Needing to get a tooth extracted due to extensive decay is bad enough, but sometimes the complications of the procedure can be worse than the actual extraction process. After your decayed tooth is extracted, you may develop dry socket, also called alveolar osteitis. Here are four things you need to know about dry socket and tooth extractions.

1. What is dry socket?

Normally, after a tooth is extracted, a blood clot forms within the socket; this blood clot protects the bone and nerves while the socket heals. The clot also helps new bone and gum tissue grow over the extraction site. In some cases, this blood clot either falls out or dissolves before the socket is fully healed, exposing the nerves and bone underneath. This results in dry socket.

If you develop dry socket, you'll feel intense pain around the site where your tooth was extracted, and this pain can even radiate into your ear or temple. You may be able to see your exposed alveolar bone when you look inside your mouth, and the nearby gum tissue may be swollen. Some people also develop a fever or bad breath.

2. Why does dry socket develop?

Dry socket is one of the most common complications of tooth extractions, but its exact cause still isn't well understood. Researchers have studied dry socket extensively, and while they've identified numerous risk factors, the precise cause remains elusive.

Most researchers agree that trauma during surgery plays a big role in dry socket's development. For example, if your decayed tooth breaks apart as your dentist is extracting it, they may need to surgically remove the tooth in pieces. Since surgical extraction is more traumatic than a simple extraction, you may be at risk of developing dry socket afterwards.

Many studies have also determined that smoking is linked to dry socket. The more you smoke, the more likely you are to develop this complication, so you'll need to stop smoking for as long as possible after your extraction. Researchers don't know if it is the chemicals in the cigarettes that are responsible for this effect, or if it is merely the heat and suction introduced to your extraction site when you smoke.

3. How can you prevent dry socket?

You can help prevent dry socket by following the postoperative instructions that your dentist gives you. It's important that you don't rinse your mouth for 24 hours after your tooth is extracted, because rinsing your mouth could dislodge the new clot. You also need to keep your tongue away from the extraction site; the new gap inside your mouth can be distracting, but playing with it with your tongue can also dislodge the clot.

It's also important to avoid activities like drinking through straws or spitting forcefully (after rinsing or otherwise), as both of these activities can dislodge your clot. While it may seem strange that your blood clot is this delicate, remember that the inside of your mouth is very moist, and wounds cannot become crusty scabs like they can on other parts of your body.

4. Can dentists treat dry socket?

Despite your best efforts to prevent it, you may develop dry socket: about  3% to 4% of tooth extractions result in this complication. Since the pain is severe, over-the-counter painkillers may not give you the relief you need. If you're having trouble controlling your pain, your dentist can prescribe a pain medication to help you remain more comfortable as your socket heals. Your dentist may also pack the socket with a bone graft material to encourage healing.

After getting your decayed tooth extracted, you may develop dry socket. Take steps to prevent it, but if you develop this complication, see your dentist right away.