Alveolar osteitis

Overview
In dentistry, a dry socket is a layman's term for alveolar osteitis. The alveolus is the part of the jawbone that supports the teeth, and osteitis means simply “bone inflammation”. Alveolar osteitis (dry socket) refers to inflammation of the alveolar bone following extraction of the tooth.

Alveolar osteitis is a painful phenomenon that most commonly occurs a few days following the removal of mandibular (lower) wisdom teeth. It is commonly believed that it occurs because the blood clot within the healing tooth extraction site is disrupted. More likely, alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible (which explains why dry socket is usually not experienced in other parts of the jaws). Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris.

A dry socket typically presents as a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar. This is often extremely unpleasant for the patient; the only symptom of dry socket is pain, which often radiates up and down the head and neck. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone — it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence.

True alveolar osteitis (dry socket), as opposed to simple postoperative pain, occurs in only about 5–10% of extractions (primarily of the lower molar teeth). No one knows for certain how or why dry sockets develop following dental extraction but certain factors are associated with increased risk. Smoking, which can impede healing of wounds anywhere in the body, is one such factor; this is thought to be due to the decreased amount of oxygen available in the healing tissues. It is advisable to avoid smoking following tooth extraction for at least 48 hours to reduce the risk of developing dry socket. Additional factors increasing risk of dry socket include the use of hormonal contraception by female patients, and the amount of surgically-induced trauma to the bone required at the time of the procedure (for this reason, operator experience plays a role). Women are generally at higher risk than men for developing dry socket, because estrogen slows down healing. Dentists recommend their female patients to have extractions performed during the last week of their cycle, when estrogen levels are lowest, to minimize chances of developing dry socket.

The pain from alveolar osteitis (dry socket) usually lasts for 24–72 hours. There is no real treatment for dry socket — it is a self-limiting condition that will improve and disappear with time — but certain interventions can significantly decrease pain during an episode of dry socket. These interventions usually consists of a gentle rinsing of the inflamed socket followed by the direct placement within the socket of some type of sedative dressing, which soothes the inflamed bone for a period of time. The active ingredients in these sedative dressings usually include natural substances like zinc oxide, eugenol, and oil of cloves. It is sometimes necessary to have this done for 2 or 3 consecutive days. Maintaining good oral hygiene during the healing period by brushing all non-tender areas regularly and rinsing with warm salt water is often advised, beginning 24 hours after the extraction.

Patients are also advised to avoid drinking through a straw as the negative pressure created by the draw through the straw can dislodge the clot. Additionally, patients may be told not to spit out saliva (or anything else for that matter) excessively due to the negative pressure created in the mouth immediately prior to spitting. These pieces of advice may be helpful, but there is scant evidence that such activities are associated with the development of dry socket. Because true dry socket pain is so intense, additional analgesics are sometimes prescribed.