious illness and cancer: A 2019 analysis of dental records found that dry socket was more common in people with a history of mouth sores, hospitalization from a serious illness, and cancer.
- Smoking: Most studies suggest there is a link between smoking and dry socket. This may be due to the tobacco itself, or the sucking motion involved in smoking.
- Birth control pills: Females taking birth control pills may have higher rates of dry socket. One study suggests people taking oral contraceptives might have a two-fold increased risk of the condition.
Treatment for a dry socket focuses on reducing pain. The American Dental Association advise going returning to the dentist to manage symptoms.
A dentist will first flush out the socket with a medicated mouthwash or saline. Then, they will fill in the socket with a medicated dressing to control the pain. Depending on how long the pain lasts, people may need to change this dressing after a couple of days.
Adults can also take nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil).
In most cases, the pain of dry socket improves within 24–72 hours, according to the Canadian Dental Association. In some people, the pain may last up to 7 days.
However, prompt treatment can reduce the pain faster. If the socket dressing is not effective, or the pain persists for longer than a few days, a dentist may reevaluate to see if another condition is responsible for the pain.
For most people, the main symptom of dry socket is severe pain. However, pain tolerance and perceptions differ from person to person. Therefore, some people may experience less pain than others.
Dentists will typically diagnose dry socket based on the presence of pain and breakdown of the clot after a tooth extraction.
The primary treatment for dry socket is pain management, so if the condition causes little or no pain, it does not require treatment. The socket will heal and get better on its own.
However, contracting a bacterial infection is a potential complication following a tooth extraction. People with symptoms that indicate an infection, such as pus from the socket, should seek treatment, even if the affected area is not painful.
People experiencing worsening or severe pain after a tooth extraction should speak with a dentist. If the cause is a dry socket, they can help relieve pain quickly.
It is also important to see a dentist for:
- pain that does not respond to pain medication
- new or worsening swelling a few days after surgery
- swelling, pus, and fever
- pain elsewhere in the mouth
- broken teeth near the surgery site
Dry sockets become increasingly painful in the days after a tooth extraction. They may also have exposed bone or tissue, or an unpleasant smell. By comparison, normal healing sockets get less painful over time and do not cause any other symptoms.
A dry socket can be very painful, but it is not usually serious. A dentist can provide rapid pain relief via a medicated dressing, while people can also take medication to ease pain and inflammation.