After an extraction, the blood clot is your body's own dressing. Protect it, and you've done the most important thing.
Dry socket is one of the more unpleasant things that can happen after a tooth comes out, and it's more likely if you smoke. The good news is that most of it is avoidable, and it's very treatable if it happens.
What It Is
When a tooth is removed, a blood clot forms in the empty socket. It protects the bone and nerve endings underneath while new tissue grows. In a dry socket, that clot either doesn't form or is lost too early, and the socket is left exposed.
What It Feels Like
It usually shows up 3 to 5 days after the extraction, just when you'd expect things to be getting better. You may notice an aching or throbbing pain that can feel like toothache, a bad taste, and bad breath. The socket can look empty, with bone showing instead of a clot. It isn't normally an infection, but it hurts, and ordinary painkillers may not settle it.
Why Smokers Are More at Risk
The NHS lists smoking as a risk factor. Likely reasons include the sucking action and heat disturbing the clot, along with the effect of smoke on blood supply and healing. Other things that raise the risk include lower wisdom tooth removal, a difficult extraction, a previous dry socket, and the contraceptive pill. You can't change all of those, but you can change what you do afterwards.
How to Avoid It
On the day, don't rinse, and leave the area alone. From the next day, rinse gently with warm water and a teaspoon of salt, four times a day for four to five days, and brush as normal but carefully around the area. Avoid hot food and drinks for the first couple of days, and skip straws.
Don't smoke for as long as you can. We ask for at least 72 hours, and longer is better. That includes vaping. If you can use this as the push to stop altogether, Help Me Quit Wales is free on 0800 085 2219 (helpmequit.wales).
If You Think You Have It
Don't sit it out over the weekend. Ring us. The treatment is simple: the socket is gently cleaned out and a soothing dressing placed. It relieves the pain rather than speeding up healing, and sometimes it needs repeating. Out of hours, private patients can get our out-of-hours number from reception. Swelling, a fever, or difficulty swallowing or opening your mouth need prompt attention, so don't wait on those.
Thinking about having a tooth out? Our post on how we decide between saving and extracting explains how we approach it, and how smoking affects healing covers the wider picture.
Sources: East Sussex Healthcare NHS Trust, Dry Socket (Alveolar Osteitis). Guy's and St Thomas' NHS Foundation Trust, Dental surgery and recovery.