Dry socket after tooth extraction - symptoms and treatment

From this article you will learn:

• why does the socket hurt after tooth extraction,
• what is alveolitis: photos and videos,
• How is alveolitis treated?

The article was written by a dental surgeon with more than 19 years of experience.

Alveolitis is a classic complication that occurs after tooth extraction and consists of the development of inflammation of the socket of the extracted tooth. Often alveolitis is also called “dry socket” (this is due to the fact that the alveolar bone in the depths of the socket is exposed due to the loss of a blood clot).

On average, alveolitis develops after tooth extraction in 3-5% of cases, but this applies to teeth of any location with the exception of wisdom teeth. When the latter are removed, alveolitis occurs in 25-30% of cases, which is associated with the greater complexity and traumatic nature of the removal process.

Dry socket after tooth extraction: photo

You can see what normal healing of a socket should look like (at different times from the moment of extraction) in the photo in the article: → “What a socket should look like after tooth extraction”

Dry tooth socket: features of the disease

A dry socket appears in two cases after tooth extraction. In the first, a blood clot may fall out or dissolve, while in the second, it may not form initially (usually due to severe bleeding). On average, a similar diagnosis is made to two to five percent of people who have undergone a tooth extraction procedure, but dry socket after wisdom tooth removal is much more common. In the absence of timely treatment, the disease can progress to the stage of alveolitis, which in turn threatens the appearance of phlegmon or an abscess. What does a dry socket look like? Visually, a dry tooth socket is easy to identify: in the absence of a blood clot, part of the bone is exposed.

Symptoms of dry socket

• After 2 - 3 days, the gums begin to become inflamed and pain appears.
• As the inflammatory process develops, pain increases and manifests itself not only in the oral cavity, but also in the cervical region, as well as in the ear area.
• The appearance of an unpleasant odor and specific taste in the mouth is another characteristic symptom.
• Partial hearing loss may occur.

Edema

Swelling is another unpleasant consequence of tooth extraction. As a rule, it appears the next day after surgery and reaches its maximum value on the third day, after which it begins to decrease.

Cold compresses can be used to reduce swelling. To do this, you need to prepare ice cubes in advance, wrap them in cloth and apply them to the operation site for no more than twenty minutes. After a twenty-minute break, the procedure can be repeated. But it should be remembered that this method is effective in combating edema only in the first thirty-six hours after surgery.

Causes of dry socket after tooth extraction

• Smoking (especially immediately after tooth extraction).
• Poor oral hygiene over a long period of time.
• Poor blood clotting or taking blood thinners.
• Frequent rinsing of the mouth.
• Mechanical impact on the socket and soft tissue in its area.

In addition to the factors mentioned above, much depends on the extraction procedure itself: improperly performed tooth extraction contributes to a number of complications, including dry socket and alveolitis. To prevent this unpleasant phenomenon, dentists recommend limiting physical activity for a few days after tooth extraction, and also not chewing on this side of the jaw (especially hard foods). Under no circumstances should you touch the hole and the area around it with your hands or foreign objects. Bad habits (drinking alcohol and smoking) should be eliminated during healing. The doctor usually prescribes anti-inflammatory drugs for rinsing the mouth (miramistin, chlorhexidine or furatsilin), but this procedure should be carried out no more than 2 - 3 times a day.

What can you do at home -

After the acute symptoms of inflammation have subsided, there is no need for antiseptic turundas inside the socket, because they do not help the wound to heal (epithelialize) faster. At this stage, the best treatment method will be to fill the hole with a special Dental adhesive paste (Solcoseryl). This drug has an excellent analgesic effect (after 2-3 hours the pain will practically stop, and after 1-2 days it will go away completely), and also speeds up healing many times over.

Scheme of use - this paste is added to a hole that has been washed with an antiseptic and slightly dried with a dry gauze swab (completely filling the hole). The paste is perfectly fixed in the hole and does not fall out of it. There is no need to remove the paste from the hole, because... it slowly dissolves on its own, giving way to growing gum tissue. The only thing that may be required is to periodically add it to the hole.

