Tooth and bone fragments (following a tooth extraction). -

Why do they appear? | What do they look like? (pictures) | Removal - By your dentist. / How to remove them yourself. | What causes bone sequestra (fragments, spurs) to form?

One common complication associated with having a tooth pulled is finding that one or more small, hard fragments (splinters, shards, spurs, chips) of tooth or bone have worked their way to the surface of your extraction site and are now sticking out of your gums.

The scenario.

  • Following your surgery, the healing of your wound has been progressing normally and uneventfully.
  • After some days or weeks, your tongue suddenly discovers a tiny hard object sticking out of your gums.
  • What you feel may be a small rounded lump or a sharp-edged splinter.

This scenario is more likely to take place after relatively more difficult tooth extractions, especially surgical ones (this includes the type of procedure used to remove impacted wisdom teeth).

What you need to know.

This page explains why these hard bits and shards (tooth fragments / bone sequestra) form, and gives pictures of what they look like.

It also outlines how they are usually removed, either by your dentist or, in the case of the smallest splinters or spurs, own your own as self-treatment.

Our comments about managing larger and/or multiple fragments or those whose symptoms involve extended time frames.


What types of fragments might you find?

Any slivers or pieces you discover sticking out of your extraction site have come from within it. These bits can include:

Post-extraction
Complications

  • Tooth pieces / Root tips. - It's not terribly uncommon for a tooth to break or splinter during its extraction process. For example, root fracture is the most common intraoperative complication and estimated to occur in 9 to 20% of cases. (Ahel 2015) [page references]

    Or before a tooth does break, a dentist may strategically decide to cut it up into parts (referred to as "sectioning" the tooth). Doing so can make it easier to get out.

    But either way, if any fragments are created, some may get left behind.

  • Remnants of the tooth's dental restoration. - The forces used to remove a tooth may dislodge or break its filling. If so, they may find their way into the empty socket and get left behind.
  • Bone fragments, spurs, bony flakes. - Two different scenarios may be involved when these types of objects form.

    1) Broken bone - Bits of a tooth's bony socket may break off during the extraction process.

    2) Damaged bone - Bone is a living tissue, and if it's traumatized enough during the extraction process aspects of it may die (see below). These types of fragments are called "sequestrum" (singular) or "sequestra" (plural).

The potential for your experiencing any of the above will be affected by a multitude of factors including: skill of the dentist, extraction technique and instruments used, as well as the patient’s age and quality of bone.

What do the fragments look like?

In many cases you'll be able to visualize the spur of bone or shard of tooth sticking through your gums. But if you can't, don't be too surprised.

  • The location of the protruding bit may be such that it's essentially impossible to view it without aid (such as the good light source and small oral hand mirror that your dentist has to use).
  • Sharpness or irritation that your tongue feels may be produced by objects that are astoundingly minute in size, and therefore difficult to visualize.
How the lesion looks in your mouth.

As a response to the presence of the offending hard object, the soft tissue surrounding the fragment will characteristically show signs of redness (erythema), and possibly some minor level of swelling (oedema). It may be tender to touch.

Some degree of ulceration may form, especially when bigger bone fragments are involved. Larger lesions may display a whitish surface membrane surrounding a hard center section of exposed bone.

Any exposed or protruding bone is usually non-responsive to touch (its dead or dying) but the surrounding tissue may be extremely sensitive. (Farah 2003) Likewise, tooth fragments themselves will be non-sensitive to touch but their surrounding tissue may be.

Post-extraction bone sequestrum and tooth fragment.

Close up picture of a post-extraction bone sequestrum and tooth fragment.
Inspecting the fragment.

No doubt the piece that has surfaced or has come out will be a curiosity to you.

  • Bone bits (sequestra) - These items are usually very irregular in shape, with rounded or sharp edges. Their color is usually light tan to white. Their surface will look smooth but lobulated (not perfectly flat but bumpy).
  • Tooth fragments - These bits can be very shard-like (pointed, sharp edged, etc..., just like you'd expect a piece of broken tooth to be). However, if the aspect you're looking at is the tooth's original outer surface, that side will have contours that are smooth and rounded.

