You extract a tooth, a blood clot forms in the empty socket, and healing begins. That’s the ideal scenario, anyway. But things don’t always go as planned. For instance, the most common complication in third-molar extraction is said to be alveolar osteitis, also known as dry socket.1
Dry socket occurs when the blood clot fails to form or is lost. The bone is left vulnerable to external stimuli, and exposed nerve endings can inflict intense pain. On top of that, the healing process is interrupted.2
Reasons Blood Clots Fail to Form
While no one really knows why dry sockets occur, traumatic extractions are thought to elevate the risk for them. This is reportedly due to the release of kinins—proteins found in blood that cause inflammation and stimulate pain receptors—during more complicated extractions. Kinins are also known to vaporize blood clots.2
Other factors that might play into lack of blood clot formation include poor oral hygiene, previous infections in surgical sites, systemic disease, use of alcohol and tobacco, and gender. Location of the extraction also plays a role in this sort of complication, as dry sockets occur more often in the mandible than in the maxilla. This is especially true in cases involving impacted third-molar extractions, in which up to 30% of patients end up with a dry socket. This can also be attributed to denser bone structure, and the lack of bleeding that sometimes occurs during such extractions. When this happens, experts advise scoring the area with a bur to induce bleeding so a clot can form.2,3
Methods to Prevent Dry Socket
Aside from the need for patients to maintain good oral hygiene post-extraction, some clinicians believe that dry socket can be prevented through the use of certain suturing techniques and flap designs. Other strategies involve cooling irrigation during drilling, rinses with formulations such as chlorhexidine or warm salt water, and the application of medicated or sedative dressings. Such dressings can include pastes, or gauzes and sponges soaked in agents ranging from eugenol and benzocaine to clindamycin and sodium chloride.1,2
It’s not uncommon for today’s dental practitioners to use bone grafting materials and membranes to retain socket structure after extractions. This is especially true when implants are planned. These materials can prevent epithelial tissue from infiltrating the site and interfering with healing, but they can also minimize the risk for dry socket by increasing blood flow to the area.2
Another way to avoid complications during extractions is through the use of isolation systems such as Isolite 3, Isodry and Isovac. By containing fluid buildup via continuous suction and retracting soft tissues, these kinds of systems help keep the field of operation clear.
Treatment of Dry Socket
If dry socket does develop, some of the methods used to prevent this dental condition can also be used to treat it. However, because the pain from dry socket can be severe, the clinician’s best option is often to help get the patient through the pain.2
Patients can be given pastes to apply at home to help with dry socket, and they can take nonsteroidal anti-inflammatory drugs. Salt water has healing properties and rinsing with it can also help. But the best cure of all is probably time.2
- DeLuke DM. Recognition and management of complications in third molar surgery. Decisions in Dentistry. 2018;4(7):32–37.
- Stone R. Dry spell. Mentor. 2015;6(11):12–16.
- Torres-Lagares D, Serrera-Figallo MA, Romero-Ruíz MM, Infante-Cossío P, García-Calderón M, Gutiérrez-Pérez JL. Update on dry socket: a review of the literature. Med Oral Patol Oral Cir Bucal. 2005;10:77–85.