How to rinse the hole from food debris -

In some situations (when the turunda has fallen out of the hole, and there is no way to see a doctor right away), it may be necessary to wash the hole. After all, after each meal, the hole will become clogged with food debris, which will cause new inflammation. Rinsing will not help here, but you can easily rinse the hole with a syringe.

Important : from the very beginning you must bite off the sharp edge of the needle from the syringe! Next, bend the needle a little and fill a 5.0 ml syringe with a solution of Chlorhexidine 0.12-0.2% (it is sold ready-made in every pharmacy for 20-30 rubles). Screw the needle tightly so that it does not fly off when pressing the syringe plunger! Place the blunt end of a bent needle into the upper part of the socket (do not insert too deeply to avoid injuring the tissue), and rinse the socket under pressure. If necessary, do this after every meal.

In principle, after this the hole can be dried with a gauze swab and treated with Solcoseryl. We hope that our article on the topic: Alveolitis after tooth extraction, symptoms, treatment - turned out to be useful to you!

Sources:

1. Higher prof. the author’s education in surgical dentistry, 2. Based on personal experience as a dental surgeon, 3. National Library of Medicine (USA), 4. “Outpatient surgical dentistry” (Bezrukov V.), 5. “Propaedeutics of surgical dentistry” (Soloviev M. .).

Treatment methods for dry tooth socket

If you discover symptoms of a dry socket, immediately contact your dentist: in this case, you should not self-medicate, although on the Internet you can find a lot of advice on how to treat a dry socket at home. Can a dry socket heal on its own? Without therapeutic and preventive measures, the healing process is not always successful and takes longer. What kind of dry socket treatment will be carried out after tooth extraction depends on the degree of development of the inflammatory process.

Treatment of a dry socket after the removal of a wisdom tooth is carried out in the same way as in the case of other teeth, however, access to the area of ​​​​inflammation can be complicated due to the distance of the “eight” location.

Treatment of alveolitis -

If alveolitis develops in the socket after tooth extraction, treatment at the first stage should be carried out only by a dental surgeon.
This is due to the fact that the hole may be filled with necrotic decay of a blood clot; there may be inactive fragments and fragments of bone or tooth. Therefore, the doctor’s main task at this stage is to scrape it all out of the hole. It is clear that no patient will be able to do this on their own. Antiseptic rinses and antibiotics (without cleaning the socket) can only temporarily reduce the symptoms of inflammation, but do not lead to healing of the socket. But at a later stage, when the inflammation in the socket subsides, patients will be able to independently treat the socket with special epithelializing agents to speed up its healing.

Thus, the main method of treatment will be curettage of the hole, but there is also a second method - by creating a secondary blood clot in the hole of the extracted tooth. Read more about these methods...

Curettage of the tooth socket for alveolitis -

1. Under anesthesia, a festering blood clot, food debris, and necrotic plaque from the walls of the socket are removed. Without removing the necrotic plaque and the disintegration of the blood clot (containing a huge amount of infection), any treatment will be useless.
2. The hole is washed with antiseptics, dried, after which it is filled with an antiseptic (iodoform turunda). Usually, the turunda needs to be changed every 4-5 days, i.e. you will have to go to the doctor at least 3 times.
3. The doctor will prescribe you antibiotics, antiseptic baths, and painkillers, if necessary.

Doctor's prescriptions after tooth socket curettage –

• NSAID-based analgesics (for pain),
• 0.12-0.2% Chlorhexidine solution for antiseptic rinses (2-3 times a day for 1 minute),
• Antibiotics: usually either Amoxiclav 625 mg tablets (2 times a day for 5-7 days) or Unidox-solutab 100 mg (2 times a day for 5-7 days) are prescribed. These antibiotics are better, but not cheap. Inexpensive ones are Lincomycin capsules 0.25 (2 capsules 3 times a day), but keep in mind that after this antibiotic, problems with the stomach and intestines develop more often.