    Those portions covered with dental enamel will be white and have a shiny appearance when dry. Aspects involving the inner portions of the tooth or its roots (both composed of dental dentin) will have a more yellowish tint, and a dull appearance when dry.

The size of the fragment can be quite variable. What you see sticking through your gums in no way correlates with the full extent of what lies underneath (be it large or small).

Why do these bits and slivers come to the surface?

You might find that discovering pieces of tooth or bone coming from your extraction site to be somewhat disturbing. But experiencing this phenomenon is actually a fairly common occurrence, and it's easy enough to understand why it needs to take place.

Why it occurs.

  1. From your body's perspective, these pieces of tooth and lumps of dead bone (sequestra) are foreign objects.

    (They aren't healthy, live tissue that can once again be a part of your body. To the opposite, their presence complicates and delays your wound's healing process.)

  2. Since these objects have no beneficial value, and in fact are instead a complication, your body's goal is to eject them.

What takes place.

Fragment migration.

The path of least resistance for these pieces is through the newly forming tissues of the healing socket. Then, once they've migrated to the surface of your jawbone, they begin to penetrate into the gum tissue that lies over it, until they ultimately wind up poking through and sticking out of its surface.

Shard discovery.

In cases where the object is somewhat rounded and relatively smooth, and especially if there's a substantial portion of it still not sticking through yet, these pieces may feel like a small (possibly movable) lump in your gum tissue.

If instead the fragment has any degree of roughness or sharpness, it won't take long for your tongue to find it. And probably be quite annoyed by its presence.

Exfoliation or removal.

If given enough time, most fragments would probably work their way on through the gum tissue and ultimately fall out (exfoliate) on their own.

For most of us however, the presence of the spur is too much of a novelty or irritation to our tongue, or the process simply too drawn out, and a quicker remedy (see below) is wanted.


X-ray showing root tip fragment left after an extraction.

If this root fragment is not removed at the time of surgery it may eventually come to the surface on its own.

When can you expect fragments to appear?

Routine bone sequestra and tooth fragments can come to the surface of an extraction site at any point during its healing process timeline.

But you're most likely to start to notice these bits sticking out of your gums during the first few weeks after your tooth was removed.

Some may take longer.

Some tooth fragments, especially root tips, may prove to be an exception to the above general rule. These shards may not surface for months (or even years later, if at all) following your surgery.

 

Risk factors / Prevention.

The likelihood of experiencing tooth and/or bone chips after an extraction is most likely to occur after those where the surgery involved has been relatively difficult or traumatic in nature. The paragraphs below explain why.

[And no, despite their best efforts no dentist can prevent this complication from happening 100% of the time.]

a) Bone fragments (sequestra).

Bone is a living tissue and if it has been traumatized enough during the extraction process portions of it may die. (When a sequestrum comes out, the piece you are looking at is literally a chunk of dead bone.)

What your dentist can do.

To minimize the level of trauma that's created, your dentist will take great care whenever they work directly with bone tissue. (Like during those times when the gums lying over it have been flapped back so the dentist has direct access to it.)

This includes completing your procedure as quickly as possible, keeping the exposed bone moist, and when trimming it, constantly flushing it with water so it doesn't become overheated by the drilling process.

b) Broken bone.

The bone that makes up a tooth's socket is fragile and aspects of it can be broken during the extraction process.

An x-ray a tooth socket after having its tooth pulled.

Your dentist will thoroughly flush out your tooth's socket to remove any loose debris.

Complete breaks.
  • Any pieces that have broken free entirely and are noticed by the dentist can be picked out or washed away when the tooth's empty socket is "irrigated" (flushed out with water or saline solution).
  • Some bits may go unnoticed but will get flushed away anyway during the socket's post-extraction irrigation.

Any fragments that have broken free that aren't removed from the socket will ultimately be ejected as bone sequestra during the healing process and following.

Attached bone fragments.

Those broken pieces of bone that are still attached to tissue (still have a relationship with surrounding bone and/or gum tissue) and still maintain an adequate blood supply (the broken bit's source of nourishment), may ultimately heal and therefore may be left in place by your dentist (this is a judgment call on their part).

