The most common complication following the removal of lower wisdom teeth is “dry socket”. But just what it is, is sometimes confusing to patients. Technically, dry socket is a “localized alveolar osteitis”. It is a severe inflammation of the socket where the tooth was removed. It occurs in up to 10% of patients and is usually initiated by the premature loss of the blood clot from the socket. People who are smokers, are older than 25 years and have particularly difficult extractions are more likely to have a dry socket. Symptoms usually appear after 2-3 days and are characterized as a dull constant throbbing pain, often radiating along the jaw and up to the ear. It does not respond to normal pain medication like typical post-extraction pain does, and can increase in intensity with time. Untreated it may last days to weeks, but will eventually dissipate on its own. Dry socket is not an infection and does not respond to antibiotics.
Fortunately, a dry socket is easy to treat. The offending socket is irrigated with a warm water solution and a medicated dressing is gently inserted into the socket. Some patients may be uncomfortable enough to require local anesthetic for the initial treatment. The dressing is a small strip of gauze impregnated with medication like oil of clove and eugenol which gives pain relief and decreases the inflammation. Patients typically have no pain after 30-45 minutes. The irrigation and dressing placement is repeated every 2-4 days until the inflammation is gone, typically about a week