Q: My daughter had her wisdom teeth removed and a week later, she can feel air going inside one socket. In another socket, pus is coming out. I took her back to the dentist two times and he didn’t do anything but rinse it. She is in so much pain and over the counter meds are not working. Another dentist gave her antibiotics for an infection. Should there be cause for concern about these two sockets?
A:
It sounds like your daughter has one or two dry sockets.
What is a dry socket?
A dry socket occurs within three days after an extraction after a blood clot falls out of the socket. Without the blood clot present, the bone is exposed, which is extremely painful. A dry socket causes radiating pain up and down the face and pain upon drinking cold water or breathing in cold air. It is imperative to keep the blood clot in the socket until the bone has a chance to fill the socket and essentially heal. Without the blood clot, the socket will take longer to heal and it will be quite painful during that period of time.
The blood clot has two functions: It stops the area from bleeding and over time, stimulates bone healing. Think of the blood clot as a scab on a deep cut on your skin; if the scab comes off too early, the area is exposed and can be painful, just like a dry socket.
Dry sockets are rare and occur in 5% of all tooth extractions. However, studies have shown that women are more likely than men to develop a dry socket, which could be due to menstrual cycles and estrogen levels.
The reason there is so much pain when the blood clot is lost is because the pain receptors in the jaw bone are completely exposed to the outside world.
How to Know if You Have a Dry Socket
The best differentiator between normal extraction pain and dry socket pain is timing. Post extraction pain peaks and wanes within a 24 hour period, but dry socket pain peaks three to five days after the extraction and will take weeks to go away unless treated by a professional.
Symptoms also include bad breath, an earache, and an unpleasant taste in the mouth.
What Causes a Dry Socket?
I advise my patients to avoid the following for three days after a wisdom teeth extraction:
- Drinking from a straw, smoking, or any sort of similar “sucking” action
- Exercise
- Coughing and sneezing
- Swishing with water
- Drinking carbonated beverages (soda, beer, sparkling water etc.)
How to Heal a Dry Socket
The sockets need to be packed (or filled) with material by an oral surgeon to insulate the bone. This will alleviate the pain during the extended healing process as well as mimick what the blood clot would have done.
This can be done in two ways:
- Packing the socket with dry socket paste, which will alleviate the pain almost immediately.
- Packing the socket with bone graft material or surgical foam
The former, although it relieves pain on the spot, may be more of a short term solution. The latter is more of a long term solution, albeit more expensive.
Whenever there is pus present in the mouth, it is wise to consider antibiotics, so the second dentist was wise in prescribing these. However, I would act on either of these two methods immediately.
Take your daughter to an oral surgeon as soon as possible and discuss these two methods of packing the dry socket with him.
Mark Burhenne DDS
Mark Burhenne DDS is a family dentist and award-winning blogger who has written numerous articles on oral health and advised 
{ 7 comments… read them below or add one }
What percentage of people get dry socket from drinking carbonated beverages?
Thanks for sharing such valuable information not found anywhere eles. I need some advice about tooth decay and possible extraction. 1 week ago I noticed that a small part of my 1st bi cuspid tooth (upper) had chipped away. I went to see my dentist who took a couple of xrays. She told me that I had calcification of my root canal therefore I needed the tooth removed as root canal was not an option. I don?t have any pain at all therefore this seems a bit extreme. I really don?t want the tooth removed if it is not necessary and would really appreciate some advice.
Hi Doctor …
I’m a 4th yr. dental student with questions.
When doing endo, would it be just as effective to use a sequence of..
1- gates glidden reaming 2- sodium hypochlorite 3- EZ fill root canal sealer
and.. that’s it… without K files, gutta percha, calcium hydroxide and
without Gregorian Chanting ! Eagerly awaiting your response.. EB
Had #19 molar extracted one week ago. Still have clear discharge from extraction site. Jaw has small lump under extraction site.
Extracted tooth was infected for 10 days prior to extraction, thought once removed the discharge would clear up and infection would go away. DR, told me to wait another 6 days and see if it clears up on its own. I think I may have a bone infection. Should I go back on Antibiotics? Just came off Cliyndamycin this past Saturday, 150 mg 4 times a day. should I go back an AB, if so which would you recommend.
Do you think I may need to scrap the jaw bone again to remove any infection?
Dear Dr.
I had a bottom wisdom tooth removed 1 week ago Mon., the Dr. had me come back in a week and they removed the sutures. But he did not remove the gel pack and other stuff? he said he packed the hole with. Is this material okay to be left in? I can not call their office as they are closed on Fri. thru Mon. and I had noticed a couple of times this (material?) in very small quantities coming out. I am wondering what I can expect, and will it all eventually come out or disentegrate or what if anything I should do about it. Unfortunately I did not think to ask them at the office this past Monday.
Sincerely,
Cathy
Got a painful dry socket. Went back today and got it packed with this stuff that looked like chewing tobacco. It tastes awful but helped almost immediately and hours later I’m in no pain. What a relief!!!
Hi i need some advice, i just had my wisdom teeth out about a week ago, i woke up the day after the extraction with horrible pain where my lower right wisdom tooth use to be, so of course i went back to the surgeon i was told i had a dry socket he packed it with some paste (honest to god it looks like it has twigs in it) and sent me home, 3 days later i again woke up again in horrible pain, so again i went back to the surgeon. He told me the dry socket was my fault because i am a smoker ( and no i hadn’t has a smoke since 2 days before the extraction) he packed me with that past again and set a standing appointment for me to have it packed once a week. i’m still in a great amounts of pain even with the packing ( it keeps the pain away for 2 days then just makes me feel like i want to through up). Now i’m starting to feel the same pain in my upper left socket, and will have to seek help for that as well. I have not been given any kind of pain medication (Motrin,Tylenol and Advil give me no relief) What do i do now, how do i get rid of this horrible pain that makes even opening my jaw to talk burn like acid is being poured into my ear down my jaw and around to the front of my mouth????? Please help me i don’t know what to do!