Dry socket: symptoms, treatment and how long it lasts

After a tooth is removed, a blood clot forms in the socket. The NHS says this clot helps the wound to heal. In dry socket the clot does not form properly or is dislodged before the gum has healed.

Bedfordshire Hospitals calls it a common painful inflammatory condition. NHS wisdom tooth removal information lists it as one of the possible complications of having a wisdom tooth out, alongside infection and nerve damage.

Kent Community Health NHS Foundation Trust describes dry socket as inflammation in the bone.

George Eliot Hospital says pain should gradually improve each day after an extraction. A sudden increase in pain after a few days, or pain that becomes unmanageable, may mean you have a dry socket. It lists severe, throbbing pain, often with a bad taste or bad breath.

Hull University Teaching Hospitals says dry socket is a very painful condition. It also says that the best pain relief is provided by taking paracetamol with ibuprofen, if you are able to, and to contact your dentist or surgeon if things are not getting better.

• Pain that increases a few days after the extraction instead of settling.

• Severe, throbbing pain.

• A bad taste in the mouth.

• Bad breath.

The leaflets do not give one agreed figure for when it starts, so the honest answer is that it varies. Bedfordshire Hospitals says symptoms usually start in the first 24 to 48 hours; others describe a later start, as the table shows.

None of the sources used here gives a fixed duration for how long dry socket lasts once treated. Normal healing after an extraction is described by George Eliot Hospital as progressing within 7 to 14 days. Contact your dentist if pain is not improving, because treatment is available.

You need to be seen by a dentist or surgical team. George Eliot Hospital says that if you have these symptoms you need to be seen in the clinic.

Bedfordshire Hospitals says that if you have been diagnosed with dry socket you will require regular suitable painkillers, gentle mouthwashes and insertion of a soothing agent into the socket. Hull University Teaching Hospitals says it requires washing out, and sometimes a dressing being placed.

Both leaflets say antibiotics are not usually necessary. Bedfordshire adds that if signs of infection are noted you may need a course of antibiotics to treat the infection.

For pain between visits, Hull says paracetamol 500 to 1000 mg together with ibuprofen 400 to 600 mg every 6 hours provides the best pain relief, for people who can take them. Check the packet and with a pharmacist or your dentist if you are unsure.

George Eliot Hospital says dry socket is often the result of the blood clot being dislodged. Hull describes it as food debris collecting in the socket where a blood clot has not formed properly.

Bedfordshire Hospitals says the risk is higher in patients who smoke or vape, and in those who have had prolonged or complex extractions. It also says some people take medicines that delay healing of extraction sockets, and that your surgeon will do a risk assessment.

The NHS wisdom tooth page says not to smoke after wisdom tooth removal because smoking can increase the risk of infection.

The leaflets give consistent aftercare advice that protects the clot:

• Do not smoke or vape for at least 72 hours (Bedfordshire Hospitals).

• Do not disturb the clot in the socket with your tongue or fingers, or by spitting (George Eliot Hospital).

• Avoid scratching or traumatising the socket, as it may disturb healing tissue or cause bleeding (Bedfordshire Hospitals).

• Rinse gently with warm salt water, after the first 24 hours according to Kent Community Health.

• Eat soft or liquid food until you can chew comfortably, and do not eat hard or crunchy food or food that could get stuck in the wound (NHS).

• Do not drink alcohol or very hot drinks (NHS).

The two can feel similar, and trust leaflets distinguish them by the extra features that suggest infection. Bedfordshire Hospitals lists redness of the gums, increased pain, swelling, discharge, fever and feeling generally unwell as common features of infection. The NHS dental abscess page lists a swollen face or jaw, swollen glands in the neck and a high temperature.

Hull describes dry socket as a kind of local problem due to food debris; it also advises contacting your dentist or surgeon if swelling is "hard and hot" or not improving.

The NHS says to ask for an urgent dentist appointment or get help from NHS 111 if you have bleeding that does not stop, pain and swelling that is severe or getting worse and painkillers are not helping, or pain with a bad taste in your mouth, a high temperature or feeling unwell.

The NHS dental abscess page says to call 999 or go to A&E if you are finding it hard to breathe, speak or swallow, have a swollen or painful eye, have a lot of swelling in your mouth, or find it hard to open your mouth. It says not to drive yourself, and not to go to a GP surgery for dental treatment.

Hull says to contact your dentist or surgeon if you have any change in sensation or numbness the day after surgery.

Start with the dentist or hospital team that took the tooth out; they know the extraction and can see you. If you do not have a dentist, NHS 111 can tell you where to get help for urgent dental symptoms.

NHS dental treatment is charged in bands unless you are entitled to free care, and private dentists set their own fees. Either way the treatment for dry socket is the same.