If they don't survive, they will become bone sequestra.

c) Tooth pieces.

Routine fragments.

Anytime a tooth does splinter or break, a dentist will make sure to thoroughly irrigate (wash out) the tooth's socket with water or saline solution in an attempt to flush away any and all remaining loose bits.

X-ray showing root tip fragment left after an extraction.

A broken root tip remaining in the tooth's socket.

Root tips.

While never a first choice, a dentist may decide that leaving a broken root tip leaves the patient at less risk for harm than the damage that might be caused by trying to retrieve it.

As general rules:

  • If a tooth remnant 3mm or less (which is just slightly less than 1/8th inch) lies in close proximity to a vital structure (e.g. nerve bundle, sinus floor, etc...), the risk vs. reward (see below) of removing it as compared to just leaving it alone should be carefully evaluated.
  • Unless grossly infected, leaving behind a small fragment is usually of no consequence.
  • Any pieces of broken tooth root that do remain should be periodically monitored via x-ray examination.
  • Over time, the broken fragment may migrate to the surface of the bone where it can be removed, possibly quite easily.
Possible complications with removing root tips.

As you might imagine, the tips of some broken roots can be hard to visualize and access. And if so, they can be a challenge to remove.

In their zeal to remove a fragment, a dentist may inadvertently use more force than what the sometimes very fragile surrounding bone can bear. If so, the root tip may be pushed beyond the tooth's socket and into an adjacent anatomical space (like the patient's sinus area).

While this type of event isn't necessarily common, it can occur. And in situations where the potential for a complication occurring seems relatively possible (in this case the displaced piece will need to be retrieved), leaving the broken fragment alone in the first place may make the most prudent choice.

d) Your part.

There's really not much you the patient can do to prevent extraction fragments other than giving your dentist your full cooperation so they can complete your procedure under as ideal circumstances as possible. (In more straightforward terms, make it so your dentist is able to focus more so on the process of performing your extraction, instead of managing you.)

Removing bone fragments and tooth pieces.

a) Treatment performed by your dentist.

It's your dentist's obligation to provide the assistance you require during your extraction site's healing process.

So, if you've found anything hard or sharp sticking out of your gums, you should never be hesitant to ask for their attention and aid.

What your dentist needs to do.

In short, your dentist simply needs to remove the shard. With the small types of fragments that are the focus of this page, the procedure is usually quite easy. However, and as explained below, larger bits may offer your dentist more of a challenge and require a more involved procedure.

How they'll do it.

  • With most cases, removing the offending piece usually just takes a quick flick or tug using a dental instrument, with no anesthetic required.
  • In some cases, the spur or sliver might be large enough and/or still buried under your gums enough that a longer, harder tug or push is required. If so, the use of some type of anesthetic might be in order.

Anesthetic options.

A dentist has two types of numbing agents that might be used:

  • Topical anesthetic (i.e. benzocaine) - This type of product is usually a gel that's smeared on the patient's gums around the protruding fragment.

    Generally speaking a topical anesthetic is only able to numb up the surface of the gum tissue. But since that's where the bulk of the fragment likely (hopefully) resides, its effects are usually sufficient.

  • Local anesthetic (i.e. "novocain") - This type of anesthetic is given via injection (a dental "shot").

    This method of anesthesia provides a deeper, more profound level of numbing. The trade-off is that you're likely to feel the pinch of the shot as it's given.

You'll simply have to rely on your dentist's judgment as to which method is needed for your procedure. They'll base their decision on their interpretation of how small the object is and how quickly they expect it to flick out. Your concerns can be an important part of this calculation too, so let them be known.

Situations involving relatively larger fragments.

In some cases your dentist may feel that the shard is large enough that they will need to make an incision in your gums to be able to access and remove it (a clean incision will heal more quickly than if the tissue gets ripped or torn during the removal process). If so, local anesthetic will definitely be needed.

As far as the removal process itself goes, the hope is that once your dentist has adequate access to the fragment that they can then tease it out easily and quickly. But even your dentist won't know exactly how much of a wrestling match it will be until finished (sometimes a small bit can prove to be surprisingly difficult to get a firm grasp of).

