image of woman with dry socket pain.

Dry socket can be extremely painful.

Experienced a dry socket after a tooth was removed?  It’s a painful condition that may take a week or more to resolve.

Knowing how to prevent a dry socket is key to avoiding unnecessary pain and discomfort. I’d like to help you understand exactly what a dry socket is to help you avoid one of life’s crummy experiences.

Your tooth root rests in what is called a socket in the surrounding bone. The socket is similar to what a light bulb is screwed into. The tooth root is not directly connected to bone. It’s really a limited movement joint. Teeth wiggle a tiny bit naturally. This bony socket is lined with a layer of fibrous tissue called the periodontal ligament. And it is the ligament that attaches to the root of your tooth. The tooth to ligament to bone connection is illustrated below.

image of Dry Socket A tooth socket is a limited movement joint.

Dry Socket – A tooth socket is a limited movement joint. Courtesy of: Craig Sommer DDS

The tooth-bone joint is unlike any other joint in the body. There are similarities but there are also differences. Let’s take a look at the fingers of your hand for example.

Stretch out one of your hands. Make a fist. Watch how your fingers move. They move freely. Muscles connect by way of tendons to the finger bones to move the fingers. Ligaments wrap the joints. Along with tendons from muscles, they limit finger movement to particular directions and degrees. The normal limits are called the normal range of motion.

Begin Imagination Exercise

Imagine for a moment, falling in slow motion. You extend your arm and hand to break or slow your fall, but catch one of your fingers on a step bending it backward until it meets resistance. As the stretch of the tendons and ligaments designed to protect the joint continues, the pain level rises. Then you hear a pop as a ligament tears loose and your finger bends backward way more than you have ever seen it do before. Not good.

End The Imagination Exercise

If you have ever broken a finger or damaged a joint like I described, as I have, you know it’s is not any fun at all. But in most cases with the proper care, it will heal and resume normal function given enough time.

It’s painful, very painful. The joint is damaged, pieces displaced and your desire for reparative care is likely.

The detail to be remembered is that the inside of the joint was never visible. It was never exposed to massive amounts of bacteria. The finger joint in the imagination exercise in this case was not torn open and was not exposed to bacteria.

Tooth Removal-It’s A Damaged Joint

When a tooth is wiggled out of the jaw bone there are no muscles involved, but a ligament is torn and a joint is destroyed. Half of the joint is the tooth root with the boney socket being the other. Part of the ligament remains attached to the root and part remains attached to the boney socket.

In this case the damaged joint opening is exposed to bacteria. Not only bacteria, but food debris and anything else  in your mouth can find its way into the socket if you are not cautious.

Cleaning the socket thoroughly after the tooth is removed is recommended by some, but not all dentists. The goal is to remove the periodontal ligament, bone and tooth fragments and to establish socket bleeding for healing.

Your body responds with blood seeping out of the socket walls filling up the space that the tooth root occupied. Biting steadily on moist gauze for an hour is recommended to provide an opportunity for a blood clot to form.

If a stable, solid clot forms and is retained, live cells begin to migrate from the socket walls to begin the healing process. If healing is uninterrupted, the socket opening will close over completely within 2 to 5 weeks with minimum discomfort.

The Blood Clot Is Key

The clot is key to the prevention of a dry socket. The clot protects live bone from being exposed to saliva, food debris, bacteria, tartar, calculus etc. The clot is delicate. It is held in place by your body’s own version of superglue called fibrin. The fibrin serves as a scaffold or framework, for the healing cells to adhere to, beginning the healing process.

Keep That Clot Protected To Prevent A Painful Dry Socket

Instructions after a tooth removal always should include ways to protect the blood clot and avoid dry socket:

  • No rinsing for at least the first 24 hour with anything, not even water. You want to keep the clot from being washed out of the socket accidentally. Remember it is fragile.
  • No spitting. Do not spit out any blood. If the socket is still weeping blood, bite and hold on moist gauze for another hour or two. Spitting also creates suction in your mouth as you gather your spit and blood together.
  • No spitting.
  • No use of straws to drink liquids. Again it creates suction and can lift the clot out of the socket. Remember, the clot is protecting live bone underneath it. Use a cup or a glass for liquids.
  • No smoking. Just like the use of straws smoking creates suction and can lift the clot. Smoke is generally not good for any wound so avoid smoking.
  • Avoid sodas. The fizzy action can lift the clot out of the socket. If you need to have a soda wait until all the fizz is gone. Cup or glass time again no straws.
  • No alcohol. Even alcohol containing mouth rinses are too much for a blood clot. The clot is protecting live bone underneath. Mouthwashes designed to kill bacteria will kill live bone cells trying to heal the socket.

What Is Dry Socket or What Is A Dry Socket?

It’s the loss of a blood clot after a tooth is removed. The boney socket being uncovered is considered “dry” exposing it to your oral environment. When it occurs before your body has completely covered the lining of the socket with a thick layer of healing cells, naked bone is exposed.

Bacteria in your mouth invade the bone lining the socket and create bone inflammation, a limited infection and usually strong pain.

image of face in pain from a dry socket

Dry socket pain is one of the worst type of dental pain.

The naked unprotected bone of dry socket exposes live nerves hence the strong pain. Hot, cold, food, alcohol all increase the pain that does not respond to pain medications easily.

When Does A Dry Socket Occur?

The timing of a dry socket is usually from 2 to 5 days after the tooth is removed. Just enough time for you to have accidentally lost the clot by not following the recommended after-treatment care instructions carefully.

Other times, the clot spontaneously breaks down even though you have followed the instructions to the letter. The pain is the same. This is a frustration for your dentist too, as he or she are hoping for a pain free recovery for you. A variety of anti-bacterial rinses before treatment, antibiotics placed into the open socket after tooth removal and a host of others efforts have been tried to avoid the dreaded dry socket. In spite of your dentist’s and your best efforts you may still encounter a dry socket.

How Often Does Dry Socket Occur?

Dry socket complications occur in about 1 out of 20 routine dental tooth removal procedures. Third molar teeth, especially the lower jaw impacted type, have a dry socket complication rate as high as 1 in 3 or 4 procedures.

Considering that a joint has been destroyed and exposed to saliva and bacteria in the process, I am amazed that the rate is as low as it is. If it occurs, you are not without options.

image of cartoon character feeling Dry socket pain can affect your whole body and make you feel miserable.

Dry socket pain can affect your whole body and make you feel miserable.

Dry Socket Treatment Helps Tremendously

Your dentist can dispense a paste that can be squirted into the socket to reduce the pain, slow bacterial spread and allow your body to start healing again. It is reapplied as needed until the area is comfortable.

Various socket dressings are available that will need to be applied repeatedly so multiple visits to your dentist will be necessary until the area is comfortable.

Home remedies including olive soaked gauze with a drop or two of clove oil are said to bring soothing relief while waiting to see your dentist. If you are experiencing pain you suspect is dry socket related or any other dental pain, contact your holistic or biological dentist immediately.

Often with dry socket pain there is no easy path to follow, it just takes time.


Image sources:  1, 2, 3, 4