After a tooth is removed, a blood clot forms in the socket. It is not simply leftover blood — it is a protective cover under which bone and nerve endings heal. If the clot dissolves or is dislodged too early, bone is left exposed. This is called dry socket and it is the most common complication after an extraction.
How to recognise it
Normal healing means pain is worst for the first two days and then decreases daily. Dry socket shows the opposite pattern:
- Pain intensifies on days 3–5, having already been improving.
- The pain is throbbing and radiates to the ear, temple or neck.
- Painkillers have little effect.
- There is a bad taste and unpleasant smell.
- Looking into the socket you see pale bone rather than a dark red clot.
What causes it
- Smoking. The single greatest risk factor. Suction pulls the clot out and tobacco compounds impair blood supply. The risk rises several times over.
- Drinking through a straw. The same suction mechanism.
- Rinsing on the first day. Vigorous rinsing washes the clot away.
- Difficult extraction. Wisdom teeth and lower molars carry higher risk.
- Hormonal contraceptives. Raise the risk moderately.
How to avoid it
- Keep the gauze on the wound for 30–60 minutes; do not keep changing it.
- For the first 24 hours: do not rinse, do not spit, do not use a straw.
- Do not smoke for at least 72 hours — ideally a week.
- Cool, soft food on the first day, nothing hot.
- Avoid exertion and sauna for 2–3 days.
- From the second day, rinse gently with salt water, without force.
What to do if it happens
Dry socket does not resolve quickly on its own and there is no point enduring it at home. Treatment is simple and relief usually immediate: the socket is gently cleaned and a medicated dressing placed to cover the exposed bone. It sometimes needs changing a couple of times. Antibiotics are usually unnecessary, because this is exposed bone rather than an infection.
How long it takes to pass
A treated dry socket heals in 7–10 days. Untreated, the pain can last two weeks or longer.
If pain after an extraction starts increasing on the third day, get in touch — do not wait. Unidenta, Fr. R. Kreutzwaldi 24, Tallinn, tel +372 5361 3111.