I had a lower back molar removed 11 days ago. The oral surgeon packed it with a dry socket dressing (yellow gauze with clove oil) immediately after removal (as a precaution) and stitched the socket. I had some mild (but constant) pain, mostly in my ear and temple, beginning at about day 3. I was told that I have dry socket, but luckily, due to the dressing, I never felt the level of pain typically associated with it.

One week after the extraction, I had my post op visit. The stitch was removed and the dressing was changed. I had some pain the following day (day 8), but then I was fine after that. I had the dressing changed yet again yesterday (day 10), and I am scheduled to have it removed for good on Monday (day 14…. which is in three days).

My problem is that the dressing placed yesterday is starting to come out and my oral surgeon is out of town for a long weekend. I was told to push it back in with a Q-tip if that happened, but it just won't stay put when I do that and I don't want to keep aggravating the area. I am worried about getting the severe pain of dry socket if the dressing comes out completely though.

I have been without pain (with the dressing in) for the past couple days, so is it likely that I am healed enough that it will not be too bad if it does come out? I read that the way to know when a dressing is ready to be removed is when the patient does not have pain with it still in place. Is that correct? Or should I call the number of the oral surgeon covering for my doc in case of emergency and have it replaced? It's not an emergency as of now, so I hate to do that if it is not necessary.

I am also concerned about leaving the dressing in loosely, the way it is now. Can food particles or just general bacteria from my mouth get in the socket? I feel like the dressing is not in there well enough to seal out any debris, but yet because it is there, I cannot clean the socket as I would if there was no dressing. I am afraid to eat or drink anything other than water.

I just don't know what to do--

1. Keep trying to push it back in and aggravate the socket?….

2. Call the emergency # to have the dressing replaced when it is not an emergency as of now, and just to possibly have that one fall out too?….

3. Leave it loose and do nothing unless it comes out and I have severe pain (and if I do that, is it okay to eat? How do I ensure that the socket will not get anything "bad" in it that cannot be flushed out)??

I apologize for the long message. I appreciate any input!

Hi tlc,

I am in the dental field and can offer some information here.

First of all the oral surgeon must have anticipated a dry socket for him to place the packing in right after the extraction. I have not known any surgeon to do that and then suture the wound closed. So I am perplexed about that.

The packing does not prevent debris from getting in the socket and you should not be touching it with anything because even a clean q tip can become contaminated and infect the site. Also, avoid eating on that side of your mouth until the hole closes over. Are you rinsing with warm salt water? As that will keep the socket clean of food debris. No mouthwash because the chemicals are not therapeutic and irritate the wound.

Given the fact that he placed that packing so early on, I would suggest that you call the on call surgeon and ask what you should do. He may tell you to let this packing come out and see what happens. But it is best to call him and speak to him not only for his advice but also to give him a heads up that you may need to call him in a hurry if the pain comes back.

Hope this helps...
Bryanna

Thank you so much for your reply. I did call the on-call oral surgeon and he told me if it comes out to just rinse with salt water 4-5x's a day. I have definitely NOT been eating on that side of my mouth, I have been worried about eating at all. I have been using salt water rinses after meals and prescription mouthwash at bedtime as instructed by my oral surgeon on the day of extraction. Will that be enough to keep it clean now that the packing is so loose?

Another concern I have is that I am scheduled to have the dressing removed for good on Monday morning by one of the nurses. The surgeon will still be out of town, and no one at all will be in the office on Tuesday. Do you think it is best to have all dressings out of the socket ASAP (Monday, if it doesn't fall out before then), or do you think I should request to have it packed one more time and have it out on Wednesday, when the surgeon will be back in the office? ….What I am really asking is do you think 2 weeks is long enough for the site to heal to the point that I will likely only have tolerable pain, or do you think there is a good chance I could have severe pain once the dressing is removed?

If I do get typical (severe) dry socket pain, is there a way to ease it at home until I can get in to see someone? Should I maybe go buy some clove oil? Does salt water help it at all? Would it be safe to bite on some sterile gauze to "block" the socket from the air?

I appreciate all of your help!

Hi Tlc,

A dry socket occurs when the clot has not formed properly or the clot was disturbed soon after the surgery. Dry socket means dry bone and as you can imagine that is why it hurts so much. Initially the medicated packing put into the socket disinfects the bone and keeps it moist but after the first week the packing slows down the natural healing. So if you can leave out the packing at this point it would be better. Just do the salt water rinses 3-4 times a day. There is no reason to overdue it with those rinses and too much of a good thing can actually irritate the tissue.

The problem with keeping the loose packing in the socket is that it is collecting bacteria from your saliva and holding it there. So it's like having a loose blanket over your arm while your arm is submerged in water. The water is going to get in underneath that blanket and keep your arm wet. Did I explain that clearly?

At this stage of healing, you can apply one drop of clove oil to the socket if you develop pain but again be cautious with using that and only use one drop. Do not fill the socket or use it too often.

If breathing in air makes the area painful then you can place a piece of sterile gauze over the socket. But again that gauze will trap bacteria from your saliva. So let the lose packing fall out and then if you can do nothing to it but rinse your mouth with salt water that would be best.

Go see the dental assistant on monday for a quick peek. Chances are she will just leave it alone.

Bryanna