Method for creating a secondary blood clot -

However, there are 2 situations in which a different treatment method can be used.
This method involves the creation of a secondary blood clot in the socket and, accordingly, if successful, the socket will heal much faster than after constantly placing iodoform turundas into it for 2-3 weeks. It is preferable to use this method only in the following two situations... Firstly, when you consulted a doctor immediately after, for example, you rinsed a clot out of the hole or it fell out on its own (i.e. when the hole is not yet filled with infection and food debris , and there is no necrotic clot disintegration or suppuration). Secondly, when the patient has a sluggish alveolitis for a long period of time, and the socket is filled with inflammatory granulations.

How this technique is carried out - if the hole is empty, then under anesthesia the bone walls of the hole are scraped out with a curettage spoon to create bleeding and the hole fills with blood (video 3). If the hole is filled with granulations, then they are carefully scraped out, i.e. do the same curettage (video 4). Then, in both cases, after the hole is filled with blood, an anti-inflammatory medicine (Alvogel) is placed deep into the hole, and several sutures are placed on the mucous membrane to bring the edges of the wound closer together. Antibiotics are immediately prescribed.

Curettage to create a secondary blood clot: video 3-4

Summary: i.e. In both the first and second methods, curettage of the hole is carried out in the same way, but in the first case, the hole heals slowly under iodoform turundas, and in the second case, a blood clot forms in the hole for the second time, and the hole heals, as it should do under normal conditions .

How long does it take for a dry socket to heal?

Many people are interested in the question of how long it takes for a dry socket to heal. In the absence of complications, the wound heals in 5 - 7 days, and within a month the hole is filled with epithelial tissue. If you have dry socket, the healing process may take longer than two weeks (with proper treatment, of course). As already mentioned, extensive inflammation may occur and even require surgical hospitalization of the patient: in this case, the healing of the dry socket may be very delayed.

Temperature increase

Tooth extraction usually does not cause an increase in temperature; in rare cases, there is an increase in temperature up to 37.5º in the first few hours after the operation, but this also goes away by the evening of the same day. If the temperature is higher and lasts longer, this may be a sign of an inflammatory process in the socket. In this case, you should immediately consult a doctor.

Symptoms of alveolitis

As a rule, the patient ignores the first symptoms of inflammation without due attention, considering them to be the norm after surgery. After tooth extraction, as already noted, pain within 24 hours is considered normal. As the hole heals, the pain subsides and completely disappears after a few days.

If the patient develops an inflammatory process, then the unpleasant sensations do not subside after a day or two, and 3–5 days after the operation, severe, throbbing pain in the socket occurs, which intensifies as the infection develops.

With alveolitis, patients may complain of both unbearable and moderate pain. Pulsation and pain are focused, as a rule, only in the removal area. However, in rare cases, the pain radiates to half of the face.

Other characteristic symptoms of alveolitis are:

• a sharp rise in body temperature;
• tooth sensitivity to hot/cold food;
• enlargement of the submandibular lymph nodes;
• decreased appetite;
• increased salivation.

In rare cases, the disease causes weakness, increased fatigue, and secondary infectious foci appear on the oral mucosa.

Alveolitis – Prices

Prevention

Preventive measures are aimed at preventing the causes of alveolitis. Their success depends not only on the patient, but also on the doctor.

The doctor must remove the tooth as gently and atraumatically as possible, using sterile instruments and monitor the healing of the wound.

After the intervention, the patient must follow the doctor’s recommendations, stop smoking for a while (up to 10 days), refrain from hot and spicy foods, and monitor oral hygiene. Women should consult a gynecologist about temporarily stopping oral contraceptives.

It is extremely undesirable to feel the site of tooth extraction or otherwise influence it (clean it with a napkin or a cotton swab).

Forms of alveolitis

Depending on the course of the complication, three stages are distinguished:

1. Serous.
   It makes itself felt
   2-3 days
   after tooth extraction. At this stage, pain occurs when eating, headache. Lymph nodes increase in size.
2. Purulent.
   This is the next form that occurs after the serous one, if timely treatment is not carried out. Diagnosed a week after the tooth was removed. The pain becomes unbearable and is also felt in the head or ear. The hole becomes covered with a purulent, dirty yellow coating. There is an unpleasant odor from the mouth. Swelling and lymph nodes enlarge and become painful. Opening your mouth and eating food is extremely difficult due to pain.
3. Hypertrophic.
   At this stage, it seems that the symptoms are subside: the condition is normalized, the temperature decreases. However, atrophied tissue grows, and when pressure is applied, pus is released from the inflamed wound.

