Dry Socket

[Katie B]

On Monday 6th February I had a top back molar removed and a temporary bridge fitted next to it. My dentist had a problem removing it, loads of tugging it took a while to come out and broke off in bits, but he said he had got it all out. Tuesday I was just a bit sore but by Wednesday evening I had unbearable throbbing pain. I went back to the dentist on Thursday and he said that I had dry socket, so I was numbed again and he scraped and packed the socket with a medicated gauze. Then by Thursday night I had the throbbing pain again went back to him again on Friday. He said he could replace the gauze with another one but I would have to be numbed again, which I didn't want as I was in so much discomfort. I told him I thought it was affecting my sinus too. I was told to keep taking the painkillers (paracetamol & ibuprofen) plus he gave me antibiotics (Metronidazole) to take for 5 days. My socket is still badly swollen and very sore.
What I am concerned about now is the packing in the socket. I have read that it's supposed to be removed after three to five days. But my next dental appointment isn't until 27th February and that is for the permanant bridge. I have not been asked to come back to have it replaced or removed. He didn't rinse the socket he scraped it.
I also read ........... (The insertion step is performed quickly. No anesthetic is used.) The packing is usually renewed (removed, the socket gently rinsed, and the packing then replaced) every 24 to 48 hours, typically for 3 to 6 days.
So why was I numbed initially and yesterday when he offered to change it I would have to be numbed again?

 

[MattKW]

1. It's not always necessary to numb when dressing a dry socket, but often it's kinder for the patient. I can then give the socket a good cleansing and packing with an obtundent.
2. A second dressing is rare but sometimes necessary. Sounds like you need a redressing.
3. The antibiotics do nothing for a dry socket.
4. Many dentists use Alveogyl as a dressing. Yeah, it's OK and convenient, but I prefer my own mixture of zinc oxide eugenol on a cotton pledget. Alveogyl should be removed after 3-5 days so that it is not entrapped in the socket and becomes a foreign body. Usually easily washed out.
5. It's a bit odd to make a permanent bridge so soon. I would leave the temp bridge for at least 10 weeks to allow full healing, shrinkage of the bone, and settling down of any soreness.

 

[Katie B]

MattKW. Thank you so much for your reply. I have had the packing in since Thursday and it is Sunday now. The gum is very swollen, very sore and throbbing. The thought of having a needle up into my swollen gum and palette! Terrifies me

 

[MattKW]

Well, you may not need the palatal injection (the stingy one). I would only need you numb enough to make it comfortable, so just the simpler injection on the outside of the tooth may be enough.
It may be fiddly to change the dressing in your case because of the temporary bridge.

 

[Katie B]

Hello again. Thank you for your reply. Do you think it would be a good idea to swish salt water around the socket? My dentist told me on Thursday that maybe I should refrain from this, as this was MAYBE what caused the dry socket in the beginning. As I used salt water the day after extraction ( maybe to vigorously) Also what would be the longest time to leave this packing in? As I said earlier I have not been given an appointment to have it removed.

 

[MattKW]

• The idea that vigorous swishing after an extraction is a factor in the formation of a dry socket is balderdash. Even at the Uni where I teach, it is printed on the "Home Care After Extractions" sheet, but it's too much of a bureaucratic hurdle to get it changed!
• The main risk factors for DS are: smoking (before & after), lower extractions, difficult extractions, and the contraceptive Pill.
• So, you had a difficult extraction and the normal process of creating a clot was overwhelmed by the process of breaking down the clot (plasminogen pathways).
• There is no sure-fire way to prevent DS, and while salt water (a mild antiseptic) is all very well, the only proven mitigating factor is chlorhexidine mouthwashes for 4 days.
• Yes, I would like to make sure the Alveogyl was removed, so give the dentist a call.

 

[Katie B]

Thank you ...... To be honest I didn't think I swished too vigorously. I think it was the difficult extraction.
I really appreciate you replying to my messages. Thank you again.

 

[Katie B]

Well I phoned the receptionist yesterday and asked about removal of the packing. She asked the dentist and he said no, I said so it will dissolve, yes.
It is 8 days now I had the tooth removed. I am on my last day of Metronidazole (3 a day for 5 days)
But I am still very sore, the socket looks red and still swollen. I really don't want to bother my dentist again
I don't think there is much more he can do anyway.

 

[MattKW]

OK, then I don't know what he used.
As mentioned before, antibiotics won't do anything.
Good news - nobody ever died of a dry socket (they just wish they did), and the DS will eventually heal up by itself. If you are managing the pain without reaching the limit of your painkillers, and if you feel it is slightly improving each day, then you can let it run its course.

 

[Katie B]

Good news - nobody ever died of a dry socket (they just wish they did) <<<< That's for sure!!!

I wish I hadn't taken the antibiotics to be honest as they had a lot of side effects too

Thank you MattKW