[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [Dental emergencies and trauma](https://durgical.com/en/dentistry/areas/emergencies/) › Dry socket (alveolar osteitis)

# Dry socket (alveolar osteitis)

- Emergency

Severe pain two to four days after an extraction (most often day three or four) with an empty socket is dry socket. It is not an infection.

Updated Nov 12, 2026

**See it in 3D:** [Mandible](https://durgical.com/en/anatomy/mandible/)

## Key points

- Day two to four pain + empty socket = dry socket.
- Local care and analgesia; no antibiotics.
- Smoking is the main avoidable risk.

## What it is

Alveolar osteitis occurs when the blood clot in an extraction socket breaks down early, leaving exposed bone. Pain begins two to four days after the extraction, most often on the third or fourth day (not on the first day), is severe and throbbing, often radiates to the ear, and responds poorly to simple analgesics. The socket looks empty, with grey bone and food debris, and there is bad breath and taste. It is most common after lower third molar removal, in smokers, in women taking oral contraceptives, after difficult extractions, and in people who have had it before. Fever and swelling are absent or mild; their presence suggests infection instead.

## How to recognise it

- Onset day two to four, severe pain radiating to the ear.
- Empty socket with exposed bone and bad odour.
- Risk: lower third molars, smoking, oral contraceptives, traumatic extraction, previous dry socket.
- Treatment is local: irrigation, a medicated dressing in the socket and analgesia.
- Heals over one to two weeks.

## What to do at once

- Confirm the timeline and examine the socket.
- Look for signs of infection (fever, swelling, pus) or a retained root or bone fragment.
- Give an NSAID with paracetamol and refer to the dentist the same or next day.
- The dentist gently irrigates with warm saline or chlorhexidine and places a soothing dressing.
- Advise no smoking, gentle warm saltwater rinses after the first day, and return if pain does not ease.

## Costly mistakes

- Antibiotics do not treat dry socket; they are needed only if there is true infection.
- Pain persisting beyond two weeks needs review for osteomyelitis, a retained root, a fracture, or medication-related osteonecrosis.
- Smoking soon after an extraction is the most avoidable risk.

## Next step / Initial management

- Refer to the dentist for socket irrigation and dressing; analgesia meanwhile.
- Fever, spreading swelling or pus: treat as infection and refer promptly.
- Non-healing socket or exposed bone for weeks, especially on antiresorptive drugs or after radiotherapy: refer to oral surgery.

## Test yourself

Think of the answer, then tap the question to see it.

## When does pain from dry socket typically begin?

Two to four days after the extraction.

## Do antibiotics treat dry socket?

No; treatment is local irrigation, a medicated dressing and analgesia.

## Which extraction site and habit most raise the risk of dry socket?

Lower third molar extraction and smoking.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/dry-socket/)

## Connections

## See it in 3D 1

The structures of Durgical's 3D anatomy where it is found.

- [Mandible](https://durgical.com/en/anatomy/mandible/)

## Related 4

- [Bleeding after a tooth extraction](https://durgical.com/en/dentistry/bleeding-after-a-tooth-extraction/)
- [Pericoronitis and the wisdom tooth](https://durgical.com/en/dentistry/pericoronitis-and-the-wisdom-tooth/)
- [Toothache: approach](https://durgical.com/en/dentistry/toothache-approach/)
- [Medication-related osteonecrosis of the jaw](https://durgical.com/en/dentistry/medication-related-osteonecrosis-of-the-jaw/)

## In Pharmacology 3

- [Chlorhexidine](https://durgical.com/en/pharmacology/chlorhexidine/)
- [Ibuprofen](https://durgical.com/en/pharmacology/ibuprofen/)
- [Paracetamol](https://durgical.com/en/pharmacology/paracetamol/)

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Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: [Alveolar Osteitis](https://www.ncbi.nlm.nih.gov/books/NBK582137/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Oral Surgery, Extraction of Teeth](https://www.ncbi.nlm.nih.gov/books/NBK589654/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Oral Surgery, Extraction of Mandibular Third Molars](https://www.ncbi.nlm.nih.gov/books/NBK587405/) (StatPearls Publishing (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/dentistry/dry-socket/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/dry-socket/