Dry Socket (Alveolar Osteitis): Symptoms, Risk Factors, and Treatment

Clinical Presentation

• Severe, throbbing pain 1–3 days post-extraction, radiating to ear/temple
• Empty socket with exposed bone (white/yellow)
• Foul odor/taste (halitosis)
• Absent blood clot
• Regional lymphadenopathy, low-grade fever possible

Risk Factors

• Smoking (vasoconstriction, clot disruption)
• Oral contraceptives (estrogen ↑ fibrinolysis)
• Poor oral hygiene, traumatic extraction
• History of dry socket
• Mandibular molars (especially thirds)

Management

• Socket irrigation + medicated dressing (eugenol/zinc oxide gauze) q24–48h.
• Analgesics: NSAIDs ± opioids.
• Antibiotics only if secondary infection (spreading cellulitis, fever).
• Chlorhexidine rinses.

Resolution typically in 7–10 days. Prompt dental follow-up is essential.