Dear Dr. Mady: The other day I had a tooth extracted by my dentist. Although the appointment was very quick and simple I ended up with one whole week of agonizing pain that was worse than the toothache I had previously. My dentist said that it was from smoking. How is this possible? - Denise in Belle River
Dear Denise: It sounds like you may have experienced a case of classic “dry socket” (alveolar osteitis). This situation occurs when the bone has been exposed at the extraction site after a tooth has been removed or extracted.
Under normal circumstances, a blood clot forms in the hole where the tooth roots were (socket) and healing occurs without difficulty. The clot is an extremely important part of the healing process after extraction. If this clot is partially or completely lost prematurely, the exposed bone causes moderate to severe pain.
One usually has a foul taste in their mouth from this condition. The pain, which often radiates up and down the head and neck, can be extremely unpleasant. Like the child who "picks at a scab," the area heals in time but is painful for far longer than if the "scab" had been left alone. Dry socket is painful but otherwise a relatively harmless situation.
Instructions known as “post-op instructions” are usually given by your dentist or oral surgeon after an extraction and they must be followed closely in order to escape the possibility of dry socket. These include 24-hours of no sucking through a straw, no drinking out of a bottle, no rinsing and no smoking for 48-72 hours after. Basically, any action that can cause a negative pressure in your mouth after your surgery can cause the clot to be dislodged from the socket.
The most common cause of dry socket is smoking and it can also increase the length of time for healing.
Treatment by your dentist may include application of medicated dressings into the socket every day or other day for up to a week, after gentle flushing with a saline solution. These dressings usually give immediate relief due to the main ingredient, eugenol (similar to oil of cloves). Your dentist may also prescribe you pain medication and a mouth rinse containing chlorhexidine to use twice a day, temporarily. After the pain has subsided, the dressing will not be placed anymore so that the soft tissue around the socket can heal. In many cases, pain medication does not help and the only relief accessible is from medicated dressing.
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. Each situation may be different, so if you are having constant discomfort when you thought it would all be gone, then you most likely have dry socket. It is very important to remember that cigarette smoking or other tobacco use can delay healing with or without dry socket and should be avoided with any kind of surgery.