Dry socket (alveolar osteitis)
Definition Dry socket (alveolar osteitis) is a painful post‑extraction complication in which the intra‑alveolar blood clot is lost or fails to form, leaving exposed alveolar bone and nerve endings. Symptoms most commonly begin 48-72 hours after extraction and are typically more severe than expected post‑operative pain.
Pathophysiology Several overlapping mechanisms are proposed:
- Mechanical dislodgement of the clot (for example by sucking, smoking, or trauma).
- Premature fibrinolysis or enzymatic breakdown of the clot.
- Bacterial enzymatic activity delaying healing.
The consequence is exposed bone with localised inflammation and intense nociception rather than a primary spreading infection.
Risk factors
- Older age.
- Difficult or traumatic extractions (impacted third molars, bone removal).
- Pre‑existing periapical or periodontal infection.
- Smoking (mechanical and biological effects on healing).
- Possible associations: oral contraceptives and alcohol (evidence inconsistent).
Clinical presentation and diagnosis
- Timing: typically 48-72 hours (range about 24-120 hours) after extraction.
- Pain: severe, throbbing, often radiating to the ear, temple or eye on the same side; pain is disproportionate to routine post‑operative discomfort and poorly controlled by simple analgesia.