Dry Socket After Mandibular Third Molar Extraction: Incidence and Risk Factors in a Single-Surgeon Retrospective Study

Objectives: This retrospective study investigated the incidence and risk factors of dry socket following mandibular third molar extraction. Methods: This retrospective analysis utilized clinical information and diagnostic X-ray images of patients who underwent tooth extraction by a single oral and maxillofacial surgeon between June 2020 and March 2024. Dry socket was diagnosed according to established clinical criteria. Panoramic radiographs were used to assess angulation (Winter’s classification), depth and gingival coverage. Statistical analyses were conducted to examine differences in dry socket incidence. Categorical comparisons were performed using chi-square or Fisher’s exact tests. Multivariate logistic regression was used to identify independent risk factors for dry socket. Odds ratios with 95% confidence intervals were calculated. Results: A total of 3033 mandibular third molars were extracted from 2384 patients (859 males and 1525 females). The overall incidence of dry socket was 2.6% (80 cases), with a significantly higher rate in female patients (3.3%) than in male patients (1.4%) (p < 0.01). Increased risk was observed in age ≥ 30 years compared to early 20 s (p < 0.01), and the use of oral contraceptives (p < 0.01). Multivariate logistic regression also identified these three factors as significant independent risk factors. Conclusions: These findings suggest that patient-related factors influencing healing capacity contribute to dry socket development. Recognizing these associations may assist clinicians in identifying high-risk cases and implementing preventive strategies to reduce postoperative complications in third molar surgery.