Updated: Nov 6
A dry socket will hurt because excruciating pain is a hallmark so it is unlikely for you to have it and not know it. Therefore it is not possible to have a dry socket without pain.
Does dry socket always hurt?
Once a dry socket has fully developed, the amount of pain that you will feel is almost indescribable. Our patients often tell us that it hurt less with the infected tooth still in their mouth. That should give you a sense for how bad this condition can hurt.
Fortunately, the pain from this condition isn't always constant because it can come and go. Typically, you will experience bouts of sharp pain whenever a stimuli touches the exposed bone within the socket. After all, this condition is characterized by a lack of a blood clot in the socket so the jaw bone is exposed and unprotected from external stimuli.
Stimuli that triggers pain:
Unfortunately, almost everything can elicit a pain response from this condition. Ultimately, it is unlikely for you to have this complication without any pain. You will know if you have it.
When symptoms begin
Dry sockets do not always develop immediately because it can sometimes take 24-96 hours before the first symptoms even appear. Therefore you shouldn't be feeling relieved that you don't have it until after a solid week has passed.
It is only after about a week of being asymptomatic that you can stop worrying about potentially developing this painful post-surgical complication. The one week cutoff is also approximately how long you can expect discomfort after an extraction.
A common misconception is that if you get stitches you won't end up with a dry socket. That is simply not true.
While researchers don't know the exact cause of this condition, what they do know is that it is a biological process. Any type of mechanical alteration to the surgical site such as placing sutures will have no overbearing effect on the outcome.
Mechanical disruptions that won't cause a dry socket:
Drinking with a straw
The above may dislodge the blood clot and make you continue to bleed but what they won't do is develop the condition.
How to tell if you've dry socket
Signs and symptoms of a dry socket:
Severe pain. The toothache feels unbearably painful that can throb and radiate.
Missing blood clot. Tooth socket is missing a clot and it looks empty.
Exposed bone. Due to lack of blood clot, you can visibly see the jaw bone.
Unpleasant taste. Lodged food that is many days old can cause a bad taste.
Bad breath. Food getting stuck in the hole can ferment and cause bad breath.
Delayed healing. The extraction socket will close very slowly.
Lack of blood. Socket is devoid of blood.
These factors will increase your risk of getting it.
Smoking. Studies have shown that smokers (12%) are 3 times more likely to get dry socket vs non-smokers (4%).
Traumatic extraction. Complicated extractions do increase the incidence.
Birth control. Studies have shown that the incidence of alveolar osteitis was significantly higher for those using and on birth control.
Middle of Menstrual cycle. In addition to taking birth control, women during the middle of a menstrual cycle were more likely to get it.
Had it before. If you've had alveolar osteitis before, you're more likely to get it again.
Dry socket vs Normal socket
There are distinct differences between what a normal extraction socket should be vs this pathological one. Below is a table summarizing the differences.
Yellow exposed bone
Red (blood clot), white (white stuff)
Bad breath, smell, taste
Bad breath, smell, taste, food can get stuck
Delayed socket closure
Socket closure over time
Overall, a descriptive difference between the two is that a dry socket is essentially missing a blood clot because it failed to develop. That leads to exposed bone which is incredibly sensitive when touched by stimuli. Something went awry during the healing process.
Below is a photo of what it looks like.
What else could it be?
Oftentimes patients will see things in their tooth socket and get scared because they think something is not going right with their healing process.
What you may see in the socket:
White stuff. If you're seeing a white substance inside of the socket but you're not feeling any pain, it could be granulation tissue or it could be stuck food. The former requires no treatment but the latter does require better oral hygiene.
Red stuff. The entire tooth hole looks red but fear not, that is simply your blood clot.
Black hole. The socket looks pitch black like a black hole. This is actually a good sign because it is an indication that you're on the right track to recovery, granted you're not feeling any pain.
Exception: The only thing you need to worry about is if you see white stuff coming out of the socket. This could be purulence (pus) rather than granulation tissue or food that was stuck. What we're trying to say is that you may have an infection.
If you're not having any pain at all, it is unlikely for you to have a dry socket. The only exception would be if it was still within the first week of your tooth removal. Sometimes this condition can be delayed and show up towards the end of the first week.
Therefore, you may not have it right now but you're not in the clear until after a solid week has gone by uneventfully. Nonetheless, you should still adhere to the extraction aftercare protocol to ensure that you reduce the chances of it happening. Although if it does happen, you should follow the self-care protocol for dry sockets.