Dry socket: symptoms, how to tell it from normal pain, and what helps

What’s probably going on

After a tooth is pulled, a blood clot fills the hole (the socket). The clot works like a scab. It protects the bone and nerves underneath while the gum heals.

A dry socket means that clot came out too soon or never formed properly. The bone underneath is exposed to air, food and saliva, which hurts and slows healing. Cleveland Clinic puts it at about 2% to 5% of extractions, and it’s more common after wisdom teeth removal.

When it starts

MedlinePlus says the pain of a dry socket usually starts one to three days after the extraction. Cleveland Clinic notes that if you have no symptoms by day five, you’re likely in the clear.

How to tell it from normal healing pain

Some pain after an extraction is normal. The difference is mostly in the direction it’s heading.

• Normal healing: soreness is worst in the first day or two, then eases a little each day. Pain relievers keep it manageable. The socket looks like a dark scab.
• Dry socket: the pain gets worse around day two or three, often after it had started to ease. It can be severe and, per MedlinePlus, spread to your ear, eye, temple or neck. Pain relievers often barely touch it.

Other signs that often come with a dry socket:

• The socket looks empty, or you can see a whitish layer at the bottom (that’s bone).
• A bad taste in your mouth or bad breath that won’t go away.
• A slight fever, in some people.

Who is more likely to get one

MedlinePlus and Cleveland Clinic list these risk factors:

• Smoking or other tobacco use. Cleveland Clinic says smoking raises the risk more than threefold.
• A difficult extraction, including wisdom teeth.
• A dry socket after a past extraction.
• Birth control pills, especially ones that contain estrogen.
• Poor brushing and mouth care, before or after the extraction.
• Drinking through a straw, or rinsing and spitting hard in the first days.

When it’s infection, not dry socket

A dry socket and an infected socket can feel alike, and both need your dentist. Cleveland Clinic’s wisdom teeth guide says to call for pus from the site, a fever over 102°F, or swelling that gets worse after three days; these can mean infection. Swelling that spreads toward your eye or neck, or trouble breathing or swallowing, is an emergency.

What to do tonight

1. Call the dentist or oral surgeon who pulled the tooth. Say you think you have a dry socket. Most offices want to see you soon, and many have an after-hours line for their surgery patients.
2. Take an over-the-counter pain reliever as the label directs. The American Dental Association’s guideline for pain after a tooth is removed puts anti-inflammatories such as ibuprofen or naproxen first for adults and teens 12 and up, alone or with acetaminophen. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
3. Hold a cold pack on the outside of your cheek. MedlinePlus lists this as home care for a dry socket.
4. Rinse only if and how your dentist told you to. MedlinePlus says to rinse carefully, as your dentist directs. Hard swishing and spitting can make things worse.
5. Skip smoking, tobacco and alcohol. MedlinePlus lists these to avoid; tobacco slows healing.

If you can’t reach your own dentist before morning and want advice, The TeleDentists offer video visits at any hour. They can talk you through it, but the socket still needs to be cleaned and dressed in person.

What not to do

• Don’t poke at the socket with a finger, tongue or toothpick to see if the clot is there.
• Don’t put aspirin or anything else in the socket unless your dentist gave it to you.
• Don’t take leftover antibiotics. Only a dentist or doctor should decide whether you need them.
• Don’t take more pain reliever than the label allows. If it isn’t enough, call your dentist.

How a dentist fixes it, and what it costs

Treatment is simple and usually brings relief quickly.

1. The dentist gently flushes the socket with salt water or an antibacterial rinse to clear out food and debris.
2. They pack it with a medicated dressing or paste that soothes the exposed bone.
3. You may go back every day or two for a fresh dressing until the pain settles.

They may also give you a special rinse or a prescription, and antibiotics if they suspect infection. With care, Cleveland Clinic says a dry socket usually heals in seven to 10 days.

Many offices treat a dry socket as part of your extraction follow-up. Others charge a visit fee. Ask when you call. For what the extraction itself costs, see tooth extraction cost. If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can lower the price at participating dentists.

How to keep it from coming back

If you have another tooth coming out, these steps lower the odds:

• Stay off tobacco before and after. Ask your dentist how long.
• Skip straws for at least a week. That’s Cleveland Clinic’s advice for avoiding dry socket; the suction can pull the clot loose.
• Don’t spit or swish hard in the first days. Let water fall out of your mouth instead.
• Stick to soft foods and skip warm or fizzy drinks while you heal, as Cleveland Clinic advises.
• Keep the rest of your mouth clean. Brush your other teeth, gently, starting when your surgeon says.
• Tell your dentist if you’ve had a dry socket before, or if you take birth control pills. They may plan the timing or the aftercare differently.
• Follow your surgeon’s written instructions. They know what was done in your mouth.

For a day-by-day guide to what’s normal after surgery, see wisdom teeth removal recovery.