California Emergency Oral Surgery

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.

Wisdom Tooth Extraction or Removal - Oral Surgery Guidelines To Speed Healing

After oral surgery, it is important to follow all the instructions provided by your oral surgeon or wisdom tooth dentist.

Here are some guidelines to speed your recovery and healing.

The First Step After Oral Surgery: Proper Care for Bleeding

To limit bleeding after oral surgery, your wisdom tooth dentist or oral surgeon may place a gauze pack on the wisdom tooth extraction site.

This should be left in place for 30 to 45 minutes after leaving the office.

Bleeding might continue after the pack is removed.

If it does, follow these instructions:

• Form a thick pad from clean gauze; dampen it and place the pad directly on the wisdom tooth extraction site.
• Apply some pressure by firmly biting on it for about 30 minutes.
• Replace the pad with a clean one if it becomes soaked with blood.
• If heavy bleeding continues, call your wisdom tooth dentist.
• Avoid sucking on the wisdom tooth extraction site.

Protect the Blood Clot

A blood clot should form in the wisdom tooth extraction site; this needs to be protected for proper healing. Healing is a delicate process and requires the restriction of certain activities; otherwise the blood clot can be dislodged.

Dental Care And Things You Must Avoid After Oral Surgery:

• Sucking or blowing motions
• Smoking
• Drinking through a straw for 24 hours
• Rinsing your mouth vigorously
• Mouthwash (until your wisdom tooth dentist approves its use)
• Cleaning teeth next to the extracted site for the rest of the day
• Strenuous exercise for 24 hours
• Hot liquids or alcoholic beverages

Reduce Swelling and Pain of Oral Surgery

Your oral surgeon or wisdom tooth dentist may give you a plastic ice pack to apply to your face on the way home. A cold compress helps reduce swelling. Apply either a cold compress or cold, moist cloth periodically. Switch to moist heat (a warm wash cloth) 24 hours after oral surgery. Check with your oral surgeon or wisdom tooth dentist regarding how often and how long to use a compress.

Your oral surgeon or dentist may prescribe medication to prevent infection and control pain. Carefully follow the instructions. If you experience severe pain, swelling, bleeding, fever, nausea or vomiting, contact your wisdom tooth dentist.

Proper Oral Care after Oral Surgery

Your mouth should be gently rinsed (not vigorously) with warm salt water the day after oral surgery. Add ½ teaspoon salt to one-cup warm water. Be sure to rinse after eating to keep food particles out of the extraction site.

Brush your teeth twice daily with a soft-bristled toothbrush. Brushing your tongue is also advised to eliminate bad breath and an unpleasant taste that often accompanies oral surgery. Floss at least once a day, too.

Follow your dentist or oral surgeon's instructions carefully after dental surgery.

Contact your wisdom tooth dentist or oral surgeon if you have any of the following problems:

• Numbness doesn't subside within a few hours;
• You experience nausea or vomiting; or
• You have severe pain, swelling, bleeding, or fever in the wisdom tooth extraction area.

Oral Surgery Guideline for Consumers

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.