29/06/2026
Dry Socket
๐น Also called alveolar osteitis / alveolitis sicca dolorosa
๐น Loss/disintegration of extraction socket clot โ exposed bone
Pathogenesis
๐น Due to fibrinolysis of clot
๐น Plasmin dissolves fibrin clot
๐น Severe pain + foul odor, but usually no pus
Risk factors
๐น Traumatic/difficult extraction
๐น Especially impacted mandibular 3rd molar
๐น Women, smokers
๐น Oral contraceptives (estrogen โ fibrinolysis)
๐น Also seen with Paget disease or post-radiotherapy
Clinical features
๐น Starts day 2โ3 after extraction
๐น Lasts about 7โ10 days
๐น Severe throbbing pain radiating to ear/neck
๐น Bad odor / bad taste
๐น Empty dry socket with exposed necrotic bone
๐น May have low-grade fever and ipsilateral nodes
Management
๐น Palliative only
๐น Gentle irrigation
๐น Obtundent dressing: ZOE or iodoform gauze
๐น Change dressing until pain subsides
Prevention
๐น Atraumatic extraction technique is most important
๐น Routine socket antibiotics not routinely recommended
High-yield pearl
๐น Post-extraction day 2โ3 severe pain + empty socket + foul odor + no pus = dry socket