Alveolar osteitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 29, 2016
StartDiseasesAlveolar osteitis

Alveolar osteitis, also known as dry socket, is a condition that occurs after the removal of a permanent adult tooth, including wisdom teeth. Dry socket can cause extreme pain both at the site of the extraction and radiating outward to the entire side of the face that the extraction was performed on.


Definition & Facts

Dry socket develops when the blood clot that has formed normally over the site of the extraction either dissolves too soon or gets dislodged before the wound has healed. The blood clot is meant to serve as the protective layer that keeps the bone and nerve endings in the empty socket protected from exposure and it is also the foundation for both soft tissue to develop over the clot and for growth of new bone beneath it.

The displacement of the clot allows the exposure of nerves and bone at the site, and this is what causes the intense pain that marks the condition. The alveolar bone which is the tooth socket becomes inflamed. It is a condition that is usually treated by a dental or oral surgeon, since over-the-counter medications are usually not strong enough to relieve pain or take care of any bacterial infection that has occurred.

Symptoms & Complaints

The main symptom of dry socket is pain that generally starts within a few days of the tooth extraction. The pain can spread from the extraction site to the eyes, ears, neck or forehead on the same side of the face and can be excruciating.

The patient may notice an unpleasant taste and/or bad breath, swollen lymph nodes in the neck or jaw area, or a slight fever. If the patient looks at the site of the extraction, he or she may be able to see bone made visible by the dislodging of the clot.


The precise cause of dry socket is being studied by researchers, but the simplest explanation is that the protective covering (blood clot) over the site of the extraction is missing. It may have become accidentally dislodged by movement in the area (like chewing) or it may just have dissolved naturally but prematurely. This leaves the site open to infection, but the pain occurs with or without infection.

The condition may be caused by trauma to bone and tissue at the site of the extraction if the procedure is difficult; it can also come from tiny fragments of bone or root that remain in the site of the wound after the removal surgery is completed. Because of its exposure, bacterial contamination can occur.

There are some factors that can increase the possibility of developing dry socket. Any tobacco use can increase the risk by slowing the healing process and/or by contamination of the removal site. The chemicals in tobacco increase the problems, and even the act of inhaling cigarette smoke can cause the protective blood clot to become dislodged.

Oral contraceptives can also interfere with the healing process due to the high levels of estrogen they produce, and corticosteroids such as cortisone or prednisone are thought to increase the risk of dry socket. If the patient has suffered from dry socket previously, the chances of developing it again are increased, and if there has been or currently is tooth infection or gum infection around the area of the extraction, the risk is elevated.

Diagnosis & Tests

Diagnosis of dry socket can be as simple as the dentist suspecting the condition because of the patient reporting severe pain after tooth extraction. An examination will reveal whether or not the blood clot is still in place or if the bone is now exposed. The dentist or oral surgeon will ask when the pain began, exactly where it is located, whether or not the patient has a fever, if the pain is constant or only occurs when the area is touched, and if any over-the-counter medications the patient has taken have had any effect. X-rays may be recommended to rule out any other problems like bone infection. The patient may also be asked to rate their pain on a scale of one to ten.

Treatment & Therapy

The treatment regimen for dry socket is intended first to reduce the pain of the condition. The oral surgeon or dentist treating the problem will start by flushing out the socket to get rid of any of the tiny particles of food or bone that may be causing pain. The area will then be packed with a medicated dressing that helps provide fast pain relief, and this process may also include changing the dressing several times daily.

The course of treatment and frequency of dressing changes will be calibrated to the severity of the pain the patient is suffering. The patient will also learn how to flush the socket at home by using a plastic syringe with a curved tip that can squirt plain water, salt water or a liquid prescription rinse into the socket.

Since over-the-counter medication is not usually strong enough to relieve the pain of dry socket, prescription pain medication may be recommended. Despite the pain, dry socket isn't difficult to treat. Once the problem has been diagnosed and treatment has begun, pain relief will start to kick in within hours, and continue to improve over the next few days until it is gone.

Prevention & Prophylaxis

There is no one specific way to avoid developing dry socket, but there are several at-home methods that can be used to help prevent it from happening. Good regular oral care is always a must, but after – and even sometimes before - the tooth extraction, the patient may be advised to use an antibacterial mouthwash.

Oral antibiotics before surgery may be necessary for anyone with a compromised immune system. After surgery it’s a good idea to avoid any demanding physical activity that might dislodge the clot. The patient should be sure to drink lots of water to remain hydrated, and to avoid caffeine, hot beverages, alcohol and carbonated drinks. One should also avoid drinking through a straw because the action of sucking can dislodge the clot.