Dry socket (alveolar osteitis) is an infection in your tooth socket after a tooth is extracted. It occurs when the blood clot at the site of a tooth extraction is disrupted prematurely. This leaves the alveolar bone unprotected and exposed to the oral environment. The socket can be packed with food and bacteria. The pain typically commences 3-4 days following the extraction. This is often extremely unpleasant for the patient, as symptoms include extreme pain (sometimes worse than the toothache that indicated the extraction), a foul taste, bad breath, and swelling in the infected area. Nerves are exposed, and sometimes the bone is visible in the empty socket. It is often accompanied by what feels like an earache. There may be lymph-node involvement.

Dry socket occurs in approximately 5 percent of all tooth extractions. Women are at higher risk than men for developing dry socket. Of the women that have developed it, the majority take an oral contraceptive. Smokers have been shown to have a greatly increased risk of developing alveolar osteitis after tooth extraction. This is thought to be due to the decreased amount of oxygen available in the healing tissues as a result of carbon monoxide in tobacco smoke. It is advisable to avoid smoking following tooth extraction for at least 48 hours to reduce the risk of developing this dry socket.

Treatment for alveolar osteitis is mainly preventative. Maintaining good oral hygiene is a must before and during the healing period. If possible, have your teeth professionally cleaned several days before dental surgery. Take all of your regular medications for systemic illnesses (diabetics and cardiovascular diseases). Women are recommended to have extractions during the last five days of their menstrual cycle. This is to minimize chances of developing dry socket because the estrogen levels are lower during that part of the cycle (day 23-28).
Several things can cause the premature loss of a blood clot from an extraction site, including smoking, forceful spitting, sucking through a straw, coughing or sneezing. You should also avoid consuming carbonated or alcoholic beverages after an extraction, as these have also been associated with the development of dry socket. Also, you should:
?keep your fingers and tongue away from the extraction site.
?apply an ice pack to your jaw for the first 24 hours following surgery ? on for 15-20 minutes, and off for 30-40 minutes ? to prevent pain and swelling and stop excessive bleeding.
?not rinse your mouth the day of surgery. The next day, you can rinse gently with warm salt water; dissolve one teaspoon of salt in a cup of warm water. Be sure to rinse and spit gently.
Call your dentist right away if you notice any symptoms of dry socket. Treatment for dry socket typically includes a gentle rinsing of the socket to remove debris. This is followed by packing the socket with Alvogyl. Its fibrous consistency allows for easy filling of the socket and good adherence during the entire healing process. The active ingredients of Alvogyl include:

?eugenol for analgesic action;
?butamben for anesthetic action; and
?iodoform for anti-microbial action.

Sometimes analgesics are also prescribed. You usually need to return to the dentist's office two to three times over a two-week time period for re-dressing and monitoring the healing. Fortunately, a dry socket is often self-healed over a longer time. In very rare situation where the dry socket can't heal itself, another operation may be needed. The procedure aims to make the socket bleed again and so that a new blood clot can be formed inside the post-extraction socket.