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
- 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.
There are two ways your oral surgeon can pack the dry socket:
- 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
Image courtesy of Second Snack.