Once removed, if just a small incision was made stitches may not be required. If instead your dentist had to create a tissue flap (the situation where your gums are peeled back so to give better access), they will be.

Taking an x-ray.

Your dentist may feel it's necessary to evaluate your tooth's socket by way of taking an radiograph.

  • Since live and dying bone (sequestra) will both have a similar level of mineral content and therefore similar density, early on it may be difficult, if not impossible, for your dentist to precisely distinguish one from the other on an x-ray.

    In more chronic situations, differentiating between the two can be expected to be easier. Although with very small shards, probably still a challenge. (As tip-offs to your dentist: Your body may encapsulate the fragment in tissue, thus giving it a distinct appearance. Or because it has begun its migration, the bony piece may appear as an object out of place.)

  • Since tooth shards, root tips and pieces of filling material each have a different density (and density pattern) than bone, they are much more likely to be visible on a radiograph.

Proactive treatment.

For small, routine shards, a dentist will usually just provide treatment for their patient on an as-needed basis (as each bit surfaces and is discovered sticking out of the gum tissue).

Less common is the scenario where the dentist goes after the pieces surgically before they surface. Here are some reasons why:

  • As we've just explained, some types of fragments can be hard to identify on dental x-rays. And even if seen, routine x-ray imaging only provides a two dimensional representation, which means that it can still be difficult to know exactly where the offending shard(s) lies.
  • Visibility in an extraction site can be limited. Bleeding can further complicate this issue. Overall, especially when smaller, multiple fragments are involved, locating all of the offending bits may not be simple or entirely successful.
  • Probably the biggest question is simply, why create a whole new surgical wound just to remedy a situation that your body will most likely handle relatively uneventfully on its own?

Having stated the above, when the fragments are relatively fewer and larger, or it's your dentist's interpretation that a piece will not shed so easily or uneventfully, the case for surgical intervention can make a lot of sense.

Using our referral links for purchases supports this website at no additional cost to you. It's sincerely appreciated if you do.
Shop either ▶ Amazon related products below on this page, or else for any items on ▶ Amazon.com or ▶ Walmart.com.

b) Do-it-yourself treatment.

You may be able to remove very small tooth and bone splinters on your own.

  • These bits can usually be flicked out using your finger nail or pushing them out with your tongue.
  • It may take working with both methods, repeatedly and over the course of a day or two, to finally wrestle the piece to a point where its loose enough to come free.
  • When it comes out, you'll probably get a bit of bleeding but it should be very minor. (Bleeding is best controlled by biting firmly on gauze.)

Anesthetic.

If you're squeamish about the way it feels to wrestle one of these fragments out, you might consider using an over-the-counter gum-numbing product.

Look for products (liquids, gels) that contain the anesthetic benzocaine (ask your pharmacist). These are the same types of products that are often used with children to control teething pain.

Best practices for at-home treatment.

Do-it-yourself treatment is fine for emergencies and when the bit comes out easily. But overall it just makes good sense to touch base with your dentist when any fragments show up. (It's your dentist's obligation to provide you with the post-extraction follow-up care you require.)

If you're a generally healthy person and the area where the fragment appears was involved with a challenging extraction, then what's explained on this page likely applies to your situation.

But for others and other situations, what you're experiencing may be an indication of more serious complications. As examples, people having a history of taking bisphosphonate drugs (such as Fossmax®) or people who have undergone head and neck radiation treatments are at risk for significant complications with bone tissue healing.

Healing following fragment removal.

Since the wound that's left after removing a small fragment will primarily be soft tissue borne (lies entirely within the thickness of the gum tissue), once the offending tooth shard or bone spur has been removed you can expect a substantial amount of healing and pain reduction to take place within the first few days, with complete healing occurring within 7 to 10 days.

The actual time frame you experience will of course be influence by the initial size (diameter) and depth of the wound that was left behind.


Larger, more involved fragments.

As stated initially, the contents of this page apply to small isolated pieces of tooth or bone tissue that suddenly appear at the gum's surface of an extraction site following an otherwise uneventful healing process. Towards identifying cases that lie beyond the routine, we have a page that outlines the expected healing timeline for extractions.

