Dry Sockets … a preventable complication following dental extractions

Have some fun with your dentist.  Tell him or her that you heard that dry sockets are preventable.  First, they will step back, hyperventilate a bit, question where you heard “that,” and then explain that they are not unusual after having an extraction.  

They will explain that if the patient smokes, uses a straw, or drinks a carbonated beverage, then they (the patient) will cause a dry socket.  Actually, 95% of the factors that cause dry sockets are at the hands of the surgeon.  The patient is responsible for only about 5%.

So what is a Dry Socket?
Some people have never heard of a dry socket but those who have experienced a dry socket will remember it and warn others of the experience.  Simply, when a tooth is extracted, the remaining hole in the jaw, the socket, must heal by filling up with bone.  A blood clot, which initially fills the socket, is the first and most important part of the healing process.  It takes 4 to 6 months for bone to mature in the socket.

Any thing that dislodges that clot will leave the socket dry (empty). The bone will be exposed and the patient will experience severe and constant pain.  Pain pills will only temporarily relieve the pain and will not get rid of the cause of the pain.  Treatment requires multiple visits with the dentist/surgeon over a 1 to 3 week period.

What causes a Dry socket?
Infection, poor oral hygiene, irrigating the wound with a syringe, poor patient compliance to post op care, failure to suture or close the wound at the time of surgery and traumatic surgical techniques all contribute to wound breakdown.  These factors are important in the patient who is healthy and has good healing capacity. 

Some patients may have a compromised healing response.  Patients with diabetes, on chemotherapy or immuno suppressant medications, bisphosphonates (for osteoporosis), will have a higher incidence of post op complications following extractions.  For this reason, focused surgical technique and management is mandatory.

Back to your dentist. 
Ask how he treats dry sockets?  He will show you preparations that they use to pack the affected wounds.  He will show you irrigation syringes that he gives to his patients following surgery so they can keep the wound clean.  None of these approaches are wrong.  It is the current state of the art.  But they may need updated.

Moving forward?
Two things have to happen in order to move forward in managing the dry socket complication.   First, patients should not accept a dry socket as normal.   Second, we, the doctors, have to focus on prevention rather than treatment of the dry socket.  So long as patients accept this complication, doctors will not change what they are doing.  

The complete story on Dry Sockets is available on our Dental Specialists of America website, www.dsa-llc.net.  After 40 years and thousands of extractions, we have yet to have dry sockets.  I have taught many practitioners over the years to enjoy dry socket free practices.   We do not have magic potions.  We simply use good, safe, non-traumatic, surgical techniques. 

The dry socket issue is significant enough that drug and medical device manufactures have created substantial product lines to prevent and treat dry sockets.  At major professional meetings, there are vendors touting their answer to the dry socket complication.  They have made a good return on their investment.

What about the doctor’s practice?  Treatment will involve 2 to 3 additional visits for the patient.  This is costly for the practice and the patient.  It affects the reputation of the practice.

But what about the patient?  The patient experiences a prolonged, painful and inconvenient experience.  An unnecessary experience. 

So long as patients accept this complication, doctors will not change what they are doing.   We as practitioners must focus on prevention.  When we master prevention, patients will expect and receive a dry socket free post extraction recovery.  Dry sockets are preventable.  

Blog Archive