What is Dry Socket After Dental Extraction?
Dry socket (alveolar osteitis) is a painful postoperative complication occurring 2-3 days after tooth extraction, characterized by disintegration or loss of the blood clot within the socket, resulting in exposed bone and severe pain. 1, 2
Clinical Presentation
- Severe, throbbing pain develops 2-3 days postoperatively, often radiating to the ear or temple 1, 3
- Exposed bone visible within the socket, which may be partially or totally devoid of a blood clot 3
- Halitosis (foul odor) frequently accompanies the condition 3
- No signs of infection such as fever, purulent discharge, or lymphadenopathy distinguish this from true infection 4
The condition is fundamentally different from postoperative infection—it represents a localized inflammatory process rather than bacterial infection, which is why antibiotics provide no benefit. 4
Incidence and Risk Factors
The prevalence varies dramatically based on extraction complexity:
- Routine extractions: 1-5% incidence 3
- Surgically extracted mandibular third molars: up to 30% incidence 2, 3
- Mandibular molar extractions are disproportionately affected compared to other tooth positions 1
Key risk factors include traumatic extraction technique, smoking, patient age and sex, and use of local anesthetics with vasoconstrictors. 5
Pathophysiology
The condition results from premature breakdown of the protective blood clot that normally fills the extraction socket. 1 This exposes bare bone to the oral environment, triggering an inflammatory response without the protective fibrin matrix needed for normal healing. 5 The exact mechanism remains controversial, but fibrinolytic activity appears to play a central role in clot disintegration. 6
Clinical Significance
Dry socket substantially increases postoperative visits and patient morbidity through severe pain requiring multiple interventions, though it does not typically affect long-term healing outcomes once resolved. 3 The condition is self-limiting but causes significant quality of life impairment during the acute phase, typically lasting 7-10 days without intervention. 2
Common Terminology
Alternative names include alveolar osteitis, postextraction osteitis, fibrinolytic alveolitis, and alveolar sicca dolorosa, though "dry socket" remains the most widely recognized term among clinicians and patients. 6