Tooth extraction complications: Bone fragments (sequestra) and tooth chips.

It's not uncommon that after having a tooth extracted (especially after a relatively more difficult or "surgical" extraction), a person will notice that one or more small, hard fragments have worked their way to the surface of their extraction site.

The type of scenario we're describing is this:

The healing of the area where a tooth has been pulled is progressing normally and uneventfully. Then one day, out of the blue, the person's tongue discovers that the edge of small hard object can now be felt poking through the surface of their gum tissue.

Causes and solutions.

This page describes the most common sources and causes for these types of objects. It also discusses how this type of condition might be addressed, either on your own (DIY tooth-chip removal), or, for larger pieces or more complicated situations, with treatment provided by your dentist.


If an extraction is difficult, a root tip may get left behind.

What kind of hard fragments come out of extraction sites?

The type of hard bits and pieces that come to the surface of a healing tooth extraction site are:

  • Remnants of the extracted tooth or its dental restoration. - In cases where the tooth broke apart or splintered during the extraction process.
  • Bone tissue. - Damaged or compromised, now dead or dying, bone tissue. These types of fragments are called "sequestrum" (singular) or "sequestra" (plural).

When can you expect a fragment to appear?

Bone sequestra or tooth fragments can come to the surface of an extraction site at any time. In most cases, however, they will appear, and then be uneventfully shed, within the first few weeks after the tooth has been removed.

It's possible that some tooth fragments, especially root tips, will prove to be an exception to the above general rule. These pieces may not surface for months, and conceivably even years (if at all), after a person's surgery.

Risk factors.

Having a tooth fragment or bone sequestrum come to the surface of an extraction site is more likely to occur in those cases where the associated oral surgery has been relatively difficult or traumatic.

Examples

This includes instances where a tooth has fractured or splintered. It also includes situations where the extraction site's bone tissue has been traumatized. It may have been bruised, broken (in a manner where the broken fragment has lost its blood supply) or over-heated (which can happen when a dental drill is needed for bone tissue removal).

Why do these bits and pieces come to the surface?

You might find the idea of having bits of bone or tooth coming out of your healing extraction site to be mildly disturbing. This type of event is, however, a reasonably common occurrence and there is a simple explanation as to why this activity needs to take place.

Why it happens.

As interpreted by your body, these pieces of tooth and dead bone tissue are simply foreign objects. They can't be integrated into the healing tissues. And, in fact, their presence complicates and delays the healing process.

Since these objects have no benefit or value, your body's goal is to eject them. So, over time, these fragments gradually drift towards the bone's surface and then into its overlying gum tissue where they can ultimately be shed.

Preventing bone sequestra and tooth fragments.

There's really nothing you, the dental patient, can do to prevent bone sequestra and tooth fragments (other than giving your dentist your full cooperation when they perform your extraction so they can perform the procedure as ideally as possible).

There are, however, things that your dentist can do:

Bone fragments.

A dentist will take great care when manipulating exposed bone tissue so it's not excessively traumatized. They will also try to use an appropriate amount of pressure when removing a tooth so bone fracture is less likely to occur. However, despite their best efforts, no dentist can always prevent bone sequestra from forming.

Tooth fragments.

In regards to tooth chips and fragments, if a tooth does break during the extraction process, a dentist will thoroughly wash the tooth's socket in an attempt to flush out any and all remaining bits and pieces.

As a side note, we will state that, as you can probably imagine, some extractions simply don't go as expected. And in these cases the treating dentist may decide that leaving a tooth fragment behind (like a root tip) is a necessary choice. However, if a dentist does know that they are leaving a tooth fragment in the socket, it is their obligation to advise you of such and discuss the matter with you.


Treatment.

A) Do-it-yourself treatment.

You may be able to remove the smallest tooth and bone splinters from your extraction site on your own. Usually you can just flick these objects out with your finger nail, or push them out with your tongue (or possibly by doing either or both, repeatedly, over the course of a few days). You may experience a bit of bleeding after you get the chip out but it should be very minor.

If you're squeamish about the way it feels to wrestle one of these small fragments out, you might consider using an over-the-counter gum-numbing product (like those used to treat a child's teething pain). Look for products (liquids, gels, pastes) that contain the topical anesthetic benzocaine.

B) Don't be hesitant to ask your dentist for assistance.

It's your dentist's obligation to help you throughout your extraction's healing process. So, if you prefer (or if the fragment seems sizable or any way out of the ordinary), you might request that they evaluate and treat your situation.

Providing this type of treatment is usually quite easy for your dentist. After all, they'll be able to visualize the situation better than you and, of course, they have more experience and the proper tools.

In some instances, they may feel that they must "numb you up" before they can remove the protruding fragment. And, in more involved cases, the removal process might include some type of minor surgical procedure (such as incising the gum tissue and reflecting it back so the fragment can be visualized and accessed more easily).


 All FYI's ► 

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