When a tooth is extracted there is an occurrence of a painful
postoperative inflammation known as Dry Socket Disorder. This
happens when a blood clot in the open tooth socket is removed
or is unsettled. The possibility of dry socket disorder occurrence
is from 20% to 30% of all extraction of wisdom teeth or after
extraction of the third retained molars. As compared to other
tooth removals, the probability of this happening is ten times
The tendency to experience dry socket is higher in women that
in men, probably because of the hormone estrogen. It would be
best for women to schedule the removal of their wisdom teeth
towards the end of their menstrual cycle. Doing the surgery at
this time tends to pose lesser chances of having dry socket.
Epidemiology of dry socket disorder
The possibility of dry socket disorder occurring in wisdom teeth
is much greater as compared to other teeth. This may be because
of the factors that differentiate in diagnostic criteria, in
evaluation, in information from simple extractions and retained
teeth, small or unrepresentative samples and in surgical and
post operative surgery procedures. As there is a lot of flaws
in the methodology a lot of these studied cannot be depended
upon. According to authors, a study that shows an incidence that
is lower the 1% or higher than 35% cannot be accurate.
Although the reasons of dry socket disorders are not known,
studies show the following risk factors: tooth extraction difficulty,
inexperienced surgeons, oral contraception use, patient’s
advanced age, female sex, tobacco, immunosuppression and surgical
The incidence of tooth extraction trauma is most likely because
of the surgeon’s lack of experience. This may cause the
healing to take longer and bring about complications like reduced
resistance to infection in the jawbone.
The risk of dry socket disorder is five times higher in women
than in men because of the gender and more because of the use
of oral contraceptives. The creation of the dry socket and the
early destruction of blood clots are contributed by the use of
estrogen and other drugs.
The possibility of experiencing dry socket disorder increases
by 500% for people who smoke. Smoking a packet a day increases
this further to 20% and by 40% for patients who smoked on the
day of the operation or immediately after the operation.
For diabetics or immunosuppressed patients, the change of the
healing process tends to make them more inclined to have dry
Clinical forms of dry socket disorder
Dry socket is easily recognizable by the appearance of on empty
tooth socket with no blood clot and exposed jawbones as well.
The patient will experience sharp pain which increases because
of chewing or suctioning. It is not unusual for the pain to spread
from the ear and parts of the head. The characteristic appearance
develops two or three days after extraction.
With or without
treatment, this appearance will last usually from ten to fifteen
days. In the beginning, there will be a minor improvement then
suddenly worsens with pain; even with analgesics, this is hard
to control. Dry sockets rarely appear before the day after
the tooth extraction as time is needed for the clot to break
Treatment of dry socket disorder
Prevention is the best treatment for dry socket disorder as
the causes are not yet known. Reduction of the pain is the goal
of the treatment as the infection develops. The usual practice
is to continue analgesic symptomatic treatment, anti inflammatory
treatment even 10 to 15 days after the condition heals. Some
doctors would even recommend antibiotic treatment.
Prevention of dry socket disorder
Antifibrinolytic agents, laundries, antiseptics and antibiotics
are the preventive drugs used in the therapy of dry sockets.
In all antifibrinolytic agents, antiseptics and antibiotics are
proven to be the best.
Using antifibrionolytic agents hinder the early ruin of blood
clot. Tranexamic acid, an antifibrinolytic agent, does not help
in lessening the occurrence of dry socket. Although PEPH is more
successful, but because it has important secondary effects, their
use should be prevented. What should be included in the prevention
therapy of dry socket is laundries of serum as this have proven
to be effective.
A 50% reduction of dry socket incidence can be brought about
by the use of antiseptics, after removing the third mandibular
molars and this is now considered as a suitable therapy for dry
socket prevention. Even if antibiotics is deemed to be the right
treatment but their use is limited because of the possibility
of developing resistance to them and their toxicity. Using topical
antibiotics is recommended instead as they have proven to give