Dry socket hell - someone please offer advice :(
 

Hi everyone, I hope you are all well. I come to the forum for the first time in a time of need. On 11/06 I had all 4 wisdom teeth taken out by an oral surgeon. He said the extractions were complex because they were all impacted and that the surgery took much longer than expected. I am a 22 year old female in good health typically. After the surgery I followed all instructions (I do not smoke) but on the 3rd day after extraction I had a follow up appt with the surgeon. He told me I had dry socket which was a surprise to me because I was NOT experiencing unbearable pain. Anyways, he packed both of the lower sockets with the clove dressings and I was on my way. On 11/26 the surgeon took out the packing and thought I should be ok without it.. a couple hours later the throbbing pain returned so I went back to get them repacked. It is now 12/02 and I thought I was doing very well, although the surgeon has still been packing the sockets a couple times a week. My last packing was last night during which he said that it would be my last packing and I would come back on Thursday to get the packing out.... well... he then asked me if I had any pain at all.. I told him I had mild pain when clenching or biting down hard on the top on my left side.. He then proceeded to get very worked up and told me I "may have a dry socket on the top" and then despite my saying I did not want him to put anything in the top socket or touch it at all.. he packed the top socket.. well now of course the top socket has been in pain since being packed.. I feel this packing was completely useless but now since I am in pain I'm terrified he has created a dry socket where there wasn't one. It seems hard to believe I would have a dry socket on the top after almost 4 weeks...

I really don't know what to do, I don't want this packing in my top socket but I'm scared that it will begin to hurt now if the packing gets taken out. Can anyone offer me any advice? I feel like this has all been going on so long. Up until he packed and irrigated that top socket I was in no pain in the top or the bottom. I'm at a loss and I'm starting to really not trust his opinion. Oh.. I forgot to mention he also cut my lip during surgery and it needed 6 stitches..

:( I'm so upset I've been having a mental breakdown for the last 24 hours since he packed the top one.

Hi JG,

There is no benefit to packing a surgical extraction site unless a dry socket is without question determined to be present. It sounds like this OS is rather eager to pack the sites which makes me wonder why he was so quick to do that?? If you feel that this dentist is not caring for you properly, please don't assume this is normal and go on suffering, consult with a different oral surgeon this week. FYI... you would need to have your pre op xrays for that "new" appointment.

Please let us know how you're doing.
Bryanna

Hi Bryanna,

Thank you for your reply. I have another appointment with the same oral surgeon tomorrow morning first thing. I will see what he does during this appointment then decide whether to seek out another opinion. I really just want to heal. It doesn't seem like there is any infection present so I don't see why I can't just get the dressings out and be ok. Its been nearly a month :(

Is there anyway he CREATED a dry socket on the top site by packing it and irrigating it?!?! I'm so worried.

Again, thank you!

JG

Hi JG,

If the extraction sites were healing on their own, then disturbing them could result in ......... less than ideal healing as the initial blood clot and healing cells were disrupted .......... or a bone infection and inflammation called Osteomyelitis .... or prolong the healing time.

A dry socket is called Alveolar Osteitis which basically means inflammation of the jaw bone. Surgical dressings for this condition are intended to soothe the inflammation and promote healing. Depending on what type of dressing was used, the non dis-solvable type are not intended to be left in the socket for longer than 2, 3 days max without being removed and changed if needed. Depending on the severity of the condition, some patients need to have the dis-solvable packing replaced or undissolved packing removed and a new one placed once a day for several days. Due to the fact that extraction sites are holes in the jaw bone, food debris can collect inside the hole. This is not a problem if the food debris is minimum and rinsing with warm salt water is able to keep the sites relatively debris free. The dry socket packing is like an insulator to prevent food debris from embedding inside of the socket. However, to leave a non dis-solvable packing in the socket for longer than 2-3 days is like leaving a dirty band-Ade over a deep wound which would prolong the healing of the site.

If you get the sense that this dentist is making light of your situation and perhaps not treating you properly, then please consult with another oral surgeon.

