It's the patient's home care within the first 24-48 hours that are the most crucial to avoiding a dry socket. Beyond 48 hours, the socket's fate is sealed.
There are circumstances out of the patient's control that can lead to a dry socket regardless of the precautions taken; the individual's body's ability to form/maintain the blood clot in a timely fashion (a dozen or more different anatomic/physiologic factors including the major factor of overall general health), as well as the size/shape/condition of the extraction site. These are reasons why even those who follow their post-op instructions (dont smoke), still get dry sockets... as well as those who DONT follow the instructions (smoke like a chimney) and still don't get a DS. That said, I've seen some of the gnarliest-looking extraction sites heal perfectly w/o DS but then a perfect, small extraction site in healthy individual get a DS and the soft tissue surrounding the site become necrotic and the patient be in pain for weeks.
That said, your chances increase dramatically of everything being fine if you don't smoke for 24 hours, and increase dramatically more if you abstain for an additional 24 after that.
48 hours without a smoke (feel free to use nicotine supplements all you like) is well worth avoiding the severe pain with a DS. You thought the tooth pain was bad? Ask someone who's had a DS.
Someone mentioned buying eugenol from the store. It's worth a shot if you really need to avoid the Dentist. Im a dental student, and at the school - we provide dry socket treatment free of charge. So, dont hesitate to call your Dentist to see if you'll get the same.
Your best option is to see the Dentist to make sure there isn't an infection that requires antibiotics, or any shards of sharp bone that need to be smoothed that may be prolonging the healing process. While we do use Eugenol soaked ribbons and paste, we also clean out the socket with an antiseptic called Chlorohexidine and sterile water, as most often opportunistic bacteria get trapped down there w/o a good way for the body to flush the area out otherwise. We also are able to place the paste and eugenol ribbons more ideally, sometimes requring sutures to hold them in place. generally a return trip to the dentist for this will also yield in another opioid prescription, usually bumped up in strength (at school this means if we sent them home with vicodin, they then get percocet)
Anyway... this is all why I choose to suture my extraction sites up if the tissue allows. It's no guarantee, but it helps seal the socket up and protect it from patients negligence and promote healing. this isnt always necessary, and usually is not in simple extractions - however if I had one extracted, I'd request it to be sutured. they dissolve on their own in a few days.
for those who don't know, a dry socket is the result when a blood clot does not form properly in a tooth socket following extraction. this can happen from disturbance of the area due to vacuum created during smoking, spitting, swishing, and sucking (straws). hot food/beverages and carbonation can also disturb the area.
i realise none of this was rocket science, but hope its informative.
