Dry socket happens when the blood clot in a tooth extraction site breaks down or comes out too early, leaving the bone underneath exposed. It usually causes pain that gets worse, rather than better, two to four days after an extraction. If you think you have it, call your dentist. Treatment is simple, and many people feel noticeably better once the socket has been cleaned and dressed.
Worsening pain after an extraction is one of the problems our dental emergency guide lists as needing prompt care. Here’s how to recognise the problem, what your dentist will do and how to lower your risk.
What is dry socket?
After a tooth is removed, a blood clot forms in the empty socket. The clot protects the bone and nerve endings and is the base on which new tissue grows.
If the clot doesn’t form properly, dissolves early or is dislodged, the bone is left exposed to air, food and fluids. The medical name is alveolar osteitis. It isn’t usually a serious infection, but it can be very painful and slows healing. It’s more common after lower wisdom tooth removal than after other extractions.
Signs of dry socket
- pain that eases for a day or two, then gets worse, usually two to four days after the extraction
- severe, throbbing pain that can spread to your ear, eye, temple or neck on the same side
- a socket that looks empty, where you may see pale bone instead of a dark red clot
- a bad taste in your mouth or bad breath
- pain that isn’t well controlled by over-the-counter pain relief
Normal healing or something more?
Some pain, swelling and bruising is normal after an extraction, especially after wisdom tooth removal. It usually peaks within the first two to three days and then gradually improves. The key difference is that with a dry socket, the pain gets worse over time instead of better.
A creamy white or yellowish layer in the socket after a few days is often normal healing tissue, not a sign of a problem on its own.
Signs of infection
Fever, pus, or swelling that increases several days after the extraction may point to an infection instead. Call your dentist promptly.
When to go to hospital
Call 000 or go to your nearest hospital emergency department if you have:
- difficulty breathing or swallowing
- swelling that is spreading to the eye, neck or floor of the mouth
- bleeding that won’t stop after 15–20 minutes of firm pressure
- a possible broken jaw, or a jaw that won’t open or close properly
- a knock to the head with loss of consciousness, vomiting or confusion
If something happens outside clinic hours and you’re not sure what to do, call healthdirect on 1800 022 222 for 24/7 nurse advice.
How dry socket is treated
This condition should be managed by your dentist rather than at home. At your appointment, your dentist will usually:
- check the socket and may take an X-ray to rule out other causes, such as a fragment of root or an infection
- gently rinse the socket to remove food and debris
- place a medicated dressing in the socket to cover and soothe the exposed bone
- talk you through pain relief and home care
- ask you to come back if the dressing needs changing, sometimes every few days, until the pain settles
Antibiotics aren’t usually needed for the condition itself. With care, the pain often eases within a few days and the socket usually settles over about a week to 10 days.
Why you shouldn’t treat it yourself
It’s tempting to try home remedies, but putting things into the socket can irritate the bone or introduce bacteria. Don’t poke the socket with fingers or cotton buds, don’t pack it with clove oil, aspirin or other products, and don’t take leftover antibiotics. Until you’re seen, take over-the-counter pain relief such as paracetamol or ibuprofen, taken as directed on the pack, if it’s safe for you. Your dentist may also suggest gentle warm salty water rinses.
How to prevent dry socket
Some things raise your risk:
- Smoking and vaping. The suction and chemicals can disturb the clot and slow healing.
- Drinking through a straw, which creates suction in the mouth.
- Vigorous rinsing or spitting in the first day or so.
- Lower wisdom tooth removal, especially a more difficult extraction.
- Having had the problem before, or taking the oral contraceptive pill, which some studies link to a higher risk.
To lower your chances:
- Follow the aftercare instructions you’re given, and bite on gauze as directed.
- For the first 24 hours, avoid rinsing, spitting, hot drinks and strenuous exercise.
- Avoid smoking and vaping for as long as your dentist recommends, and ideally longer.
- Eat soft food and chew on the other side.
- Keep your mouth clean by brushing your other teeth gently.
- Tell your dentist about any medicines you take and whether you smoke or vape, so they can tailor their advice.
Our tooth extraction page explains what to expect before and after having a tooth removed.
Getting help in North Sydney
If your extraction site is getting more painful, call us. We aim to see urgent problems as soon as possible, often on the same day. If your extraction was done elsewhere, it’s usually a good idea to contact that dentist first, but our emergency dentist in North Sydney can see you if they aren’t available.
Frequently asked questions
How long does dry socket last?
With treatment, the pain often eases within a few days, and the socket usually settles over about a week to 10 days. Healing can take longer without care, so it’s worth seeing your dentist.
Can dry socket heal on its own?
It usually heals eventually, but it can be very painful in the meantime. Your dentist can clean the socket and place a medicated dressing to ease the pain, so it’s better to call than to wait.
When can I smoke or vape after an extraction?
Ask your dentist, as advice depends on your extraction. Many dentists suggest avoiding smoking and vaping for at least 48 to 72 hours, and staying off them longer helps healing.
Is it normal to see something white in the socket?
A creamy white or yellowish layer can be normal healing tissue. If the socket looks empty, you can see bone, or the pain is getting worse after a few days, call your dentist.
Need help now?
North Sydney Dentistry is at Level 1, Suite 102/71 Walker St, North Sydney, a two-minute walk from North Sydney station. We’re open Monday to Friday, 9am to 6pm, and keep time aside for urgent problems where we can. Call (02) 8090 1108 or book online.
This article is general information only and is not a substitute for advice from your own dentist or doctor. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.