What is the treatment for a dry socket?

Treatment of Dry Socket (Alveolar Osteitis)

The primary treatment for dry socket involves thorough socket debridement with removal of all granulation tissue (preferably using a degranulation bur), followed by placement of an obtundant dressing and pain management. 1

Immediate Management Protocol

Socket Preparation (Critical First Step)

• Carefully remove all granulation tissue from the socket using a degranulation bur - this is the most important therapeutic intervention 1
• Irrigate the socket with chlorhexidine (74% of practitioners use this) or normal saline (26% use this) to cleanse the area 2
• Create small perforations in the socket wall if blood supply appears poor, as this improves vascularization 1

Pain Control

• Place a non-resorbable obtundant dressing (such as zinc oxide eugenol paste) into the socket - this is used by 56% of practitioners and provides significant symptomatic relief 2, 3
• Prescribe systemic analgesics (NSAIDs and/or acetaminophen) for pain management
• The obtundant dressing typically needs to be changed every 1-3 days until symptoms resolve

Home Care Instructions

• Instruct patients to rinse the socket at home with chlorhexidine (44% of practitioners recommend this) 2
• However, delay chlorhexidine use until 3-5 days post-extraction to avoid interfering with early soft tissue healing 1
• Patients should perform gentle saline rinses in the interim period

Advanced Treatment for Complicated Cases

When Bony Dehiscence is Present

If examination reveals exposed bone or bony dehiscence:

• Extend an envelope between bone and periosteum up to ≥5 mm around the bony dehiscence 1
• Pack L-PRF (leukocyte and platelet-rich fibrin) plugs tightly throughout the socket 1
• Place a double layer of L-PRF membranes over the bony dehiscence, extending 3-5 mm over bony borders 1
• Seal the socket entrance with L-PRF membranes 1
• Suture without attempting primary closure - the goal is only to keep the dressing material in place, allowing healing by secondary intention 1

Critical Technical Points

What NOT to Do

• Never attempt primary closure of the socket - healing by secondary intention is the preferred approach 1
• Do not place sutures directly over bony dehiscence as this may push dressing material out of the socket 1
• Avoid placing sutures that create tension on soft tissues 1

Proper Suturing Technique

• Ensure sutures are placed over and supported by alveolar bone to avoid pulling on soft tissues 1
• Sutures should only stabilize the dressing, not close the wound 1

Follow-Up Care

• Re-evaluate patients every 1-3 days initially to assess healing and change dressings as needed
• Most dry sockets resolve within 7-10 days with appropriate treatment 2, 4
• Continue dressing changes until the socket shows signs of granulation tissue formation and pain subsides

Evidence Quality Note

The treatment of dry socket remains largely empirical, with most recommendations based on clinical experience rather than high-quality randomized trials 2. The most recent guideline-level evidence 1 emphasizes socket debridement and appropriate use of biological dressings (L-PRF) for complicated cases, while traditional approaches using obtundant dressings remain widely practiced and effective 2, 3.