## 2 Materials and Methods  
This double-blind randomized controlled trial was carried out from 7 March to 12 August 2021 in the Department of Oral and Maxillofacial Surgery at the College of Dentistry, Jouf University, Saudi Arabia. This was an interventional study, carried out using quasi-experimental design. To calculate the sample size, OpenEpi software was used. A mean value of 2.567 \(\pm\) 2.67 for pain severity was considered. The power of the test was 80% and the confidence interval (CI) 95%; the sample size for each of the three groups was 30 participants. Thus, a total of 90 patients were included in the present study. The Ethical and Review Board of Jouf University approved this study (Ethical review number: 11-04-42), and all of the procedures in this study were in compliance with the Helsinki Declaration and its amendments. This trial has been registered under the Saudi Clinical Trial Registry (SCTR) with application no. 21021702. Informed and written consent was taken from the participants before they were included in this trial study. The inclusion criteria were patients above the age of 18 of both genders who underwent extraction of teeth and were clinically diagnosed with dry socket at the clinic of the College of Dentistry, Jouf University, Saudi Arabia. Patients who were below the age of 18 years or above 70 years of age; had various bone diseases, including osteoporosis; had a history of taking oral or intravenous bisphosphonates; and had a history of radiotherapy on the head, neck, and jawbones were excluded from this study. After demographic characteristics of patients were determined and clinically diagnosed with dry socket, they were assigned numbers from the first to the 180 th patient and randomly allocated via lottery method to three groups numbered 1, 2, and 3. Group 1: patients were treated with honey (Al Shifa, 100% pure, certified by Saudi Arabian Standards Organization (SASO)) soaked into sterile gauze as a dressing; Group 2: patients were treated with zinc oxide eugenol (SPIDENT EsTemp zinc oxide eugenol temporary cement) gauze dressing (a gauze piece soaked with freshly prepared ZOE paste), which was placed into the socket; Group 3: patients were treated with normal saline rinse as control. The types of treatment and medication provided to the patients were beneficial and non-harmful according to medical ethics, with approval from the institutional ethics committee. Confounding variables such as age, gender, and history of pain were controlled by matching. The medications were placed in unmarked identical bottles and the saline was placed in a covered syringe, all without the original labels on them, and marked as Group 1, 2, and 3. Patients were allowed to continue their oral analgesic medication, namely ibuprofen 200 mg, 400 mg, or 600 mg twice daily, depending upon the severity of initial pain upon diagnosis. Pain relief was recorded and compared between the three groups on a visual analog pain scale at every appointment. The intra-alveolar packing was changed until the postoperative pain symptoms subsided. Patients were reviewed at 5 min post-medication, 30 min post-medication, 60 min post-medication, 2 nd day post-medication, 4 th day post-medication, and 7 th day post-medication. The patients were requested to note daily pain records on a (0-10) visual analog scale, with 0 representing no pain and 10 representing the worst pain. For safety purposes, any harmful effects of the medications were also recorded. Patients were instructed to call the investigator immediately about any problem; in such circumstances, treatment was immediately terminated and discontinued. The patient was requested to visit the investigator at the earliest possible time. If no side effects were noted, the treatment option was repeated a maximum of four times over a period of two weeks to assess the complete effect of the medication in case complete relief was not achieved the first time.