Alveolar osteitis (dry socket)

Alveolar osteitis (dry socket) is a localised painful osteitis of an extraction socket following premature lysis of the blood clot. It complicates approximately 5% of tooth extractions. The condition presents as postoperative pain in and around an extraction socket that increases in severity between 1 and 4 days after the extraction. A disintegrated blood clot within the socket, with or without halitosis, is diagnostic. Although alveolar osteitis is caused by a failure of healing, it is commonly misdiagnosed as an infection. Antibiotic therapy has no place in the management of alveolar osteitis.

Although alveolar osteitis usually resolves spontaneously over 2 to 3 weeks, initiate interventions to reduce pain early because symptoms are severe. Initial management strategies include:

socket irrigation with warm sterile saline until there is no more debris present
nonopioid analgesics (see Choice of analgesic for acute dental pain)
an obtundent dressing.

Note: Use of antibiotics for alveolar osteitis (dry socket) is of no benefit.

If pain persists for more than 3 weeks or if there are signs outside the tooth socket, review the diagnosis. Differential diagnoses include osteomyelitis, medication-related osteonecrosis of the jaws, alveolar squamous cell carcinoma, and localised odontogenic infection with retained tooth fragments.