Bryanna

Hi Bryanna,

Oh man. Well this morning I went back and he took the non-dissolvable packing out of the top extraction site. It doesn't hurt and hasn't since he took the packing out. He did re-pack the bottom sites and I'm supposed to have this packing out on Tuesday. I'm not in much pain anymore. I'm terrified now though that I will have complications with the top site. If I'm not feeling any pain what is the chance I would have any of these complications :( ? How will I know if any of these things happen to the top site?

Thank you!!!
JG

JG,

No pain on the top with the packing out is a good sign. If that site stays quiet... great ... if it should start to hurt, then it's not a good sign.

So he packed the lowers again today and wants to leave that packing in for another week?? I would question if it's "ideal" to leave that packing in for that length of time. Is he doing that for convenience of less appointments on his part and yours? How did the sites feel when he removed the packing? What is he instructing you to rinse with?

Bryanna

Hi there,

Still no pain in the top and it's been all day - so I'm pretty happy about that. He has left the packing in this long before during this whole process, said it's perfectly okay to do so.. I'm not entirely sure why, I don't think it matters to him how many appointments I have. I've been kinda confused during the process why I needed to leave the dressings in for so long and have so many dressings. When he changes it and takes the packing out it feels fine and doesn't hurt, but I imagine I would have to wait a while before pain set in after taking it out? We took the packing out last week and within a few hours the pain returned so I called his office and he put it back in for me that afternoon.

He hasn't really told me to rinse lately.. he told me at the very beginning of this all to use warm salt water so I've still been doing that about 3 times a day. My mouth feels ok for the most part and it seems like everything looks ok when I look inside it. So far no signs of infection (I've had an infection in the wisdom tooth area before). I guess I should just continue doing this until I get the packing out? He gave me a syringe to use to flush the sockets out with once the packing comes out for good.

Thank you for your advice,

Janice

Hi Janice,

I am stumped as to why the dentist leaves the packing in for so long. To my knowledge that is not commonly done so I am thinking he has a specific motive for doing that.

The dry socket packing is used to soothe or reduce the pain associated with a dry socket and it works super well for that. However, other than soothing the pain, the ingredients have basically no healing abilities. If it is used unnecessarily or for too long a period of time, the healing of the sockets will be delayed. So based on your symptoms and the post operative time frame, I am puzzled as to why he keeps packing the sockets and why he leaves it in for so long a period of time. This could be something "he" does routinely, but I have no idea why he would do that.

Has he told you that you have an extreme case of alveolar osteitis? Do you have unusual extenuating circumstances that he is concerned about?

I would keep rinsing with the warm salt water since it seems to be helpful in spite of the packing in the sockets.

Bryanna

Hi!

Yes, I'm really not sure why he leaves it in for so long. I don't know if I should just ask him to take it out or be patient since I'm not really in any severe pain or anything and wait for Tuesday to roll around. He has not said that my case is extreme or extenuating. There is another girl who seems to be my age who had her teeth extracted on the same day who also has dry socket and who has been getting hers packed just as long as I have. I feel it is not common for them to be packed still after 4 weeks? Every time I go in to get the packing changed all he says is that it looks good. He never really gives me any details or says his opinion. It's hard to think about getting a second opinion as he is very well known around my small city and I don't want to cause any conflict or anything.

I have been experiencing sensitivity to cold in my upper extraction sites, is this normal? I don't want to ask him because I'm scared he will just pack the top ones again like a mad man lol.

Thank you so much for your helpful replies, I sure do appreciate it.

Janice

Oh, and another thing... I don't see how in any case my situation could be extreme. I have not been in extreme pain at ALL through this whole ordeal. I would not say the level of pain has been high. Mainly it's just been uncomfortable. I don't know if that helps.

Jan

Hi Jan,

Not only has it been my professional experience but if you were to google "dry socket packing by dentist" you would find that the repetitive nature of the information pertains to extreme pain that began on the 3rd to 4th day post op the extractions and the recommendation is to pack, remove, repack every 24-48 hours as needed. Nothing indicates leaving the packing in for longer than that. In fact, the packing usually falls out by the second day if it is not purposely removed. A dry socket causes A LOT of pain not just discomfort.... even in someone who has a high pain tolerance. So I am thinking that for whatever reason this OS packs routinely almost as a precautionary measure. The problem with that is the packing is for soothing pain only as it can delay the healing because it disrupts the natural healing process. So it's used to get people out of pain during the peak times of pain and really for no other reason. Does that make sense to you?

