Alveolar osteitis or, colloquially, a dry socket, is a complication of wound healing following extraction of a tooth. The term alveolar refers to the alveolus, which is the part of the jawbone that surrounds the teeth, and osteitis means simply "bone inflammation".

Signs and symptoms

Dry socket usually occurs 3-5 days after tooth extraction and causes severe throbbing and radiating pain which is difficult to localize. Dry socket is characterized by detritus

Detritus

Detritus is a biological term used to describe dead or waste organic material.Detritus may also refer to:* Detritus , a geological term used to describe the particles of rock produced by weathering...

, grayish slough, severe pain and foul odor. The foul odor, in particular, is a result of the disintegration of the blood clot by putrefaction

Putrefaction

Putrefaction is one of seven stages in the decomposition of the body of a dead animal. It can be viewed, in broad terms, as the decomposition of proteins, in a process that results in the eventual breakdown of cohesion between tissues and the liquefaction of most organs.-Description:In terms of...

 rather than by orderly resorption.
If a probe is gently passed in the tooth extraction socket, then bare bone is encountered which is very sensitive.

Cause

Multiple types of alveolar osteitis can result from disturbances in the healing process. The type that is commonly referred to as dry socket is one in which the disturbance is from the time a blood clot forms immediately after tooth extraction to the initiation of healing in the 4-5 day period after extraction occurs. The healing tissue that is supposed to replace the blood clot, known as granulation tissue

Granulation tissue

Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size it heals...

, may fail to grow or be disrupted after beginning to grow, leading to the well known symptoms of dry socket.

Wound healing is a complex process and can be positively and negatively affected by many factors. Alveolar osteitis is the most common healing disturbance of extraction sockets.

Suppurative osteitis results when the disturbance of extraction socket wound healing occurs later, during the third stage of healing from day 14-16 after extraction, and is a manifestation of the disruption of connective tissue

Connective tissue

"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...

 development. This form usually results from an infection

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

 and exhibits a purulent discharge (pus) from the extraction socket.

Disruption of the extraction socket during an even later stage of healing might result in necrotizing osteitis in which encapsulated shards of bone (bony sequestrae

Sequestrum

A sequestrum is a piece of dead bone that has become separated during the process of necrosis from normal/sound bone.It is a complication of osteomyelitis...

) will be noted alongside inflammatory cells.

Prevention

True alveolar osteitis, as opposed to simple postoperative pain, occurs in only about 1-3% of extractions. No one knows for certain how or why dry sockets develop following dental extraction but certain factors are associated with increased risk. One of these factors is the complexity of the extraction. Smoking

Tobacco smoking

Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...

 may be a contributing factor, possibly due to the decreased amount of oxygen available in the healing tissues. It is advisable to avoid smoking for at least 48 hours following tooth extraction to reduce the risk of developing dry socket.

Women are generally at higher risk than men of developing dry socket, because estrogen

Estrogen

Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...

 slows down healing. Dentists recommend that their female patients have extractions performed during the last week of their cycle, when estrogen levels are lowest, to minimize chances of developing dry socket.

Patients are also advised to avoid drinking through a straw as the negative pressure created by drawing liquids through the straw can dislodge the clot. Additionally, patients may be told not to spit out saliva (or anything else for that matter) excessively due to the negative pressure created in the mouth immediately prior to spitting. Maintaining good oral hygiene

Oral hygiene

Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...

 during the healing period by brushing all non-tender areas regularly and rinsing with warm salt water is often advised, beginning 24 hours after the extraction.

Treatment

The pain from alveolar osteitis usually lasts for 24–72 hours. There is no real treatment for dry socket — it is a self-limiting condition that will improve and disappear with time — but certain interventions can significantly decrease pain during an episode of dry socket. These interventions usually consist of a gentle rinsing of the inflamed socket followed by the direct placement within the socket of some type of sedative dressing, which soothes the inflamed bone for a period of time and promotes tissue growth. This is usually done without anesthesia. The active ingredients in these sedative dressings usually include substances like soluble aspirin

Aspirin

Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...

, zinc oxide

Zinc oxide

Zinc oxide is an inorganic compound with the formula ZnO. It is a white powder that is insoluble in water. The powder is widely used as an additive into numerous materials and products including plastics, ceramics, glass, cement, rubber , lubricants, paints, ointments, adhesives, sealants,...

, eugenol

Eugenol

Eugenol is a phenylpropene, an allyl chain-substituted guaiacol. Eugenol is a member of the phenylpropanoids class of chemical compounds. It is a clear to pale yellow oily liquid extracted from certain essential oils especially from clove oil, nutmeg, cinnamon, basil and bay leaf. It is slightly...

, and oil of cloves

Oil of cloves

Oil of cloves, also known as clove oil, is an essential oil from the clove plant, Syzygium aromaticum.* CAS number: 8000-34-8It is a natural analgaesic and antiseptic used primarily in dentistry for its main ingredient eugenol...

. It is usually necessary to have this done for two or three consecutive days, although occasionally it can take longer. Because true dry socket pain is so intense, additional analgesics are sometimes prescribed.

External links

• Dry socket information at WebMD
• How to prevent dry socket after a tooth extraction
• Wisdom: A Tale of Dental Redemption: An entertaining story about the pain suffered from dry socket.