Dry socket (postextraction alveolitis, alveolar osteitis, fibrinolytic alveolitis) refers to a painful syndrome that follows a dental extraction. There is some evidence that oral bacteria may play a role in its development.


Onset: 1-3 days after extraction of a molar, especially a third molar


Duration: 1-6 weeks


Features of delayed healing of the socket:

(1) empty socket with exposed bone without epitheliazation

(2) inflammation without suppuration

(3) tenderness to palpation

(4) a foul odor or necrotic granulation tissue may or may not be present


If a person with delayed healing of the socket has severe radiating pain (often to the ear), then the diagnosis is alveolar osteitis.


Differential diagnosis - infected socket with or without osteomyelitis:

(1) fever

(2) swelling and purulent discharge

(3) eventual diagnostic changes in X-rays


Recommendations of Swanson (1990) to prevent:

(1) preoperative mouthrinsing with 0.2% chlorhexidine gluconate

(2) lavage of the socket site after extraction with 175 mL of sterile normal saline

(3) dress the socket with gelatin sponge with tetracycline


To read more or access our algorithms and calculators, please log in or register.