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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 Surgeons and Wisdom Tooth FAQ

Q. What is an oral surgeon?

A. An oral surgeon is a dentist that performs many aspects of surgery in and about the head area including wisdom tooth removal. They can perform simple to extremely difficult extractions, such as wisdom teeth extraction. They also perform dental biopsies and remove tumors in the head and neck region. Most place implants in the jaw for future restorations and do complex jaw realignment surgeries. They usually have four or more years of continuing education after graduating dental school, and most limit their practice to only oral surgery.

Q. What is oral surgery?

A. Oral and maxillofacial surgery is the specialty of dentistry that includes diagnosis, surgical, and adjunctive treatment of diseases, injuries, and defects involving both the functional and esthetic aspects of the head, face, mouth, teeth, gums, jaws, and neck. An example of oral surgery would be extracting an impacted wisdom tooth or even extracting multiple impacted wisdom teeth.

Q. What are wisdom teeth?

A. Wisdom teeth are third molars. Normally people have three permanent molars that develop in each quadrant of the mouth; upper, lower, right and left. The first molars usually grow into the mouth at around six years of age. The second molars grow in at around age 12.

The third molars, wisdom teeth, usually will try to grow in at around age 18 to 20 years. Since that is considered to be the age when people become wiser, third molars gained the nickname, "wisdom teeth".

Actually, wisdom teeth are no different than any other tooth except that they are the last teeth to erupt, or grow into the mouth. Wisdom teeth are just as useful as any other tooth if they grow in properly, have a proper bite relationship, and have healthy gum tissue around them.

Q. Why do wisdom teeth cause problems?

A. Wisdom teeth cause problems because the shape of the modern human mouth may be too small to accommodate these teeth. As a result, they become impacted, or unable to come in or move into their proper place.

When wisdom teeth are prevented from erupting into the mouth properly, they are referred to as impacted. Teeth that have not erupted are not necessarily impacted. It may be that it is still too early in someone's dental development, and if time passes they might grow in properly. A dentist must examine a patient's mouth and his or her x-rays to determine if the teeth are impacted or will not grow in properly.

Impacted wisdom teeth may cause problems. Impacted wisdom teeth can result in infection, decay of adjacent teeth, gum disease or formation of a cyst or tumor from the follicle, which is the tissue which formed the crown of the tooth. Many dentists recommend removal of impacted wisdom teeth to prevent potential problems.

Q. What problems occur from partially erupted wisdom teeth?

A. Partially erupted wisdom teeth are breeding grounds for bacteria and germs that may cause infection, and cysts and tumors may grow on a trapped wisdom tooth. Jaw pain and gum disease may occur.

Partially erupted wisdom teeth can cause problems with the teeth in front of them, such as decay, bone loss, or root resorption. Any soft tissue which may is partially covering them is subject to infection. Again, if any of your wisdom teeth are partially erupted, you may want to carefully consider extraction. Not all wisdom teeth cause problems.

+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.