If what you have experienced varies from the norm, you need to be in touch with your dentist for evaluation. Assisting you with any and all post-extraction complications is their obligation to you.

  • Beyond the routine causes we describe on this page, some post-extraction fragments (bone sequestra especially) form for other reasons (pre-extraction bone infection, history of taking bisphosphonate drugs, history of radiation treatment involving the jaws, ...), and therefore require more involved treatment.
  • When larger and/or multiple fragments or chronic symptoms are involved, a dentist's evaluation will be needed to determine how the patient's case is best treated. Close monitoring, medication, and/or surgical intervention may be indicated.

Bone fragments not associated with a tooth extraction.

The contents of this page address the subject of small, routine bone spurs that rise to the surface of a patient's gum tissue following a tooth extraction. Possibly producing a similar experience is the condition referred to as "uncomplicated spontaneous sequestrum."

Just as above, the word "sequestrum" as used here (the plural form is sequestra) refers to dead, ejected bits of jawbone. However, with this condition the cause of the sequestra is unrelated to the removal of a tooth. And in fact, the precise cause of the bone tissue's devitalization (death) frequently remains unexplained.

A common location for the formation of these bone bits is the tongue side of the lower jaw in the area of the molars.

Why they form.

The usual explanation given for the formation of these sequestra is local tissue trauma.

  • The idea is that the gum tissue in the affected region has been traumatized to the point where there is a disruption to its blood supply. This might take the form of continuous low-grade trauma, or a more substantial event.
  • Due to the blood supply loss, the soft tissues that lie over the bone are less capable of protecting it, and as a result it necroses (dies), ultimately resulting in the formation of a sequestrum (the body's ejection of dead bone tissue).

Some suggested causes of continuous, low-grade trauma include abrasion associated with eating foods (in cases where there's a less than ideal teeth-jawbone relationship or jaw shape, or an area of missing teeth) or trauma caused by repeated activities such as tooth brushing.

Treatment and concerns.

After evaluation, with very minor cases a dentist might conclude that the event has been a self-limiting condition that lies within the normal limits of what a person may experience.

With these minor cases, once the sequestrum has been lost (either spontaneously or assisted) the patient's pain relief and healing will progress rapidly, with complete healing occurring within 7 to 10 days.

With more involved cases, the potential for contributory systemic health factors may need to be considered and evaluated. Additionally, the size of the affected area/lesion may be large enough that your dentist feels that surgical intervention is required.

(Farah 2003)

Back to our post-extraction complications page. ▶

 

Written by: Animated-Teeth Dental Staff

Content reference sources.


search

Topic Menu ▶  Tooth Extractions

 
search

Comments

Bone Fragments

A bit of advice here for people wearing dentures maybe? It seems that using the dentures exacerbates the problem greatly, causes much pain and is ill-advised while you have fragments of bone still working through.

Nice calmly worded article! Helped me to find this after ripping a nice large shard of bone out of my mouth!

bone fragments

that would fall under the category of common sense

Uppers all out

Last 5 pulled, uppers jan25--- lots of seemingly large debris extremely sensitive to touch made last 40 days have been miserable, lost 18 lbs....only good thing. Going this aft for Dr to do something, hopefully get the daggone pieces out so I can get new uppers

Somewhat related to this post

Somewhat related to this post and the one above is the issue of ridge shape augmentation in preparation for denture placement.

While no dentist can know what exactly will transpire in regard to bone fragments appearing after an extraction. And we can only assume that both posters here have/had active plans with their dentist about denture placement ...

... if in your mind you have future plans about dentures and you have not yet shared those thoughts with your dentist when you are having extractions done, make sure they know.

Knowing that dentures are definitely in your future might influence them as the degree of alveoloplasty (use link above) they preform. (The assumption here being that any additional bone they feel should be smoothed off, removed, etc... because of denture placement might be at least some of the same fragile/disrupted bone that has greater potential to become a sequestrum.)

Nasty bone shards

I agree with Isaac about how nicely the article is worded. I didn’t see any reference to how excruciating these pesky shards are. I’ve had several, not due to an extraction, and they are no fun! They also don’t mention that your gun will not heal until the shard is removed.

