Summertime is traditionally the season when many high school and college students schedule wisdom tooth removal. Time off for summer vacation allows flexibility in scheduling and July thru August are often peak times for this treatment before school resumes. COVID-19 may effect school opening this fall, but so far, our schedule seems pretty similar to previous years.
Just to remind you, not every wisdom tooth needs to be removed. Some impacted teeth may never cause problems, but many do. These problems can range from infection to bone loss as well as the formation of cysts and, in some cases, tumors. That is why any patient that has impacted wisdom teeth should be evaluated by an oral & maxillofacial surgeon.
One of the possible outcomes of wisdom tooth removal is the development of a “Dry Socket”. The medical term for this is Alveolar Osteitis. Alveolar pertains to the bone of the jaw where the teeth reside. Osteitis is simply inflammation or irritation of that bone. Dry socket is a possible complication of surgery and is estimated to occur anywhere from 5-30% of cases (depending on which scientific research papers you read).
In our clinical experience, the incidence is definitely less than 5 %. The higher incidences noted above usually relate to studies of multiple dentists/clinics or even dental students with varying levels of technical ability. The studies do show that dry socket is more common with wisdom tooth removal, but it can be seen with removal of other (almost exclusively) lower back teeth.
Dry socket is a pain management problem that can start anywhere from 3-5 days after tooth extraction. Most wisdom tooth surgery patients can control pain with prescription-strength Motrin/Ibuprofen supplemented with Extra Strength Tylenol. It is rare to have to prescribe opioids. If patients are having persistent or increasing pain 2-3 days after extraction, it could be a dry socket.
The rare patient that develops dry socket will usually experience a persistent ache in the jaw that typically radiates up to the ear, temple, or behind the eye on the same side. Alternatively, it can radiate to the front of the lower jaw. If Ibuprofen controls the pain, that is the best way to manage it along with rinsing the socket with warm water to clean out irritating food.
If Ibuprofen and rinsing does not work and the pain is interfering with sleep, an office visit is usually scheduled for socket packing. A dry socket pack is a short (1-2 inch) wick of gauze impregnated with clove oil and other medication. Clove oil contains the aromatic chemical Eugenol that has pain soothing properties.
Dry socket pain can be relieved quickly by gently placing a dry socket pack into the tooth extraction socket. Relief is usually complete within 20 minutes. The packing works for one to two days. If a dry socket is severe and persistent, a patient may require more than one packing.