I would ask him what he is using exactly and if it has something in it that promotes healing. Perhaps he has his own formula of something that he uses that is not the same as dry socket paste. The fact that he gets annoyed with you when you inquire about something is not a reason for you not to ask questions. He is obligated to inform you of everything he does and uses. You are not questioning his judgement, you are inquiring about his post op protocol and nothing more.

It's not really fair to you to assume that your situation is the same as the other persons situation. She may (or may not) genuinely have dry socket. Everyone is a bit different.

It is common to experience cold sensitivity in the areas near the extraction sites. This is due to some recession of the gum tissue on the adjacent teeth as the inflammation subsides and the tissue is healing. Sometimes a bit of root becomes exposed on the second molar and most often the sensitivity goes away. It also occurs because the extraction site is open to the jaw bone which makes it vulnerable to temperature changes, cold in particular. As the bone fills in and the tissue closes over the sensitivity generally subsides.

Bryanna

Hello,

Yes, I fully understand that. That has been a big reason why I've been questioning the frequency and duration of the packing process. The packing in mine have not fallen out at all, I think he packs it quite deep inside the socket and it stays in even when I eat. I really have no idea what to do, I will wait until Tuesday and have all the packing removed then hope for the best and let my body heal naturally - I hope. The top extraction site has been feeling strange as today has gone on and it hurts. I do not want to consult the oral surgeon about this as I really do not want him to put any packing in it and call it a "maybe dry socket" and I have a feeling that is exactly what he would do. I wonder if I should go to my regular dentist and have them take a look at it? I'm scared he disrupted the natural healing that was taking place up there when he packed it and now I'm worried about an infection.

I will ask him next time I go in what he was using to pack the sockets, although once it's all out it wont really matter, will it? I have one other question... he has told me to use the syringe to flush out the sockets once the packing has been removed for good. I understand this is common practise.. but he also wants me to use the syringe to push the gum apart - pry it really... for 6 weeks so it can heal from the bottom up and not close over from the top... is this normal? Is it really normal to PUSH my gums apart and not let them close to prevent an abscess?!

Thanks a lot for your correspondence with me! :)

Jan

Hi all and apologies for disrupting your correspondence, but I cannot help but think of this possibility, however unlikely it may seem, and that is the financial interests of the surgeon. So, does he charge you for doing the packings (ie. for anything after the surgery itself), or is it all free ever since he did the surgery?
Once again sorry for even thinking about that, but I've heard of similar situations before where doctors would try make their patients visit them unnecessarily or for longer than actually required.

Hi Siobhan,

No worries, I take no offence haha. I don't think his motivation is financial, my insurance is covering it... but if my insurance wasn't covering it I believe I would have to pay each time actually... so not entirely sure... good question.. I like to believe he wouldn't do that though! I hope...

Jan

Jan,

Generally, the ideal at home oral care for tooth extractions is to avoid over chewing and eating food that will get lodged in the socket which means eating a soft food diet, rinse with warm salt water a few times a day and leave the site alone until the gum tissue heals closed. Unless there is a specific reason to keep repacking a socket or to suggest to aggressively use the syringe to irrigate underneath the flap of the healing tissue.... those things are not necessary and best to avoid doing.

I really think he should be explaining to you his reasons for this aggressive post operative care.

FYI... your general dentist will most likely be clueless as to the reasons why the OS is doing this as I said, it is not the norm. Also your general dentist will probably not want to get involved in this current situation because he has no idea what actually transpired during the oral surgery.

Regarding the upper extraction site... are you feeling sharp, throbbing or dull pain..... intermittent or constant .... more when you lay down, stand up, after eating or just at random times .... is it in the socket itself or in the sinus area above the socket or near the ear???

Bryanna

Jan,

Based on my experience, dentists do not charge to remove and repack the extraction site. However, I would ask the receptionist if he is charging your insurance company each time because if it were me.... that would raise a red flag.

Bryanna

Hi Bryanna,

I will check with my insurance company and with the receptionist to make sure he isn't charging me each visit. He said the socket needs to be repacked until I am at "zero pain. not even a point one." that's what he keeps repeating and that's why I still have the sockets packed. Most of today my top site has been fine, I've come to notice it IS actually the sinus above that is causing the pressure/quite mild pain. Not sure what this means.

