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

Treatment of Dry Socket (Alveolar Osteitis)

The primary treatment for dry socket is surgical debridement of the socket with irrigation, not antibiotics or simple placement of medicated dressings, as this approach provides the most rapid pain relief and healing. 1

Initial Management Protocol

Socket Preparation (Essential First Step)

• Carefully remove all granulation tissue from the socket using a degranulation bur to expose healthy bone and promote proper healing 1
• Irrigate the socket with saline or chlorhexidine to remove debris 2
• Create small perforations in the socket wall if blood supply appears poor to improve vascularization 1

Pain Management Approach

• The surgical debridement itself provides the most effective pain relief, superior to simply placing obtundant dressings 3, 4
• Prescribe systemic analgesics (NSAIDs and/or acetaminophen) for symptomatic relief during the healing period 3
• Avoid relying solely on intra-alveolar dressings (like Alvogyl or zinc oxide eugenol), as these prolong healing time despite reducing pain 4

Advanced Treatment Options

When Standard Debridement is Insufficient

• Low-level laser therapy (LLLT) shows superior results for pain remission and healing compared to conventional dressings 3
• Platelet-rich plasma or L-PRF can be packed into the socket after debridement to accelerate healing 1, 3
• Zinc oxide eugenol dressings may be used as an adjunct after debridement, though healing takes longer than surgical management alone 3

Antibiotic Consideration

• Antibiotics are NOT indicated for uncomplicated dry socket, as this is primarily a surgical problem, not an infectious one 1
• One recent study suggested ciprofloxacin 500 mg three times daily may provide rapid symptom relief in refractory cases, though this represents a novel approach requiring further validation 5
• Reserve systemic antibiotics only for cases with clear signs of spreading infection or systemic involvement 1

Follow-Up Protocol

• Instruct patients to rinse gently with chlorhexidine starting 3-5 days post-treatment (not immediately, as this can interfere with early healing) 1
• Re-evaluate within 24-48 hours to ensure pain is improving 5
• Expect complete healing within 1-2 weeks with proper surgical management 4

Critical Pitfalls to Avoid

• Do not simply pack the socket with medicated dressings without first debriding the socket - this prolongs healing and provides inferior pain relief 4
• Avoid aggressive curettage that removes excessive bone, but ensure all necrotic tissue and debris are removed 1
• Do not prescribe antibiotics routinely, as they show no benefit for localized alveolar osteitis 1
• Recognize that difficult extractions and mandibular molars have the highest dry socket incidence (up to 30% for impacted third molars), so counsel these patients appropriately 2, 6