Dry socket – Reason and treatment

After removal of tooth, blood clot formation is an essential element for the healing to take place. When the blood clot is dislodged from the socket, healing becomes extremely slow or nil and the condition is called as dry socket.

Reasons for dry socket :

  • Dislodgement of blood clot from the socket
  • Difficulty in tooth removal due to its anatomical hinderance
  • Person underwent radiotherapy recently
  • Use of oral contraceptives

signs and symptoms of dry socket :

  • It usually occur couple of days after tooth removal, sometimes may appear after five to ten days as well.
  • The tooth removed region becomes very painful with necrotic bone, foul smelling and without pus formation.
  • The pain may get radiate to neck and ear region
  • Some patients may encounter mild fever and lymph node enlargement

Treatment and instructions :

  • Do warm saline gargle and immediately report to the dental surgeon
  • Complete debridement with ample of irrigation and ZOE + iodoform dressing will be given
  • The dressing should be changed every day
  • Usually the pain will be subsided in a day or two after debridement and dressing process.



Textbook of oral pathology by shafers


Instructions to be followed after tooth removal

There are certain instructions that should be followed after removal of tooth for better healing process. All these precautions are taken inorder to provide a healthy environment for the blood clot formation and enhance the healing of the tooth removed socket.

On the day of extraction ,

  • Bite the cotton firmly for about one hour
  • Avoid hot and spicy food for three days
  • Do not spit the saliva instead keep swallowing for a day.
  • Do not rinse the mouth heavily for a day
  • Do not use straw kind of stuffs for drinking liquid, just do sipping.
  • Avoid forceful sneeze and cough for three days
  • Keep ice pack on the cheek over the tooth removed region ( particularly during the extraction of wisdom tooth and on the other tooth region when the extraction of the tooth was in difficulty level )
  • Hydrate well
  • Take the medications properly as prescribed by your surgeon.
  • Avoid smoking and alcohol consumption for a week.
  • Do not bite and check the cheeks or lips for three hours after extraction because of numbness feel.
  • If any abnormal bleeding encountered or if mild bleed does not stop for 6 hours after extraction, immediately report to the hospital.

From the next day of extraction,

  • Rinse the mouth well for 4-5 times with warm saline water ( 2 ml of salt mixed with 250 ml of lukewarm water)
  • Brush and floss every day to remove plaque formation
  • Avoid brushing on the tooth removed region for three days or do gentle brushing
  • Gently start with mouth opening exercise after 48 hours of extraction
  • Do not stop antibiotics (if prescribed) in a day or two just because the symptoms are subsided , complete the full course as recommended by your surgeon.
  • If sutures are placed, report to the hospital and get it removed after a week of extraction
  • Maintain proper oral hygiene for asymptomatic healing
  • If any abnormal pain encountered after three days of extraction, it could be due to dry socket Dry socket – Reason and treatmentand report to the hospital.
  • If not able to open the mouth adequately or encountering pain while opening after 4-5 days of extraction , it could be due to trismus, indicating inadequate mouth opening exercises. Keep hot pack on the cheek on such condition for 4-5 times on regular interval and report to the hospital.


Relationship between the heart and the tooth

Dentist : Hi Mr.(name), good morning, what’s your problem!! How can i help you ???

Patient : I wanted you to pull my tooth out. It’s shaking and it is painful sometimes, giving so much of trouble, i cannot eat properly………….and its go on

Dentist : Ok ok relax…. yes, your gums are weak and no adequate bone support as well, we will treat it appropriately, not to worry about it. But before proceeding, i just wanted to know about your medical history…Do you have any medical complaints??so that i can plan accordingly!!!!

Patient : uhh…… …………. (blank)

( * mind voice – i have heart disease, diabetes, hypertension…..even i have done surgery in my heart….should i tell !!!!!

Just to remove this shaking tooth, this guy will send me back for an opinion….all unnecessary stuffs…i know i am fit enough to handle this, then why to tell him!!! Nothing going to happen…quick treatment will be done if i hide…….)

Dentist : Excuse me sir?????

Patient : Huh… No nooo…. i dont have any other medical complaints…. You can start the treatment directly

Dentist : Are you sure????

Patient : Ya ya, i am very much sure about it. I am completely fit 

Dentist : uhh……………..(blank)

(* Mind voice – oops……now how to find out yaar!!!!)


Haha have you ever put your dentist to this situation!!!!! Ho please don’t… In this blog i will share a few things about the link between the heart disease and tooth related treatments.

There are three main reasons why your dentist is so much particular about knowing your heart condition if you have heart disease,

  • To get access on platelet and clotting factor mechanism
  • To have control over arrhythmia ( irregular or abnormal heart beat )
  • Role of micro organisms and infective endocarditis

To get access on platelet and clotting factor mechanism:

Blood thinner medicine are thumb rule tablets given to every cardiovascular complaint person. This helps to prevent from further clot formation on the blood vessels. But when the person wants tooth removal, intake of the same medicine will cause uncontrollable bleeding. It is to be noted that tooth and its supporting structures are highly rich in blood supply and it is difficult to control bleed when the blood clotting mechanism doesn’t respond properly.

At the same time it is highly NOT recommended to stop the drug just like that. Only the cardiovascular specialist knows the exact condition of every pumping organ. It is always advisable to have their opinion before taking the dental procedure. When the risk factor for the heart is more or on the moderate to severe illness condition, an alternative drug protocol will be recommended where an alternative antiplatelet drug takes up the role or the treatment regimen will be altered by the dentist. If the heart condition is under control, he may advise to go on with the procedure by stopping the drug for 5days or so…

* Person with the history of stroke or high blood pressure also will be prescribed with blood thinners. It is always better not to hide any medical history to the physicians.

To have control over arrhythmia:

As i said before, tooth structure is highly vascularised. In order to prevent excessive loss of blood during dental procedures, local anesthesia(LA) also contains a few percentage of “adrenaline ” in it. This helps for the constriction of the peripheral blood vessels thereby preventing from the excessive blood loss. Though adrenaline in the LA possess only very minimal percentage ( about 1:100000 dilution), for the person with uncontrolled blood pressure, this value is enough to shoot up the condition.

As like on blood vessels, the adrenaline has its own action on the pumping organ as well. Adr generally increases the heart rate and muscular contraction. So now when the person is having moderate to severe heart illness, this may worsen up. On such conditions LA without adrenaline is preferred if it is suggested by the cardiologists.


The role of micro organisms and the infective endocarditis:

It is well known that oral cavity is the main source of lodging micro organisms. Out of which, staphylococcus aureus and viridans streptococcus are the most predominant micro organisms which affect the inner wall of the heart called infective endocarditis. These bacteria quickly enters into the blood stream(bacteremia) to reach the heart valve. When the person is having heart valve defect or rheumatoid heart disease,  atmost care must be taken when going for the dental procedures. Antibiotic prophylaxis is a must for them. Without adequate precautionary steps, any procedures may end up into life threatening one.


Not any medical history should be taken for granted. It is to be understood that human body is a complex structure and everything is inter connected…