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Does Dry Socket Always Hurt Or Can It Be Painless?

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.


Extraction tooth socket
Extraction tooth socket

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:

  • Water

  • Air

  • Food

  • Beverages

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.


Common myths

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:

  • Spitting

  • Rinsing

  • Drinking with a straw

  • Swallowing


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.


Risk factors

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.


Traits

Dry Socket

Normal Socket

Appearance

Yellow exposed bone

Red (blood clot), white (white stuff)

Sensation

Increasing pain

Decreasing pain

Odor

Bad breath, smell, taste

Bad breath, smell, taste, food can get stuck

Healing Speed

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.


dry socket


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.


Normal progression of a healing tooth socket
Normal progression of a healing tooth socket

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.


Verdict

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.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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