If you notice any of the above symptoms, you should not self-medicate, but rather consult a dentist.

DIAGNOSTICS

It is important for specialists to conduct a correct and accurate differential diagnosis of idiopathic dental alveolitis in order to prescribe timely therapy and antibiotics. Sometimes a dentist in a clinic will be able to identify the chronicity of the process (more than a month) during preventive advisory examinations of the oral cavity. In the area of ​​the missing unit, there is an empty cavity without granulation with visible bone at the bottom. For accurate differential To diagnose the type of alveolitis, an x-ray of the affected area is prescribed.

Causes of inflammation

The disease can develop only after tooth extraction. Most often, the hole formed after removal heals within a day after the operation, and the patient feels better. But if the blood clot that covers the open wound moves or becomes deformed, an infection can penetrate into the hole, in which case alveolitis of the gums develops. As a result, the surface of the wound heals for a long time, and the patient suffers from complex discomfort.

Predisposing factors for the development of inflammation:

• Surgical injuries during complex removal. The more complex the operation, the more pronounced the postoperative inflammation of the bone tissue will be, and the more likely the release of direct plasminogen activators.
• Complex extractions associated with tooth segmentation, osteotomy, detachment of the mucoperiosteal flap. Complex operations increase the chance of developing alveolitis 10 times.
• Removal of wisdom teeth. The denser, less vascularized bone tissue adjacent to the figure eights is prone to the formation of dry sockets.
• General diseases of the patient. Alveolitis often occurs against the background of concomitant diseases. For example, patients with diabetes mellitus or immunocompromised patients are more susceptible to alveolitis due to impaired healing processes in the tissues.
• Taking oral contraceptives. The estrogen contained in these drugs may indirectly enhance the fibrinolytic process, causing the breakdown of the blood clot.
• Smoking. The direct connection between smoking and alveolitis has been repeatedly proven clinically. According to studies, the risk of socket inflammation in smokers increased 4-5 times compared to non-smokers. The incidence increased by more than 20% in patients who smoked 1 pack per day and by 40% in patients who smoked immediately before and after surgery.
• Dislocation of a bunch. If the socket is handled carelessly and there is negative pressure (for example, due to drinking through a straw), alveolitis may develop.
• Bacterial infections. Dentists agree that bacterial infections are the main risk factor for dry socket.
• Poor oral hygiene. The incidence of alveolitis increases significantly with poor oral hygiene.
• Excessive use of local anesthetics. According to some studies, excessive use of an anesthetic with a high concentration of a vasoconstrictor can provoke ischemia and make it difficult for the socket to fill with blood. This condition also increases the risk of alveolitis.

In fact, alveolitis is a fairly rare disease. According to statistics, it affects approximately 3% of patients who have undergone tooth extraction surgery. More often than not, the socket is not formed properly when lower incisors and molars are removed.

But alveolitis is especially common when removing lower wisdom teeth: according to experts, in approximately 20% of cases, the removal of “eights” with difficult eruption is complicated by alveolitis. In addition, it is believed that the risk of developing the disease is inextricably linked with age. This is explained by the fact that metabolism slows down, immunity is weakened, and the regenerative abilities of the body deteriorate.

Exogenous alveolitis

A persistent febrile condition is characteristic; throughout the entire disease there is pronounced pallor of the skin. The patient's quality of life deteriorates significantly - he cannot eat properly, because it becomes very difficult to eat.

Lymphangitis and lymphadenitis are characteristic signs of exogenous alveolitis, because the infection quickly spreads to nearby areas. Upon visual examination, a gray coating and severe hyperemia are noted, and upon palpation the patient notes sharp pain.