What is the treatment for dry socket (alveolar osteitis)?

Treatment for Dry Socket (Alveolar Osteitis)

The primary treatment for dry socket involves socket debridement with removal of all granulation tissue, followed by pain management with obtundant dressings, with advanced cases benefiting from L-PRF (leukocyte-platelet-rich fibrin) placement to promote healing. 1

Initial Socket Management

The cornerstone of treatment is mechanical debridement:

• Remove all granulation tissue from the socket using a degranulation bur to expose healthy bone and promote proper healing 1
• Irrigate the socket with chlorhexidine (74% of practitioners) or saline (26% of practitioners) to cleanse the area 2
• Create small perforations in the socket wall if blood supply appears poor, as this improves vascularization 1

Pain Control Strategies

Multiple approaches have demonstrated efficacy for pain relief:

• Place a non-resorbable obtundant dressing (such as zinc oxide eugenol) in the socket, which 56% of practitioners use and shows good results for pain remission 2, 3
• Zinc oxide eugenol dressings are among the treatments showing the best results in pain remission and alveolar mucosa healing 3
• Low-level laser therapy (LLLT) demonstrates superior outcomes for both pain relief and healing 3
• Plasma rich in growth factors shows excellent results for pain control and tissue regeneration 3

Advanced Treatment Protocol with L-PRF

For cases with significant bone exposure or bony dehiscence:

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

Home Care Instructions

• Instruct patients to rinse the socket at home with chlorhexidine (44% of practitioners recommend this) 2
• Delay chlorhexidine use until day 3-5 post-extraction to avoid interfering with early soft tissue healing 1

Critical Technical Points

Suture placement requires specific technique to avoid complications:

• Place sutures over and supported by alveolar bone, not directly over soft tissues 1
• Avoid creating traction or pressure on soft tissues or the L-PRF graft 1
• Never place sutures directly over bony dehiscence as this may displace dressing material 1

Evidence Quality Considerations

The treatment landscape for dry socket remains somewhat empirical, as most suggested methods lack robust evidence-based support 2. However, curettage with irrigation combined with adjunctive therapies (LLLT, zinc oxide eugenol, or plasma rich in growth factors) receive a level B recommendation based on available evidence 3. The condition has been extensively studied but firm conclusions about optimal management remain elusive 2, 4.

The key principle is that dry socket treatment is primarily surgical (debridement and drainage), not antibiotic-based, as antibiotics show no benefit for localized alveolar osteitis 5.