Dry Socket, also known as dento-alveolar osteitis,
alveolar osteitis, alveolitis, focal osteomyelitis without
, alveolalgia, alveolitis sicca dolorosa and
alveolar periostitis, is a well-recognised complication
of tooth extraction.

It is characterised by increasingly severe pain in and around
the extraction site usually starting on the 2 – 4 post-
operative day and can last for 10 – 40 days.

The pain radiates typically to the ear.  The normal post-
extraction blood clot is absent from the tooth socket; the
bony walls of the socket are bare and exquisitely sensitive
to even gentle probing.  Bad breath and an unpleasant
taste in the mouth are invariably present.

The condition probably arises as a result of a complex
interaction between surgical trauma, local bacterial infection
and various systemic factors.

The incidence rate probably lies somewhere between 3 -
20% of all extractions with lower pre-molar and molar
sockets most commonly involved.
Prevention & Management of
Dry Socket
Photograph of Dry Socket in the socket of the Upper Left
2nd Molar

  • Extraction of ‘wisdom teeth’ especially impacted
    lower ‘wisdom teeth’.
  • Traumatic & difficult extractions.
  • Oral / depot contraception.
  • Immunosuppressant drugs such as steroids,
    cyclosporine & methotrexate.
  • Active / recent history of Acute Ulcerative Gingivitis
    (‘Trench Mouth’) or Pericoronitis (infection /
    inflammation around the crown of a tooth)
    associated with the tooth to be extracted.
  • Smoking (> 20 cigarettes per day).
  • Increased bone density either locally or generally    
    (e.g. Paget’s Disease & Osteopetrosis).
  • Previous history of ‘dry sockets’ following extractions.


  • Wherever possible pre-operative oral hygiene
    measures to reduce plaque levels to a minimum
    should be instituted, such as using an antiseptic
  • Patients who smoke should stop before the tooth
    extraction and for at least two weeks post-extraction
    whilst the socket(s) heals.
  • Patients should avoid vigorous mouth rinsing for the
    first 24 hours post extraction and to use gentle tooth
    brushing and mouth rinses for 7 days post-extraction.
  • Patients should return to the Oral Surgeon / Dentist
    immediately they develop increasing pain from the
    extraction socket, awful taste in the mouth or bad


  • The infected socket is gently irrigated with an
    antiseptic mouthwash.
  • The socket is packed with a dressing that contains
    sedative and antiseptic ingredients.  The dressing
    prevents the accumulation of food debris in the
    extraction socket, protects the exposed bone from
    local irritation and calms down the inflammation-
    infection within the extraction socket walls.
  • Antibiotics may be prescribed or changed (if already
    on these).
  • Painkillers will still need to be taken until the effects
    of the sedative dressing become apparent and the
    infection has started to clear.
  • If the pain does not settle within 48 hours, then get
    back in contact with the Oral Surgeon / Dentist.

Useful Website & Article:

Management and Prevention of Dry Socket

J Oral Maxillofac Surg 2010.  Clinical Concepts of Dry
Last Updated 4th November 2010