An FYI for removal of a shard yourself: a very tiny (1/16” wide) metal crochet hook works great, if you can stand the pain. Make sure to clean it and swab it with alcohol before you start digging. Good luck!

Bone fragments

I had a tooth extracted mid January. Over the past several weeks the site has been sore due to what I believe are teeth or bone fragments working their way up through the gum. So far I’ve managed to extract only 2 teeny tiny pieces (which still blows me away because my tongue was telling me these were huge pieces of tooth or bone). My mouth is so sore all the time now. Should I wait until these fragments work their way out or go to my dentist to have them removed? I don’t want to go back to the oral surgeon who pulled my tooth. Can my regular dentist do it? Thanks for advice in advance.

Dj

If you're uncomfortable all of the time, it makes sense to check in with a dentist so they can pass judgment on what you are experiencing. Small, routine fragments are expected to be a non-issue until that point in time when they come through the surface of your gums and your tongue finally discovers them.

In regard to a proactive solution, fragments can be difficult to identify and locate, and for that reason a dentist may be hesitant to perform a surgical procedure to (hopefully) remedy what your body would have taken care of on its own. (For example, with multiple small bits it would be easy for some to be overlooked or not found and therefore left behind.) It just all depends on what they determine when they evaluate you.

The obvious choice of practitioners for your evaluation would be the oral surgeon since they performed your work, know your case, might consider this follow-up treatment as opposed to a separate procedure, and should generally have more experience with this complication than a general dentist.

But yes, a general dentist is perfectly capable of making an evaluation (and making a referral if needed) and/or removing extraction fragments, especially smaller ones already near the gum's surface.

Hope this experience is over for you soon.

Thank you!

Thank you!

Bone fragment

Had my last 9 teeth extracted 5 weeks ago, and waiting to heal and be fitted for dentures. Everything went well, except for the 2 mollars side by side .(on the bottom right). I was told by a previous dentist, he wouldn't pull the 2 Millard, that from the x-rays it showed they were really deep, and he suggested an oral surgeon. I went for months, until I finally HAD to get them pulled, and got in to see a dentist I use to go to years prior. He said no problem, and pulled them. Litterly took him max, 15 minutes to pull ALL 9 teeth! I thought it a little odd because he did it so quickly, and thought about the dentist who wouldn't pull them because they were so deep...this guy pulled and tugged pretty hard, fragments went flying everywhere! I was gagging on broken chunks of teeth floating down my throat! Stitched me up, and sent me on my way...The first week and the stitches started dissolving, one to the particular molar come loose, and the opening gapped open! Its been real slow healing in that one only, and I believe it's the same molar that this razor sharp piece of bone is protruding through the gum, on the inside next to my tougne! Each movement from my tougne, feels like it is being sawed on! Hurts like all heck! I have been back in to see this dentist 2 more times. They x-rayed it, and her said it is bone, and that in time it will work its way out. He said to leave it alone and don't touch or mess with it. I went for another week, the pain was miserable! This time he decided to shave some of it off, it was very little, but it seemed to help for the time. It started to feel a bit better in a week, but now, it's like it grew back or something! This is really getting to me, and most miserable!!! I don't want to have to call him again, because he's giving me the idea he has done all that he can for me. HELP PLEASE! I can't live with this like this!

Lona

We've taken some of the lines out of what you report and have added our comments, some for your benefit, and then others for the benefit of others reading about your experience.

You state the first dentist recommended having the teeth removed by an oral surgeon ("... and he suggested an oral surgeon ..."). You don't state whether the dentist that actually did the work was an oral surgeon or not ("... a dentist I use to go to years prior ...").

Both general dentists and oral surgeons can be expert at removing teeth. However, and as this page explains, the formation of bone sequestra is frequently related to the level of trauma created during the extraction process (... pulled and tugged pretty hard, fragments went flying everywhere! ...").

Either type of provider may encounter the exact same procedural difficulties and same outcome. But especially with difficult cases, the expectation would be that the added experience and advanced skills that an oral surgeon typically has would result in the creation of less trauma during the extraction process.