He said the reason for aggressively keeping the socket open after the packing comes out is to "let it heal from the bottom up and not close over from the top. Apparently if it closes over from the top I could get an abscess. So there fore, he would like me to push my gums apart for 6 weeks until it heals from the bottom. Seems like such a long time :( He said he gives the same instructions to every patient. I'm feeling confused about his care, but I feel I'm so close to being done, that I just want it over with.

Thank you again,

Jan

Hi Jan,

I have never known of any dentist packing an extraction sight repetitively for several weeks post op unless there was a specific reason to do so. In fact, some oral surgeons do not even pack a dry socket unless it is very severe because the packing can interrupt the healing. I wonder what he is packing it with and what his reasoning is for doing that for such a long period of time? Tooth sockets always heal from the bottom up even if the gum tissue closes. In fact, the gum tissue closes over (the hole gives the appearance that it is slowly growing smaller) fairly quickly in people who have no post op complications. So I'm puzzled as to the reasoning he gives you. Do you recall having a taste or smell of cloves after he packs the site?

Just to give you a simple description ..... The extraction site is similar to a deep cut on a limb that has reached the bone. Everything is done to clean the wound and then help the wound close because the closed skin protects the inside of the wound from bacteria, etc. The visible cut in the skin is superficial compared to the depth of the actual wound. The only time a deep wound is repetitively packed or left open is when it needs to drain. Otherwise it's best to close it up.

He must have specific reasons for following this protocol with you. Maybe he's using something that has healing properties because regular packing paste does not. That's why I am puzzled as to why he's telling you the sites are fine, but then continues to pack them. I don't mean to keep harping on this. I just want you to heal okay and I'm curious what he's using as it may be something that promotes healing.

Bryanna




QUOTE=JG1993;1187012]Hi Bryanna,

I will check with my insurance company and with the receptionist to make sure he isn't charging me each visit. He said the socket needs to be repacked until I am at "zero pain. not even a point one." that's what he keeps repeating and that's why I still have the sockets packed. Most of today my top site has been fine, I've come to notice it IS actually the sinus above that is causing the pressure/quite mild pain. Not sure what this means.

He said the reason for aggressively keeping the socket open after the packing comes out is to "let it heal from the bottom up and not close over from the top. Apparently if it closes over from the top I could get an abscess. So there fore, he would like me to push my gums apart for 6 weeks until it heals from the bottom. Seems like such a long time :( He said he gives the same instructions to every patient. I'm feeling confused about his care, but I feel I'm so close to being done, that I just want it over with.

Thank you again,

Jan[/QUOTE]

He says the repetitive packing is because I am not at absolutely zero pain yet. He said I need to have no pain what so ever for 48hrs with the packing in before he will take it out. He classifies even a .1 as pain. I'm really not sure why. I don't believe the dry socket was EVER severe, he has some strange very strong philosophy about preventing even the smallest amount of pain. He packs it with a gauze that is covered in oil of cloves and I think one other thing mixed in. I'm not sure completely. I know without a doubt it is clove oil though. He always says they are "looking good and the tissue looks healthy". As for the sinus pressure/discomfort, what should I make of this?

I agree that the site should be allowed to close and it puzzles me that I have to push it open 3 times a day! All my other friends say they didn't have to do that after their extractions. I just want this stuff out of my mouth so I can heal normally. I keep thinking that its no doubt I still have very mild pain in my mouth because I have open wounds that are being forced to stay open with the packing in!

What should I do :(?

Jan

Oh, also I'm terrified now to get the packing out when I have even slight pain because he said the pain will return if I do that. I'm so confused.

Jan,

The only thing I can think of is maybe he is using a hemostatic agent called ActCel and perhaps he's adding tetracycline to it. Why he would add the clove oil too.... at this stage, I'm not sure.

Actcel is basically used to control bleeding. But it has been shown to reduce the incidence of dry socket in sites where there is no infection present. Because it degrades to a biocompatible state (glucose and water) it does not cause disruption in the healing process. Basically it is a water soluble sterilized cellulose (plant fiber) that expands 3-4 times its size when it comes in contact with blood. It rapidly turns into a gel like substance so it plugs up the socket pretty well. It completely dissolves in about 1-2 weeks but it can be dissolved sooner with saline or hydrogen peroxide.

