Osteitis (Dry Socket)

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This is a common occurrence after about 5-10% of all tooth extractions. Osteitis is the result of the blood clot above a tooth extraction being removed, leaving the bone and nerve endings exposed to all food and drink consumed as well as the air and general mouth environment.  The bone exterior begins to inflame, causing a lot of pain to the patient.  They normally become present after a lower wisdom tooth extraction or when molars are removed due to reduced circulation in this area of the mouth. Osteitis is also more common for women, as the increased rates of estrogen in their bodies fail to help the healing process of an extraction.

Symptoms of Osteitis

• Pain and discomfort – This is due to the exposure of the bone and nerve endings and will be constant. This is likely to start quite small and gradually increase over a period of two to five days. 
• A bad smell and/or taste– There is sometimes a bad smell from the socket that will last about a week after the extraction and can be noticed within a couple of days.

Causes of Dry Socket

There are many reasons to explain why the blood clot above the bone and nerve ending should come away, and there are things that you can do to prevent this happening. 

• Smoking prematurely after an extraction.  It is recommended that you do not have a cigarette until at least for the rest of that day, but longer if possible.  This is due to the impact smoking has upon your blood flow, the toxins within the smoke can affect the healing process and even the motion of sucking a cigarette can create pressure changes that might dislodge the blood clot.
• Taking oral contraception has been linked to a higher risk of osteitis.
• The higher the amount of surgical trauma to the area, the greater the risk of a dry socket developing

Preventing Dry Socket (Osteitis)

• Avoid smoking too soon after an extraction.  It is advised that you wait for at least 48 yours before you have a cigarette as they can affect the amount of oxygen in the blood and reduce the healing time.  Also the sucking motion might dislodge the blood clot.
• Align the extraction to fit in with your menstrual cycle.  Estrogen has a negative effect on the healing process and so it is best to wait until there is only a small amount in your body before having an extraction, the last week of the menstrual cycle.
• Avoid drinking through a straw, sucking or spitting.  These actions can dislodge any blood clots.
• Avoid chewing on the side of your mouth that has had the extraction.
• A day after the extraction it is important to maintain high standards of oral care, and warm mouth rinses are advised. 

Treating Osteitis

There is not treatment as such for a dry socket, although there are things that your dentist can do to make you more comfortable.  The socket is normally rinsed out and cleaned and then a sedative soaked dressing fitted into the socket to cover the bone and nerve endings that have been exposed.  This sooths the inflamed bone and also helps to quicken the healing process as tissue growth is also stimulated.  Repeat dressings might be necessary for two or three days after the initial one, and you may be given painkillers or analgesics to conquer the pain.  Eventually the dry socket will heal itself over time

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