Why Following Post-Extraction Instructions Is Essential for Preventing Dry Socket
Many people view tooth extraction as a fairly simple procedure that requires nothing more than a few minutes in the dental chair. Nevertheless, the healing process takes time, and you should be prepared to carefully follow the instructions of your dentist in order to avoid complications such as the development of dry socket.
What actually happens in the socket after extraction
Right after the extraction, the body sets in motion the process of wound healing. Blood fills the area where the tooth used to be, and the clotting begins. It becomes clear that tooth extraction is serious surgery involving bone, deep tissue and the proper healing sequence. The clot serves as a natural bandage protecting bone and nerve endings that are left in the socket and forming the basis for future new tissue.
Within the first several days, the granulation tissue forms in the clot. It is very sensitive, with many blood vessels and little protection. Indeed, the bone underneath the socket remains without any protection until the tissue is fully formed. It is during this period that complications can occur.
The biology of dry socket
Alveolar osteitis, otherwise known as dry socket, is the condition that develops when the blood clot is displaced or dissolved too early before the granulation tissue gets a chance to form. The outcome is the exposure of the bone and nerve endings that remain unprotected and in direct contact with air, saliva, food and fluids.
The pain won’t start immediately. This is what makes dry socket so confusing for many patients. Normal post-extraction pain reaches its peak within the first 24-48 hours and then disappears as days pass. The pain caused by dry socket does the opposite – it starts appearing between the 3rd and 5th day of healing and comes as a strong, throbbing pain spreading up to the ear or down to the jaw. People tend to describe it as even more painful than the pain they had from the tooth problem that led to the extraction.
Dry socket is more common in the mandible because the bone in this area is denser and has fewer vessels than in maxilla. Also, the problem tends to develop in the wisdom teeth. Although dry socket can affect somewhere between 1% and 5% of all extractions, the rate rises up to nearly 30% when it comes to impacted mandibular third molars, i.e., wisdom teeth.
The specific behaviors that destroy the clot
There is a common belief that the blood clot is dislodged from the socket by accident. This is the main reason why a straw is contraindicated. Inserting a straw into your mouth creates negative pressure. This pressure acts directly on the hole and dislodges the blood clot. The same negative pressure is created while sucking on a cigarette, spitting forcefully, rinsing vigorously. Additionally, nicotine is a vasoconstrictor, meaning that it narrows the blood vessels, thus restricting the blood flow to the clot in the first place.
It is not a hypothetical force that acts against the soft tissue. The blood clot in your extraction site is a soft clot of blood and platelets. In the first 24 hours of existence, the clot uses fibrin to stick to the walls of the hole. This is why there is 72-hour rule – it is the time that the clot needs to attach to the walls tightly enough to resist the suction from a straw.
Diet and oral hygiene during recovery
A soft diet is necessary for the same reason. Hard, crunchy and sticky food can make contact with the socket or apply the pressure in it disrupting granulation tissue. It is better to stick to food requiring minimal chewing – yogurt, soup, soft vegetables, scrambled eggs – during the first week.
Despite this, you will still need to maintain oral hygiene, but you shouldn’t disturb the extraction site. Do not brush this area during the first 48 hours after extraction. After that, your dentist may advise you to rinse your mouth with salt water or another solution. Do not swish the liquid around in your mouth vigorously.
NSAIDs, such as ibuprofen, are the best choice to treat the inflammation that causes pain. They are usually prescribed as the primary way to control the pain. You should call your dentist if the pain starts growing stronger after the third day.
What happens if dry socket develops
Treatment for dry socket is performed in the following way: your dentist cleans the socket to remove any debris. Then he or she puts medicated dressing into the socket, which usually includes substance called eugenol, derivative of clove oil. This medication numbs the area and can feel soothing. Dressing is replaced once or twice a day, and the socket is examined each time.
Pain relief due to medicated dressing is usually quick and strong, but it reminds you that the source of pain was the exposed bone. Healing takes time. Dry socket will eventually heal on its own.
Compliance as pain prevention
All the instructions you receive after the extraction are not the precautions taken by the dentists. They are not just advice to help you feel comfortable while healing. Each "do not do" is there because of the danger for the blood clot and the healing process. It is not a question of neglecting the rules and letting your mouth heal on its own. It is a wound that you should care for properly.