--
"... I have been back in to see this dentist 2 more times ..." "... They x-rayed it, and her said it is bone, and that in time it will work its way out. He said to leave it alone and don't touch or mess with it...".

As we describe above, identifying the full scope of a bone sequestrum can be difficult. Over time the object can be expected to ultimately work it's way out. That doesn't mean however that at some point in time a dentist might not feel that conditions are right to speed things along by surgically removing the bit. Your dentist won't be able to decide if this is an option unless you allow them to continue to monitor your situation.

"... but now, it's like it grew back or something ...". This could be evidence that the bony bit continues to migrate up and out, which is what is supposed to be happening.

"... I don't want to have to call him again, because he's giving me the idea he has done all that he can for me ...". It is your dentist's obligation to provide you with the post-operative care that you require.

All dentists understand that some cases will be simple and others won't be. And while it may be that your solution only can be solved by allowing time and the bone fragment to pass, as mentioned, there may be a point where their assistance might provide a quicker outcome. And for that reason, they should encourage you to allow them to continue to monitor your situation.

You mention that you plan to have dentures made. If a different dentist will be providing that service, you might go ahead and appoint with them for evaluation. They can double check that everything you are experiencing seems within normal limits, and that all of the proper ground work about your jawbone (general shape, contours, etc...) are appropriate for future denture construction.

Good luck with this. We hope your situation resolves soon.

1 cm bone left

I had my 4 wisdom teeth taken out last fall and became very sick. I was in constant pain. The oral surgeon kept telling me it was normal and I should not worry. It was the worst pain ever. I was going back to them several times a week for over a month because I could not deal with the pain and swelling.

6 weeks later they actually took time to examine the area and discovered a 1 cm bone chip in one of my sockets. Although they removed the bone chip I was very sick and wound up spending over a week in the hospital for infection. It was very expensive and made me sick for a long time.

Is this size bone chip normal or should I contact a lawyer to try to get money for all my hospital bills?

Mike

What you describe really lies beyond the scope of this page and any information we have to share, but it seems reasonable to state the following.

You mention "wisdom teeth taken out," so we're assuming they were impacted teeth requiring surgical removal. Surgical extractions by nature are traumatic events for bone tissue, thus increasing the likelihood of post-extraction sequestrum formation.

You mention an "oral surgeon" performed the treatment. General dentists sometimes get involved in performing extractions beyond their skill level, one wouldn't think that applies in your case.

As far as the incidence rate of sequestra formation, we found a study by Sigron (2014) (see page reference sources link above) that followed over 1000 lower wisdom tooth extraction cases and determined that the incidence rate for sequestra was 0.3%. (An associated study involving upper wisdom teeth didn't even mention this complication.) Despite that seemingly low number (the highest incidence rate reported for a specific complication by this study was 4.2%), sequestra formation is certainly a known complication.

As far as size, our unqualified opinion would be that 1 cm cube would lie in the "not small but certainly not unheard of" range.

We should also mention that your comment is titled "1 cm bone left." As this page describes, the more likely scenario is that the bone tissue at the time of the extraction was stressed beyond repair, and was ultimately ejected by your body because it finally died, but the word "left," as in left behind, probably is not an accurate description.

We would think that the management of your case was more of an issue than the event itself ("6 weeks later they actually took time to examine ...").

Just when your complication could have/should have been anticipated/suspected/identified/treated lies beyond our level of expertise. We're glad you're OK now but really have no qualified opinion to offer about what transpired.

bone spurs after toothextractions

I had my teeth extracted over four months ago and I'm having problems with bone pieces under my gums that are getting more annoying and painful. I haven't got dentures yet because of the fear these bones will interfere with the process of forming my new dentures and fitting properly afterward.

Roger

You need to go ahead and appoint with the dentist who will ultimately make your dentures. It's common and routine to be evaluated by them first in preparation of your returning for denture construction (even if it is months later). During their exam they can evaluate what you are experiencing and make plans from there.

It could be that what you notice is fragments. If that can be determined, possibly a simple surgical procedure (like that described above) could be used to remove them now, so complete healing can go ahead and occur and you can be more comfortable.

