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Dry Socket With Bone Graft, Is That Even Possible?

You can still get dry socket even WITH a bone graft, which means that it does NOT prevent it from happening. Unfortunately the cause of it is still not understood by researchers but what we do know is that it is initiated by a biological process.


extracted tooth socket

Well, we know that your bone graft was expensive but it still won't prevent it. We'll explain what the symptoms are so you know if you have this condition and what you can do to treat it.


Table of Contents:


Can you get dry socket with a bone graft?

It is possible to get dry socket after a bone graft because there have been research studies which have documented it occurring.


The first study tested various grafting materials (platelet-rich plasma, platelet-rich fibrin, and hydroxyapatite) and their effects on socket healing after lower wisdom teeth extractions.

  • Two control cases end up with a dry socket.

  • 2 PRP (platelet-rich plasma) cases and 1 PRF (platelet-rich fibrin) developed it.


The second study was based on a 3-year analysis of implants placed into bone grafted extraction sites.

  • A total of 313 extractions were done and grafted with mineralized bone.

  • One patient complained of severe increasing pain 5 days post-extraction and ultimately developed a dry socket after the bone graft.


In conclusion, getting a bone graft after the extraction does NOT prevent dry socket. The studies provided above should be enough evidence to convince you of so.


Etiology

Unfortunately, no one knows the exact cause of a dry socket except that a blood clot fails to form thus leaving the jaw bone exposed. However, mechanical disruption of the clot such as by drinking with a straw or spitting doesn't seem to cause it. Although it does induce persistent bleeding after the extraction.


What researchers are certain of is that it is due to a biological process rather than a mechanical one. Although not all hope has been lost because certain risk factors have been identified which do increase the chances of it.


Risk factors:

  • Smoking - Studies have shown that smokers (12%) are 3 times more likely to get dry socket vs non-smokers (4%).

  • Traumatic extraction of mandibular wisdom teeth

  • Birth control - Studies have shown that the incidence of alveolar osteitis was significantly higher for those using birth control.

  • Middle of Menstrual cycle.

  • Previous occurrence


Abstaining or minimizing the above risk factors will decrease the chances of you getting this painful condition. Also taking antibiotics prophylactically before your extraction will also reduce your risk.


Chances of dry socket with bone graft

There has not been any studies on the chances of getting dry socket with a bone graft. Studies have merely demonstrated that it is still possible to get it but that is about it.


Although in one of the studies, they did quote a different research study which said that grafting can be an effective "preventive factor". However they also stated that the results were not statistically significant.


Therefore we cannot say for certain that the grafting will reduce the chances of it happening. Nonetheless, we do have data for how common a dry socket without bone graft is:


Prevalence statistics:

  • A study from Melbourne, Australia found a 2.3% incidence rate.

  • A different study found the incidence to be about 2.6%.

  • A study of the South Chennai population found an incidence rate of 5.37%.


Overall it appears that women were at higher risk than men. The mandibular teeth were also 3x more likely to get it than maxillary teeth.


Would getting stitches reduce the risk?

No, you can still get a dry socket even with stitches and evidence of that is for all bone grafting procedure you WILL get stitches. Typically the grafting material is placed at the bottom of the socket and then covered over with a membrane. Finally, stitches are placed on top of all of that to hold all of it together.


bone graft with stitches
Credit: optimal dental

The image above demonstrates what we're talking about.


How to tell if you have it

A severe toothache that occurs within the first week after your extraction is a hallmark trait of a dry socket. The pain is often worse than before you had the surgery.


Symptoms:

  • Severe pain. Terrible toothache that can throb and radiate.

  • Missing blood clot. No blood clot inside of the socket.

  • Exposed bone. Due to lack of blood clot, you can visibly see the jaw bone.

  • Bad breath or unpleasant taste. Food getting stuck in the hole can ferment and cause bad breath or taste.

  • Delayed healing. You're healing slower than normal.


dry socket
dry socket

Typically it is the excruciating pain that is tell-tale sign of this condition.


Treatment

There is no cure for this condition and most of the treatments are palliative. However, as an example one of the studies above used this treatment method.

  • Socket irrigation with peroxide.

  • Iodoform gauze with dry socket paste placed in socket for 3 days.


The patient recovered with no complications after the above treatment.


Other potential treatment options:

  • Induce bleeding. Sometimes by forcing the socket to bleed, it can restart the healing process. Your dentist can drill small holes into the jaw bone to try to restart it.

  • Curettage and irrigation. Alternatively, your dentist may curettage (scrape) the inside of the socket to clean it and hopefully it may induce healing. Finally they'll flush out the site with an antibiotic solution or saline.


Aside from the above, taking pain medication will always help alleviate the pain. NSAIDs are particularly helpful in that they also reduce inflammation.


Takeaway

Even with a bone graft, you can still get dry socket. It does not prevent it and no one knows if it reduces the chances of it occurring either. Nevertheless, the grafting procedure was never meant for this condition. Usually if you were getting it, it's to preserve the bone so that you can get an implant in the socket later on.


Therefore, if you happen to start feeling excruciating pain within a week after your surgery, it may be it. You should make a follow up consultation with your dentist to be sure.

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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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