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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 Solution to Wisdom Tooth Impaction Oral Surgery: The Solution to Wisdom Tooth Impaction Oral Surgery: The Solution to Wisdom Tooth Impaction

Oral surgery is frequently a part of growing up and developing wisdom teeth. Many people don't have the space in their mouths for their wisdom teeth, so the teeth aren't able to come in straight.

Impacted wisdom teeth happen when the developing wisdom tooth pushes into the tooth next to it. This can be quite painful, but some patients don't experience pain and don't realize they have impacted teeth.

That's why wisdom teeth dentists take x-rays. This enables a dentist to see how much the teeth have developed so far and where they look to be headed.

If the patient has impacted wisdom teeth, then the dentist will recommend oral surgery to remove the wisdom teeth. Simple extractions may be performed by a general dentist in his or her office under local anesthesia (like Novocain), but more complex cases will be referred to an oral surgeon.

During wisdom tooth oral surgery, the dental surgeon surgically removes the problematic teeth. (Most people get all four wisdom teeth removed, but that's not true for everyone.) In general, wisdom tooth surgery is easier to perform on younger people, as their wisdom teeth are still developing and haven't fully hardened to bone.

A visit to the wisdom tooth surgeon is not an inevitable part of becoming an adult, but for many people, it's a wise investment in their long-term dental health!

+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.