After a tooth extraction, a blood clot forms that promotes healing and development of new bone tissue. It's very important that you follow the homecare instructions that we provide after your extraction. Otherwise, a painful condition may develop, which is called dry socket or alveolar osteitis (al-VEE-uh-lur oss-tee-EYE-tis). Dry socket puts a monkey wrench into the natural healing process.

Homecare instructions after an extraction

To promote healing and prevent dry socket, be sure to follow these homecare instructions.

• On the day you have the tooth extracted, do not rinse your mouth. The next day, rinse gently with a salt water solution (1 tsp. of salt stirred into a cup of warm water). After the first day, gently brush and floss your other teeth, and spit gently.
• Relax and avoid strenuous activities for the first 24 hours.
• Apply an ice pack to your jaw for the first 24 hours (on for 15-20 minutes, then off for 30-40 minutes).
• Keep your head elevated with pillows to control bleeding. Change the gauze pads that we will give you as often as needed. Or, bite on a moist tea bag for 20 minutes.
• Wait to eat or drink until the numbness completely wears off.

For the first 3 to 4 days, do not eat foods with a lot of textures or particles, such as popcorn, peanuts, pasta, or chicken noodle soup. Instead, eat soft foods such as yogurt, soft cooked eggs, mashed potatoes, clear soup, ice cream and pudding. Drink lots of water or diluted fruit juice every day.

Also, you may want to try using honey rather than processed sugar in your foods and beverages. Researchers are investigating the healing properties of honey's antibacterial agents.

During the course of healing, you may experience some discomfort. Be sure to take all of your antibiotics or pain relievers as prescribed. Also, try to avoid coughing, sneezing, or blowing your nose forcefully. (Use sinus or allergy medications if needed.)

To avoid disturbing the blood clot, here are things you should not do:

• Do not explore the tooth-extraction area with your tongue or fingers.
• Do not smoke or use tobacco products.
• Do not spit forcefully.
• Do not suck through a straw.
• Do not drink carbonated or alcoholic beverages.

Symptoms of dry socket

If the blood clot does not form (or if it is dislodged or lost), the open area becomes infected and inflamed. (This image shows an example of an extraction site next to a tooth, with the reddened area representing dry socket.) Sometimes the bone is visible in the empty socket, and the exposed nerves are extremely sensitive.

It may take 3 to 5 days before you have any symptoms of dry socket, such as:

• Severe pain that doesn't subside
• The feeling that you might have an earache
• An unpleasant taste in your mouth
• Bad breath

Dry socket may result in 5 percent of all tooth extractions. Studies have shown that women are more likely than men to develop dry socket, but this is due to oral contraceptives and changes in estrogen levels through the menstrual cycle.

Whether female or male, smokers are significantly more likely to develop dry socket, because smoking reduces the body's ability to bring a fresh blood supply to the blood clot. Sucking on a cigarette or cigar increases the chance of dislodging the blood clot. Tobacco products also bring toxic ingredients to the area, interfering with the healing process.

Solutions for dry socket

In general, the severe pain from dry socket will not go away with over-the-counter medications. If you suspect that you may have dry socket, please call our office immediately.

We will gently rinse the area and then pack it with a topical anesthetic and sterile gauze dressing. We will also recommend that you return to our office several times over the next week or two, so that we can change the dressing and check the healing process.