Dry socket—an update

Dry socket is one of the most common complications reported by patients following the removal of teeth. Patients will often report severe pain and discomfort (Birn, 1973; Vedtofte et al, 1974). It typically occurs within 2–4 days postoperatively (Turner, 1982; Al-Khateeb et al, 1991; Colby, 1997; Blum, 2002; Noroozi and Philbert, 2009; Cardoso et al, 2010). Most definitions describe a partial or total break down of the blood clot, resulting in a localised inflammatory response and intense pain. This pain is often reported to be worse than the original toothache, and frequently radiates to the auricular and temporal regions.

The literature reports a variety of names for the condition: localised osteitis, post-operative alveolitis, alveolalgia, necrotic socket, localised osteomyelitis and fibrinolytic alveolitis. The reported incidence of dry socket is around 3–5% for all extractions (Oginni et al, 2003; Nusair and Younis, 2007; Parthasarathi et al, 2011;). However, it is more common with lower third molars, with the incidence reported as high as 47%. Studies with more evidence report this to be more around 25–30% (Lilly et al, 1974; Fridrich and Olson, 1990).