Alveolar osteitis usually occurs where the blood clot fails to form or is lost from the socket (i.e., the defect left in the gum when a tooth is taken out).

[1] Since alveolar osteitis is not primarily an infection, there is not usually any pyrexia (fever) or cervical lymphadenitis (swollen glands in the neck), and only minimal edema (swelling) and erythema (redness) is present in the soft tissues surrounding the socket.

[4] This blood clot is replaced with granulation tissue which consists of proliferating fibroblasts and endothelial cells derived from remnants of the periodontal membrane, surrounding alveolar bone and gingival mucosa.

[5] Bone tissue is exposed to the oral environment, and a localized inflammatory reaction takes place in the adjacent marrow spaces.

In a dry socket, healing is delayed because tissue must grow from the surrounding gingival mucosa, which takes longer than the normal organisation of a blood clot.

Some patients may develop short term halitosis,[5] which is the result of food debris stagnating in the socket and the subsequent action of halitogenic bacteria.

[1] The oral microbiota has been demonstrated to have fibrinolytic action in some individuals, and these persons may be predisposed to developing dry sockets after tooth extraction.

[2] Another risk can be attributed to the actual inhalation, as drawing smoke, particularly from dense filters or tightly rolled cigarettes, creates a small amount of suction that can cause the blood clot in a healing gum to become loose or dislodged over a period of time.

Studies have shown that because of hormonal changes, women in the middle of menstrual cycle and the ones taking oral contraceptives (birth control pills) have a higher tendency of having alveolar osteitis after their tooth extraction surgery.

It is recommended that elective surgeries be performed during the menstrual period in both users and non-users of oral contraceptives, to eliminate the effect of cycle-related hormonal changes on the development of alveolar osteitis.

[5] Another review concluded that preventative antibiotics reduce the risk of dry socket (and infection and pain) following third molar extractions in healthy individuals.

[2] Prevention of alveolar osteitis can be exacted by following post-operative instructions, including: Treatment is usually symptomatic,[5] (i.e., pain medications) and also the removal of debris from the socket by irrigation with saline or local anesthetic.

[5] Medicated dressings are also commonly placed in the socket;[5] although these will act as a foreign body and prolong healing, they are usually needed due to the pain.

Examples of medicated dressings include antibacterials, topical anesthetics and obtundants, or combinations of all three, e.g., zinc oxide and eugenol impregnated cotton pellets, alvogyl (eugenol, iodoform and butamben), dentalone, bismuth subnitrate and iodoform paste (BIPP) on ribbon gauze and metronidazole and lidocaine ointment.

[1][2] Overall, the rate of dry socket is about 0.5–5% for routine dental extractions,[2][4][5] and about 25–30% for impacted mandibular third molars (wisdom teeth which are buried in the bone).

[4][5][9] Other factors in the postoperative period that may lead to loss of the blood clot include forceful spitting, sucking through a straw, and coughing or sneezing.