Dry Socket & Smoking
Thursday December 3, 1998

Dear Dr. Mady: The other day I had a tooth extracted. Although the appointment was very quick and simple I ended up with one whole week of agonizing pain that was worse than the toothache. My dentist said that it was from smoking. How is this possible? - Diane in Russell Woods

Dear Diane - It sounds like you experienced a case of classic "dry socket" (alveolar osteitis). This situation occurs when the bone has been exposed at the extraction site after the tooth is removed. Under normal circumstances, a blood clot forms in the hole where the tooth was (socket) and healing occurs without difficulty.

If this clot is partially or completely lost the exposed bone causes moderate to severe pain that can last a long time and throb worse than any toothache.

Post-op instructions are usually given by your dentist after an extraction, and they must be followed closely to escape the possibility of dry socket. These include 24 hours of no sucking through a straw, no drinking out of a bottle and no smoking for 48-72 hours.

Basically, any action that can cause a negative pressure in your mouth after your surgery can cause the clot to be dislodged from the socket, and you now know what can result. The most common cause of dry socket is smoking, and it can also increase the length of time for healing.

Treatment by your dentist may include application of medicated dressings in the socket every day or other day for up to a week, after gentle flushing with a saline solution. These dressings usually give immediate relief because of the main ingredient, eugenol (similar to oil of cloves).

Your dentist may also prescribe pain medication and a mouth rinse containing chlorhexidine to use twice a day, temporarily. After the pain has subsided the dressing will not be placed anymore so that the soft tissue around the socket can heal over. In many cases pain medication does not help and the only relief accessible is from the medicated dressing. Each situation may be different, but if you are having constant discomfort when you thought it would all be gone, then you most likely have dry socket.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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