Dry socket after tooth extraction: symptoms and treatment
Originally published
Some discomfort is expected after a tooth extraction, but severe or worsening pain needs a dental review. One possible cause is dry socket, also called alveolar osteitis. You do not need to wait several days with uncontrolled pain before asking for help.
What is a dry socket?
A blood clot normally forms in the socket left by the tooth and protects the healing area. If it fails to form properly, breaks down or is lost, the underlying bone can be exposed and become very painful.
Dry socket is a problem with healing and inflammation. It is not, by itself, a bacterial infection or proof that the extraction was performed incorrectly. A retained root fragment is a separate clinical issue, not the usual explanation for dry socket.
Symptoms and when to contact a dentist
Pain often develops or becomes much worse a few days after the extraction. It can spread towards the ear or side of the face, and there may be an unpleasant taste or smell. The socket may look empty, but appearance alone cannot confirm the diagnosis.
Contact the dentist who treated you promptly for severe or increasing pain, particularly if pain relief is not helping. Fever, increasing facial swelling or bleeding that will not stop also need urgent advice; they may indicate a different complication. If you cannot reach a dentist, use NHS 111. Call 999 or go to A&E for heavy bleeding from the mouth that will not stop, or if swelling causes difficulty breathing or swallowing.
The Gloucestershire Hospitals guide distinguishes dry socket from infection after wisdom tooth surgery.
Reducing the risk
Dry socket can occur even when you follow the aftercare instructions. Smoking increases the risk, and risk varies with the tooth and the procedure. Tell the dentist about your medicines and health conditions, but do not stop a prescribed medicine to try to prevent this complication.
Protect the clot during the first 24 hours: avoid rinsing, spitting or touching the socket. Follow the instructions you were given about eating and cleaning. Choose soft foods initially and avoid hot food or drink while the mouth is numb.
After the first day, gentle warm salt-water rinses may be advised. Avoid smoking and vaping during recovery and follow the team’s instructions about alcohol and exercise. The UCLH extraction aftercare guide provides general advice; your own clinician may adapt it to your procedure.
Pain relief while you arrange care
Paracetamol or ibuprofen may help if suitable for you. Follow the label and ask a pharmacist if you have other conditions, take medicines or are unsure what you can use. Do not exceed the stated dose or combine products without checking their ingredients.
Avoid taking aspirin as an extra painkiller after an extraction because it can increase bleeding. This does not mean stopping prescribed aspirin or another blood-thinning medicine: only change those on professional advice. Painkillers can help you cope while waiting, but persistent severe pain still needs assessment.
How is dry socket treated?
The dentist will examine the area and check for other causes of pain. Treatment may include gently washing debris from the socket and placing a soothing dressing. They will explain how to clean the area and whether a further visit is needed.
Antibiotics are not routine treatment for dry socket. They may be appropriate if the clinician finds a separate infection or another indication. This follows SDCEP guidance on dental antibiotics.
Healing time varies. Follow the review advice and contact the dentist again if symptoms worsen or fail to improve. Do not try to scrape out the socket or place household remedies inside it.
What does treatment cost?
Our listed dry socket treatment fee is £60 per visit. If further treatment or reviews are needed, ask about the expected total cost. See the current oral surgery fees for the price list.
If you are worried about pain after an extraction, contact the practice and explain when the tooth was removed and how the symptoms have changed.