He may use this routinely for 3rd molar extractions because he may be getting good results with it. Perhaps you could ask him if this is what he is using? However, the irrigation of the sockets by pushing the gum tissue open is something I would be cautious about doing... especially if the sites are healing okay.

The sinus pressure .... did he mention anything about a sinus opening or perforation when he removed your teeth? Pressure and discomfort in the sinus area generally indicates inflammation. Have you or are you getting any drainage from your nose into your mouth? Do you feel pressure or anything unusual like throbbing in your sinus when you drink water or when you put your head down towards your feet?

Bryanna

None of those products sound like something he would be using, I'm really not sure. I know for sure it's cloves though, haha.

In your personal opinion should I still have the packing in if I have a bit of pain still? I'm due to get it out tomorrow but I'm scared because I have had some random pains over the last couple days...but on the other hand I really don't know that it's a good idea to keep putting packing in the socket. I guess you can't fully tell me unless you know what specifically he is using to pack it. The sinus pressure and pain seems to have gone away completely over the last day. He did not mention or perforation or anything like that. No pressure or water leakage either. I guess if the pressure/pain is gone that's good news?
Thank you so much, your replies really ease my mind.

I'm so nervous for tomorrow :(

Jan

Jan,

I don't know why he's still packing the site or what he is using so I cannot say you if he should continue to do it or not.

Intermittent pain for several weeks post op tooth extractions is normal and does not mean that there is a problem. Severe, throbbing, sharp pain and/or swelling are indicative of a problem.

You could tell him that friends keep asking you why he keeps packing the sockets if everything is healing okay. If he tells you it is to control pain.... I would ask.... what are you using that controls the pain and why would I have pain this many weeks after the extractions if everything is healing okay?

Is it possible that you gave him the inclination that you could not tolerate any pain and that's why he keeps packing it?

If the sinus has calmed down then that is a good sign. Hopefully it will stay that way and the site will heal well.

Bryanna

Hi Bryanna,

So, I got the dressings out about an hour ago and so far so good. I've been having some discomfort from the top site this morning, but I'm thinking I will wait to see if it calms down again. I really think it's just from being packed.

My sister said that she used oil of cloves directly in her dry socket when she had the same issue. She said she just used one drop and it provided immense relief and that the socket closed in a couple days this way. Is this a bad idea? I have some oil of cloves I can use if it's a good idea :)

The OS did tell me once again to use the syringe to push my gums open and not let them close from the top.. however, I don't think this is a good idea based on what you and most people have told me.. So I will just gently irrigate the socket and let it close. Hopefully all heals well and I don't have to make another trip to see this OS. Oh and PS, I'm in Candada.. don't know if that makes a difference on the advice my OS has given me.

Thanks for your continued advice, it's so much appreciated

Jan

Hi Jan,

Thanks for the update.

Clove oil is used as a soothing agent, not a healing agent. Therefore, it is meant to be used in the early stages of a dry socket to help soothe the pain. Otherwise, it really is best to just leave the surgical socket alone and let your naturally produced healing cells take care of it. If you keep disturbing it, the healing cells will be diminished and it will take longer to heal.

Your sister most likely only needed to use clove oil once, maybe twice a day for a couple of days. You have had the surgical sites packed with clove oil and who knows what else for a month! If you can, it is best to just leave them alone and let them heal on their own.

The typical post operative protocol following wisdom tooth removal is universally similar. It can vary slightly, as it did with your os, from one dental practice to another based on a personal/professional preference.

Hopefully you will not have too much discomfort from here on out and all will heal well!

Bryanna

Hi!

Thank you for the information. I seem to be doing good without any pain killers or clove oil. Am I likely to develop an abscess if I let the gums just heal over on their own and do not engage in the act of pushing apart my gums to let the hole remain open? Provided I am rinsing with salt water and maintaining good oral hygiene and that nothing gets caught in the socket while it's healing. I am really nervous about keeping my gums open like that, I just want them to be able to close :(


Jan

Hi Jan,

If the sockets are healing well, as your dentist has told you, then there is no need to have to irrigate the sockets with a syringe. Thorough oral hygiene and rinsing with warm salt water 3-4 times a day until the gum tissue closes completely is all that is necessary.

