Some soreness after a tooth extraction is expected. Pain that suddenly gets worse a few days later may be dry socket. Mayo Clinic calls it the most common complication after tooth removal, including wisdom teeth. This guide explains what it is, how to recognize it, how dentists treat it and how to lower your risk, based on Mayo Clinic and the American Dental Association (ADA).
What dry socket is
After an extraction, a blood clot normally forms in the empty socket. Mayo Clinic explains that this clot protects the underlying bone and nerve endings and contains cells needed for healing. Dry socket happens when the clot doesn’t form, comes out or dissolves before the wound heals, leaving bone and nerves exposed.
Signs of dry socket
Mayo Clinic lists:
- severe pain within a few days of the extraction, usually starting 1 to 3 days after
- partial or total loss of the blood clot, so the socket may look empty
- visible bone in the socket
- pain spreading from the socket to the ear, eye, temple or neck on the same side
- bad breath or a foul odor, and a bad taste in the mouth
Normal post-extraction pain should be manageable with the pain reliever your dentist prescribed and should ease with time. Mayo Clinic says to contact your dentist or oral surgeon right away if you develop new pain or the pain gets worse in the days after removal. Over-the-counter medicine usually isn’t enough for dry socket pain.
How it’s treated
The ADA says treatment may include:
- cleaning the extraction site and placing a medicated dressing in the socket
- changing the dressing daily until pain diminishes and healing begins
- a nonsteroidal anti-inflammatory drug such as ibuprofen
- avoiding smoking and other tobacco, which can delay healing
Mayo Clinic notes dry socket rarely causes serious complications, though healing may be delayed and the socket can become infected.
Who is at higher risk
According to Mayo Clinic, risk factors include smoking and tobacco use, birth control pills (high estrogen levels may affect healing), not following home-care instructions or poor mouth care, and current or past infection around the tooth. Difficult extractions, such as impacted wisdom teeth, may also play a role.
Lowering your risk
Before the extraction
- Brush twice a day and floss once a day to reduce bacteria (Mayo Clinic).
- Try to stop smoking or using tobacco beforehand. See smoking, vaping and oral health.
- Tell your dentist about all medicines, herbs and supplements. Mayo Clinic notes some affect blood clotting.
After the extraction
Follow your dentist’s instructions. Mayo Clinic says these typically include:
- Rest the day of surgery, and avoid vigorous exercise for as long as advised.
- No straws for at least a week. Sucking can pull the clot out.
- Drinks: plenty of water. Avoid alcoholic, caffeinated, carbonated or hot drinks for as long as recommended.
- Food: soft foods such as yogurt or applesauce the first day, then foods that need little chewing. Avoid chewing on the surgery side.
- Cleaning: brush and rinse gently but avoid the site for the first 24 hours. After that, rinse gently with warm salt water (1/2 teaspoon of salt in 8 ounces of water) several times a day for a week, as directed.
- Tobacco: none for at least 48 hours, and longer if you can.
- Swelling: cold packs on the face the first day, then warm packs may help.
For more on extractions, see tooth extraction cost and recovery and our wisdom teeth removal guide.
Frequently asked questions
When does dry socket happen?
Mayo Clinic says the pain usually begins 1 to 3 days after the tooth is removed.
Will dry socket heal on its own?
Healing may be delayed, and over-the-counter medicine often isn’t enough for the pain. Contact your dentist, who can clean and dress the socket.
Why can’t I use a straw?
Mayo Clinic explains the sucking action may cause the blood clot to come out of the socket.
Sources
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “Dental extraction forceps” by Revolver00870, via Wikimedia Commons, licensed CC BY-SA 4.0. Resized and compressed for the web.
Our guides are written and reviewed by the Dentist Review editorial team. We research each topic using public, authoritative sources such as the CDC, the National Institutes of Health (NIH/NIDCR), the American Dental Association (ADA) and CMS, and we update guides when guidance changes. Guides are for general information only and are not dental or medical advice; please read our disclaimer and learn more about us.