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Wisdom Tooth Removal: What Is a Dry Socket?

After a wisdom tooth has been extracted, the socket is filled with a blood clot. Slowly, the clot shrinks and fills in. That is, a skin or a covering with tissue similar to the rest of the mouth (mucous membrane) begins to cover the clot and the tissue in the clot area is ingrown by bone cells and tissue cells. Eventually, the area shrinks and the socket is eliminated and replaced by firm tissue, and the depth of the socket fills with bone. The healed area usually is narrower than the site of the original wisdom tooth.

The pain following a wisdom tooth extraction usually lasts no more than a day or two, at the most. If the clot breaks down or is washed away, the protective covering of the exposed bone is lost and the bone can be exposed to the mouth bacteria. This painful condition is known as dry socket. One of the features of its presence is that wisdom tooth post-extraction pain persists longer than a couple of days and can be quite severe.

Though the causes are not known with certainty, some factors seem to predispose individuals towards a dry socket:

• those people who have gingivitis or periodontal disease.
• those who have had lower or mandibular extractions, particularly on posterior (back) teeth such as molars and pre-molars.
• those who have wisdom teeth that are difficult to extract and necessitate bone removal.
• those that are particularly difficult to numb and so need several cartridges of local anesthetic. Some local anesthetics contain epinephrine, which is used in preventing rapid dissipation of the anesthetic by constricting the blood vessels at the site. This perhaps may prevent good clot formation. People who smoke also are predisposed towards dry socket. Again, this may be because of the constricting effect of nicotine and tar products on the blood vessels.

Rinsing the mouth within a few hours of a wisdom tooth extraction may flush the clot out of the socket. Using a straw may have a similar effect. That is why post-operative instructions urge the patient not to smoke, rinse or use a straw for at least a day.

Unfortunately, there is no sure way of guaranteeing that a dry socket won't occur, but there is some evidence that placing a small piece (quarter of a square inch) of gel foam (a clotting agent) covered with tetracycline powder (an antibiotic) in the socket after the extraction can reduce the chance of a dry socket. This will be absorbed over a few days and has not been shown to induce allergies or have any other effect on the patient. Fortunately, dry socket is a relatively easy condition to treat.

by Myer Leonard, DDS, MD

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Oral Surgery: The Wisdom Teeth Removal Procedure

Wisdom teeth, those third molars at the very back of our mouths, are so named because they generally erupt during late adolescence and early adulthood. When properly positioned they can be a valuable asset to us. When the jaw is not large enough to accommodate these wisdom teeth, they can cause dental problems, such as infection, requiring wisdom tooth removal.

Wisdom Teeth in Teens

Wisdom teeth usually appear in young adults between the ages of 15 and 25. Some wisdom teeth will grow in normally; others are "impacted." An impacted wisdom tooth allows no room for the rest of your teeth to grow. Dentists use X-rays to evaluate whether your wisdom teeth have any chance of coming in properly and can advise you on the best time to have wisdom tooth removal.

Why Are Wisdom Teeth Removed?

When there is no room for wisdom teeth to come in properly or when the teeth haven't reached their permanent location by age 25, then they're considered to be impacted wisdom teeth. Dentists recommend removing the tooth early, before wisdom tooth and other dental complications can develop.

Partially visible wisdom teeth are susceptible to bacteria that can cause wisdom tooth infection. Cysts and tumors can grow on a trapped wisdom tooth, causing irritation and some pain as well as diseases of the gums. Another problem occurs when the second molar, the last tooth before the wisdom tooth, is damaged as the wisdom tooth grows in without enough room.

The younger the patient, the easier the healing will be, which is another reason not to wait before removing impacted wisdom teeth. This oral surgery will be performed in the office of either a dentist or an oral surgeon, under anesthesia, providing patients with maximum comfort while keeping the procedure efficient and cost-effective. Local anesthetic (such as Novocain) is always used, but you may opt for additional comfort with nitrous oxide ("laughing gas"), IV sedation (twilight sleep) or deep sedation (general anesthesia.)

Wisdom Tooth Removal

An oral surgeon or your dentist can provide guidance whether you're a candidate for wisdom teeth removal (extraction). The bottom line is that wisdom teeth most often don't fit well in our mouths and they can cause other teeth to move or lead to gum disease or bone problems. Ask the dentist to make an evaluation and suggest the best course of action!

by Brian J. Gray, DDS, MAGD, FICO

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.