After tooth extraction, a typical socket will develop a blood clot while the wound heals. In a dry socket, the blood clot will partially or fully detach from the wound, which can worsen the pain.

Dry socket, or alveolar osteitis, is a common complication of tooth extraction. It develops when the blood clot that protects the wound disintegrates or breaks loose, exposing the nerves and bone in the socket.

This article looks more at the differences between dry sockets and typical healing sockets. It also explores what causes dry socket, treatments, and recovery time. We also discuss whether it is possible to experience this condition without pain.

Dry socket is a common complication of tooth extraction. Following a tooth extraction, an empty socket will usually heal on its own, while any pain from the procedure will gradually improve.

In contrast, with a dry socket, the pain will improve and then suddenly worsen, which could be more painful than the extraction procedure.

The pain of a dry socket may throb and radiate across a large area of the jaw or up toward the ear.

The following table shows the differences between a dry socket versus a typical socket:

Dry socketNormal socket
Pain that improves but then worsens.Pain that continues to improve.
No visible blood clot or a blood clot that has partially disintegrated.A visible blood clot that stays in place until the wound heals.
Visible exposed bone or tissue, which may have increased since the time of surgery.No visible exposed bone or tissue.
Unpleasant taste in the mouth.No change in taste.
Unpleasant smells coming from the wound, which may lead to bad breath.No noticeable change in how the breath smells.

Most cases of dry socket develop within roughly 3–5 days after surgery. The risk of this condition decreases over time, so the longer the wound heals, the lower the likelihood.

For standard tooth extractions, complete recovery takes a couple of weeks. However, wisdom tooth extractions can take much longer to heal. Once the wound fully heals, there is no risk of dry socket.

After a tooth extraction, the body creates inflammation. This causes mild swelling around the affected area. Platelets in the blood clump together to form a clot, which protects the wound by sealing it.

If this clot disintegrates, becomes dislodged, or does not form, the empty tooth socket is unprotected. This increases the risk of intense pain due to the exposed nerves in the socket.

Certain risk factors increase the likelihood of developing a dry socket, including:

  • Pressure on the wound: Chewing or biting down on the empty socket can dislodge the blood clot. Similarly, using straws, sucking on foods, and blowing the nose can create negative pressure inside the mouth, increasing the risk of the blood clot detaching.
  • Location and type of extraction: Dry socket is more common in wisdom tooth removal. It is also more prevalent if the extraction is complicated or traumatic, as well as depending on the surgeon’s experience level.
  • Preexisting infection: People with bacterial infections in the mouth before undergoing tooth extraction have a higher risk for dry socket. Those with preexisting infections should speak with their dentist about antibiotics.
  • History of serious illness and cancer: A 2019 analysis of dental records found that dry socket was more common in people with a history of mouth sores, hospitalization from a serious illness, and cancer.
  • Smoking: A 2022 systematic review suggests a link between smoking and dry socket. This may be due to the tobacco itself or the sucking motion involved in smoking.
  • Birth control pills: Females taking birth control pills may have higher rates of dry socket. A 2022 systematic review and meta-analysis suggests that people using oral birth control were at a significantly higher risk of dry socket.

Treatment for a dry socket focuses on reducing pain. The American Dental Association advises returning to the dentist to manage symptoms.

A dentist will first flush the socket with a medicated mouthwash or saline. Then, they will fill the socket with a medicated dressing to help manage the pain. Depending on how long the pain lasts, people may need to change this dressing after a couple of days.

Adults can also take nonsteroidal anti-inflammatory drugs, such as ibuprofen.

In most cases, the pain of dry socket improves within a few days, but may last up to a week. Evidence notes that following suitable treatment, pain should resolve within a few days.

However, prompt treatment can reduce the pain faster. If the socket dressing is ineffective or the pain persists for longer than a few days, a dentist may reevaluate to check whether another condition is responsible for the pain.

For most people, the main symptom of dry socket is severe pain. However, pain tolerance and perceptions differ from person to person. Therefore, some people may experience less pain than others.

Dentists will typically diagnose dry socket based on the presence of pain and the breakdown of the clot after a tooth extraction.

The primary treatment for dry socket is pain management, so if the condition causes little or no pain, it does not require treatment. The socket will heal and get better on its own.

However, contracting a bacterial infection is a potential complication following a tooth extraction. People with symptoms that indicate an infection, such as pus from the socket, should seek treatment, even if the affected area is not painful.

People experiencing worsening or severe pain after a tooth extraction should speak with a dentist. If the cause is a dry socket, they can help relieve pain quickly.

It is also important to contact a dentist for:

  • pain that does not respond to pain medication
  • new or worsening swelling a few days after surgery
  • swelling, pus, and fever
  • pain elsewhere in the mouth
  • broken teeth near the surgery site

Some common questions about dry socket may include:

Can a person smoke with a dry socket?

Health care professional advise people with dry sockets to discontinue smoking as it can disrupt blood clot formation and interfere with the healing process.

Also, tobacco adversely affects oral health outcomes of almost all routine dental procedures.

How can a person smoke and avoid a dry socket?

Cigarette smoking is related to an increased risk of dry socket after tooth extraction.

Indeed, according to a 2022 study, the combined incidence of dry socket in smokers was about 13.2% and in non-smokers about 3.8%.

Therefore, a person should avoid smoking to decrease their likelihood of getting a dry socket.

Is it usual for the blood clot from tooth extraction to fall out?

A blood clot should form in the socket after a tooth extraction. The clot will protect the bone during healing. If the blood clot becomes loose or falls out of the socket, this may result in a dry socket.

Can a person get a dry socket after a week?

Most cases of dry socket occur within roughly 3–5 days after surgery, and the risk of dry socket decreases over time. However, the risk of a dry socket is still present until the socket fully heals, which may take 7–10 days.

Will a dry socket heal on its own?

A dry socket can heal on its own. However, without suitable treatment, the pain from a dry socket will last longer. Additionally, the risk of complications that may further delay healing, such as infections, is also higher without treatment.

Dry sockets become increasingly painful in the days after a tooth extraction. They may also have exposed bone or tissue, or an unpleasant smell. By comparison, typical healing sockets become less painful over time and do not cause any other symptoms.

A dry socket can be very painful but is not usually serious. A dentist can provide rapid pain relief via a medicated dressing, while people can also take medication to ease pain and inflammation.