The human permanent teeth are strong and made in such a way that they should last for a lifetime. But sometimes for one reason or the other, extraction of a tooth may be needed. Some of the common reason why tooth extraction may be necessary is when a tooth is dead, severely damaged by trauma or decay and when a damage can’t be repaired. Tooth extraction is surprisingly painless as it is done under the effect of a strong general anesthetic. Before a tooth is extracted, the dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed.
If the tooth to be removed is an impacted wisdom tooth, the dentist may need to cut away gum and bone tissue that cover the tooth and then, use forceps to gently rock the tooth back and forth to loosen it from the jaw bone and ligaments that hold it in place. (1) Immediately a tooth has been pulled, the dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. In some cases, the dentist may place a few stitches over the extraction site to promote healing.
Once the wisdom tooth removal has been completed by an oral surgeon, a blood clot usually forms, covering the empty socket. Sometimes, a painful condition known as dry socket can occur if the blood clot fails to form in the socket or dissolves before the wound from wisdom tooth extractions has fully healed.
Dry socket vs normal socket healing
The healing process of a socket after tooth extraction, including dry sockets, will generally be the same for any extraction. Although, deeper wounds tend to take longer time to fully heal than comparative smaller ones. If you just had a wisdom tooth surgically removed, your healing time and treatment for dry sockets will take longer than someone who just had a lower incisor or baby tooth pulled. Severe pain may occur during the healing process and may require additional treatment.
Normally, after a tooth is extracted, the natural healing process generally goes well. However, some people develop dry socket during the healing process. People who smoke, those with poor oral hygiene, those on blood thinning medications or oral contraceptives, and those who have had tooth or gum infections in the past are more likely to have dry socket after tooth extraction surgery. (2) Dry socket is one of the few complications that can occur after a permanent is extracted.
Dry socket also known as alveolar osteitis, usually develop when the blood clot where a tooth has been removed fails to develop properly or dislodges before the wound has a chance to heal. Well, dry socket is not common as you may think, only very small percentage of about 2 – 5% of people develop dry socket after having a tooth extraction. Without the protective layer that is being provided by blood clot, the bone and nerves underneath the socket are left exposed. This can lead to intense pain inside the socket and along the side of the face.
How a normal healing socket looks like
Immediately after undergoing a tooth extraction surgery, the empty socket will be filled with blood and the formation of a clot will begin. The formation of the blood clot is one of the most important part of healing. The clot forms a protective layer that covers the underlying bone and nerve endings. The blood clot typically fills the socket up to the level of the gum tissue surrounding it. (3)
Blood clot
It’s normal to experience some degree of swelling and tenderness in the tissues that surround your wisdom tooth extraction site and possibly on your face too after a tooth removal. The traumatized gum tissues that surround your socket may have a whitish appearance. Hopefully, you will notice that the level of pain associated with your extraction site has begun to slowly subside. Although, the swelling and pain should be at their peak within the first 48 to 72 hours and then start to subside.
During the first few weeks following your tooth extraction surgery, you should notice that the gum tissues surrounding your extraction site have started to heal. It’s normal to experience some pain and a metallic taste in your mouth due to the blood clot. After the first week, granulation tissues will replace the blood clot, promoting healing. Within 3-4 weeks, most of the soft tissue healing will occur and new bone growth will begin to fill the socket.
How dry socket looks like
When you look at an extraction site following a tooth removal procedure, what you should see is a dark blood clot. If it turns out that the clot is missing or partially dislodged, then it can be a sign that the area is not healing as it should. Like I said earlier, dry socket happens when this blood clot either fails to develop or dislodges before the wound has a chance to heal.
The pain from dry socket typically starts about 3 days after the tooth was pulled. As more days passes, instead of dying down, the pain becomes more severe and can radiate to your ear, neck and some parts of your face. Well, here are some of the common symptoms of dry socket:
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Severe pain. Dry sockets usually occur 2-3 days after the removal of the tooth, the discomforts may last for a week or more. The pain may radiate to other parts of the head such as the ears, eyes, neck and face.
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Visible bone within the socket. Due to lack of protective covering, the white jawbone may be visible in the socket and the surrounding tissue may appear gray due to poor healing.
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Unpleasant taste and extreme bad breath. Patients with dry sockets tend to have extreme foul odor coming from within their mouth. This is due to the accumulation of food debris and bacteria in the socket.
Dry socket healing and treatment
To treat a dry socket, the dentist will need to flush the empty socket to eliminate harmful bacteria and food particles or debris. The empty socket is then packed with medicated paste or gel to relieve pain and promote healing. In the meantime as the treatment is ongoing, it’s important to practice self-care to promote healing and prevent debris from accumulating. (4)
The average healing time for dry socket pain is 7 to 10 days. During this time, new tissue grows to cover the exposed socket, protecting the bone and nerves. However, the healing time can vary from person to person. It is important to follow your dentist’s instructions during dry socket treatment.
To learn more about dry socket and the pain it causes, I have written other articles on the topic.