On the genesis of “dry socket”

One major school of thought regarding the pathogenesis of a dry socket occurring following tooth extraction is based on the concept that a blood clot fails to form, a concept that is, however, refuted by the clinical symptoms associated with the phenomena of a dry socket. A second theory maintains that, initially, clot formation takes place, but that the clot is subsequently lysed, bringing about the severe symptoms of a dry socket. Fibrinolysis generated by tissue activators only partly explains the occurrence of a dry socket. Based on the data accumulated in the literature, it is postulated that bacterial agents are involved in the fibrinolysis and that Treponema denticola may play a leading part in this process.