Dry Socket
Dry socket is an infection in your tooth socket after
a tooth is extracted. The condition usually develops when
a blood clot fails to form in the socket, or if the blood
clot comes loose. Dry socket occurs in approximately 5
percent of all tooth extractions. Normally, the blood
clot that forms after a tooth is removed promotes healing,
laying the foundation for the growth of new bone tissue.
When dry socket occurs, this blood clot is lost and the
infected, inflamed socket appears empty — hence the
name. Nerves are exposed, and sometimes the bone is visible
in the empty socket. You may not have symptoms until 3
to 5 days after the extraction. Then, the condition will
manifest itself as severe pain that doesn’t subside,
often accompanied by what feels like an earache. You may
also have an unpleasant taste in your mouth, and bad breath.
Causes and prevention
Several things can cause the premature loss of
a blood clot from an extraction site, including smoking,
forceful spitting, sucking through a straw, coughing or
sneezing. You should also avoid consuming carbonated or
alcoholic beverages after an extraction, as these have
also been associated with the development of dry socket.
Also, you should:
• keep your fingers and tongue away from the extraction
site.
• apply an ice pack to your jaw for the first 24
hours following surgery — on for 15-20 minutes, and
off for 30-40 minutes — to prevent pain and swelling
and stop excessive bleeding.
• not rinse your mouth the day of surgery.
The next day, you can rinse gently with warm salt water;
dissolve one teaspoon of salt in a cup of warm water.
Be sure to rinse and spit gently. Call our office right
away if you notice any symptoms of dry socket. Treatment
for dry socket typically includes a gentle rinsing of
the socket. We then pack it with topical anesthetic and
a sterile gauze dressing. You’ll usually need to
return to our office two to three times over a two-week
time period so we can change the dressing and monitor
the healing.
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| Dry socket — loss of blood clot |
Avoid smoking |
Single Tooth Extraction
People are sometimes anxious when they have a tooth removed,
and fear of the unknown is usually the cause of this anxiety.
We’d like you to know about the steps we take when
we extract a tooth, as well as what we do to ensure that
you’re comfortable — before, during and after
the procedure. 
First, a little bit about tooth anatomy
and the tooth extraction process...
The roots of your teeth are encased in sockets in your
jawbone, and are held in their sockets by ligaments. When
we extract a tooth, we need to expand the tooth socket
and disconnect the tooth from the ligament that holds
it in place. An appropriate analogy for tooth removal
is the removal of plant roots from soil. If a plant’s
root is deep and entwined in the soil, you can’t
simply pull it up to remove it. You rock the root back
and forth and maybe twist it from side to side to gently
enlarge the hole, making removal much easier. This is
precisely what we do when we’re removing a tooth.
When are tooth extractions needed?
There are a number of situations that indicate to us that
we need to extract your tooth. Perhaps the tooth is badly
decayed and cannot be saved, or the gums surrounding it
have advanced periodontal disease (gum disease) so there’s
no longer enough bone and connective tissue to hold the
tooth in your jaw. Other teeth need to be removed because
they aren’t positioned correctly in the mouth and
there is no other solution, as is the case when wisdom
teeth are impacted.
Preparing for the extraction
First, we’ll examine your mouth and teeth,
and we may take X-rays of the questionable tooth so we
can evaluate its root and the bone that surrounds it.
Be sure to tell us about any medical conditions you may
have, or problems you’ve had with previous extractions.
You’ll also need to be sure to tell us about any
medicines or supplements you’re taking, including
aspirin, ibuprofen, herbal supplements and any other overthe-
counter medicines. If you take oral contraceptives, we’ll
need to know about that, as well, because you could be
more prone to having problems with healing. If we find
a significant amount of infection during the exam, we
may prescribe an antibiotic for you to take for several
days before your tooth is extracted. Be sure to take them
exactly as directed.
Wisdom Tooth Extraction
Before we begin Before we remove your wisdom teeth,
we’ll thoroughly examine your mouth and teeth, and
we’ll also take X-rays of the teeth we’re going
to remove so we can evaluate their roots and the bone that
surrounds them. Be sure to tell us about any medical conditions
you may have, or problems you’ve had with previous
extractions. You’ll also need to tell us about any
medications or supplements you’re taking, including
aspirin, ibuprofen, herbal supplements and any other over-the-counter
medicines. If you take oral contraceptives, we’ll need
to know about that, too, as you could be prone to more problems
with healing.
Preparing for the extraction
An appointment to have all four of your wisdom teeth removed
usually takes only an hour or two. Before we begin, we’ll
use anesthetic to numb the entire area around the teeth
so you’ll be comfortable throughout the procedure.
What happens during the extraction?
If your wisdom teeth haven’t yet erupted (grown in)
above the gum line, we’ll remove them through a small
incision in your gums. To remove the wisdom teeth, we’ll
use either forceps or an instrument called an “elevator.”
Elevators are placed next to your tooth, and are used
to gently roll it out of its socket. Forceps carefully
grip the tooth so we can remove it. As the tooth is removed,
you’ll feel pressure, but not pain. If you feel any
discomfort beyond just a sensation of pressure, be sure
to let us know. We’ll stop immediately and give you
more anesthetic. Sometimes, if your tooth’s roots
are curved or are tightly held in the socket, we might
need to cut the tooth into sections and remove them one
at a time. This is a very common practice, that can significantly
reduce the amount of time and effort needed to remove
an impacted wisdom tooth. Once the tooth is removed, if
an incision was necessary we’ll close it with a couple
of stitches.
Taking care of yourself after the
extraction
You may feel a bit groggy after the procedure, so you
should arrange to have someone pick you up when you’re
done. Then, to minimize problems after your tooth is removed,
you ll need to follow our post-operative instructions
carefully, especially for the first 24 hours. These instructions
will tell you how to control bleeding, how to relieve
pain and minimize swelling, how to prevent dry socket,
and what to eat and not eat. We’ll also give you
a prescription for a pain reliever, which will help to
keep you comfortable. We may also prescribe an antibiotic;
be sure to follow the directions precisely.
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| Damage to neighboring
tooth |
An impacted wisdom tooth |