Bryanna

I've read through all of this with interest - my bottom right molar was extracted last Monday and I developed dry socket really quickly and went back to have it packed on the Wednesday. (The dentist didn't advise me not to use a drinking straw after extraction, so I did. Duh). I've had a completely different experience, lots of pain and discomfort, but he just sent me away and told me the packing would eventually come out and only to go back if it came out really quickly. The site looks whitish now with some brown residue that I suspect is what's left of the packing. I've been really miserable as the pain has come and gone and I've been treating it with toothache kit. But the hole does look slightly smaller as if it's healing over. I am so glad I didn't have to go back to the dentist as I found the whole thing very unpleasant and think I'd need sedation of some kind! My main problem has been pain and discomfort, there is no swelling or any other symptom and now I've got some referred pain across my other teeth. I'm on day six nearly day 7 of dry socket so hoping it will all settle down very soon.

Hi shell,

What is in the "toothache kit"?

When a person has pain, intense pain, beyond the 3rd or 4th day of a tooth extraction and it is due to a dry socket.... then having the site packed every day or two brings great relief. This would require that the previous packing be removed in order for the new packing to be placed.

Basic post operative instructions following a tooth extraction to be carried out for about the first 2+ weeks:

Avoid drinking through a straw.
Avoid smoking and drinking alcohol.
Avoid mouthwash.
Avoid chewy foods as it requires too much effort of the jaw and jaw muscles. Eat a soft food diet instead and do not eat on the affected side until the swelling is gone and the site is comfortable and the gum tissue is closing over.
Brush and floss all of your teeth to reduce the accumulation of plaque.
Rinse with warm salt water 3-4 times a day.

Referred pain can be due to a number of things:
Dry socket can cause a radiating pain.
Clenching or grinding your teeth... often occurs when someones mouth hurts.
Could be overuse of your jaw and jaw muscles when chewing. If you think that could be, then stick to a soft food diet.
If the gums on the adjacent teeth are sore and achey, then it could be due to an accumulation of plaque. If that's the case, they brush and floss better.

If the site is healing and there are no other contributing factors (some of which I have mentioned), then it could take a few weeks before it calms down completely. However, if the pain you have today does not get continuously less each day, then do not hesitate to go back to the surgeon for him to take a look.

Hope this info helps and you start to feel better soon.
Bryanna

Thank you for your answer Bryanna. Since I posted, I had increased pain and felt very miserable and forced myself to have a good look at the site (I get pretty freaked out by it). I also noticed heightened sensitivity of the surrounding gum which appeared white and thought it might have got infected. So I steeled myself and went back to the dentist, I was shaking I was so nervous but he cleaned out the hole and repacked it. He said the hole was smaller and he has prescribed Metronidazole (Flagyl) for three days. The pain has eased quite a bit now but I feel miserable - I have anxiety issues and am also going through the menopause so suffering with some depression, all in all I have not been dealing very well with the dry socket situation psychologically. I don't know if everyone gets depressed when they go through this. I have high hopes that the situation will now resolve, but the dentist said if it hasn't settled by next week he will refer me to the hospital. I had never heard of dry socket until last week but now feel like an expert I have read so much! Thanks again.

Thanks again Bryanna - forgot to tell you the toothache kit was clove oil, camphor and lidocaine with plastic tweezers and cotton wool.

Hi Bryanna,

It's been a week since I had the packing out for the dry sockets. I have been rinsing well with salt water because the gum tissue still has not closed. I have been mainly pain free except some random pains here and there that seem to subside completely within a few minutes by themselves, is this normal? I find my mouth still feels tired after a long day of talking or if I laugh a lot. I am wondering when it is ok to drink alcohol? I never drink, but of course it's Christmas and we are having a staff party - haha. Would it be ok to have some drinks at this stage in the healing? I really don't want to mess anything up and be in pain again.

Thank you so much for all your advice,

Janice

Hi Jan,

Yes, your description sounds like normal healing at this point.

Regarding alcohol... if the sites are still open, then it is best to refrain from alcohol consumption.

Have a nice holiday!

Bryanna