Tuesday, October 13, 2009

Alveolar osteitis

Labeled photograph of alveolar osteitis ("dry socket"), one week post-operative.

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”. It is an irritation of the bone open to the oral cavity after the loss of or premature disintegration of the blood clot.

Alveolar osteitis is a painful phenomenon that most commonly occurs a few days following the removal of mandibular (lower) wisdom teeth. It occurs when the blood clot within the healing tooth extraction site is disrupted. In rare cases, the removal of the upper wisdom teeth can also result in alveolar osteitis.

Signs and symptoms

As with any extraction of a tooth, some pain is to be expected, as the gums surrounding the former location will be damaged to a certain degree. This is especially so in extractions of impacted wisdom teeth, which may not have properly erupted; in these cases, the gums are cut open to allow access to the tooth, then sutured shut.

However, 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. It can also be accompanied by a foul taste or smell.

The pain, which often radiates up and down the head and neck, can be extremely unpleasant for the patient. It will often cause pain in the ears as well. 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.


True alveolar osteitis, 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. One of these factors is the complexity of the extraction. Smoking, which can impede healing of wounds anywhere in the body, is another possible contributing factor, possibly due to the decreased amount of oxygen available in the healing tissues. It is advisable to avoid smoking for at least 48 hours following tooth extraction 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 of developing dry socket, because estrogen slows down healing. Dentists recommend that their female patients have extractions performed during the last week of their cycle, when estrogen levels are lowest, to minimize chances of developing dry socket.

Patients are also advised to avoid drinking through a straw as the negative pressure created by drawing liquids 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. 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.


The pain from alveolar osteitis 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 with in the socket of some type of sedative dressing, which soothes the inflamed bone for a period of time and promotes tissue growth. This is usually done without anesthesia. The active ingredients in these sedative dressings usually include natural substances like zinc oxide, eugenol, and oil of cloves. It is usually necessary to have this done for two or three consecutive days, although occasionally it can take longer. Because true dry socket pain is so intense, additional analgesics are sometimes prescribed.


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