It could be possible that what you feel isn't loose fragments but instead the irregular sharp/pointed surface of the bone. If so, the bone may need to be rounded off (alveoloplasty) before successful denture construction can be accomplished.

Either way, you simply need an evaluation so you can be more comfortable and move forward on your goals.

Had 6 teeth were pulled and denture made

This was done over a month ago. Had bone spur And dentist smooth it, now about 2 weeks later it is back, I have not been able to ware the denture for bone spurs and sores. What is the best next move to solve this problem?

LH

Your solution still lies with your dentist. Having them evaluate your current situation and recommending a solution.

You state "Had 6 teeth were pulled and denture made ... This was done over a month ago."
What you don't say is if your case involved an "immediate denture" or not (your teeth extracted and the denture placed on the same day).

Generally speaking, the healing process for bone tissue takes months. During this time period the shape of the bone changes (transforms from the irregular post-extraction status to a more filled in and smooth shape).

In the case of an immediate, you're simply wrestling with multiple issues (denture fit, learning how to wear dentures and bone healing) all during the same time frame. And your dentist fully expects this type of case to require added assistance and attention while the healing process takes place. So be back in touch with them. (You use the term "spurs." We're not sure whether this means irregular ridge contours or actual fragments coming out, both tend to resolve over time but you probably need assistance with them.)

As a side note, in some cases a dentist might determine that the use of a soft denture liner (likely a temporary one) might be of aid in helping you through this troublesome period when maintaining denture comfort is an issue.

Cammy

Sorry to hear of your difficulties with your extraction and its healing.

The classic symptoms of a dry socket are ever diminishing pain during the days following your extraction, then around day three, noticing that discomfort from the extraction site has started to intensify. They frequently form in association with traumatic extractions (difficult and/or drawn out procedures). So possibly that is a factor with your case.

This page addresses the topic of small post-extraction shards (tooth or bone), because that is something that possibly a patient can manage on their own in an emergency. Anything beyond that (and including that), the person should be in contact with and in the care of their dentist.

With your case, it seems possible that you have some level of infection associated with your extraction site. And of course you have the painful piece of tooth or bone that is now poking out of your wound's surface.

No one can know what it will take to remedy your problem without directly evaluating your situation as it exists now. So, that is where your solution lies.

We'd be disappointed if the dentist who performed your work, once realizing you are having continued problems now for an extended period, wouldn't make addressing your needs a top priority. Since they know the most about your case, they make the logical choice.

If you have lost confidence in that person, then another dentist or ER are options. The idea would be that they would evaluate you and take any immediately needed actions (control your pain, infection if present) and then reschedule or refer for further treatment as is required.

In straightforward cases, as far as procedures go:
In cases where an object (bone, tooth) is identified that the dentist plans to remove:
Since you have pain, they will numb up the area.
In some cases the fragment might tease out relatively easily. If so, once the offending fragment has been remove you will have a fresh wound, but not one that's significantly worse/larger than it was before. Your healing can simply go on uneventfully to completion from there.

If in this scenario the bit offers resistance to simple removal, further surgical intervention will be required.
That may include making some type of gum tissue incision for better access or visibility - The idea here is that incised gum tissue will heal back together more quickly/uneventfully than ripped or torn tissues.
Bone removal - Depending on the object's size, shape, etc..., possibly some bone tissue will need to be trimmed before the fragment can be removed.

With this latter case, your wound will in some ways be more so than it was. But now that the offending/irritating object has been removed, the healing process can return to a more normal path and arrive at completion sooner.

If active infection is thought to be involved, your dentist probably wait until it is controlled (via the use of antibiotics) before performing any surgical procedures.

Thank you!

Thank you for this article, it was extremely helpful to me!

Thank you! Exactly what I was looking for

Thank you for taking the time to make this article. Very helpful with a lot of useful information. I will now go have my dentist remove this little thing that has been bothering me

After extraction, found a shard, then this article

I really love how this article has been written, easy to read & understand & thorough, thank you :)

Jawbione fractures

I had surgery in Jan of 2018 and cannot yet get my plates due to fractures that are now pushing through the gum line. I also have a lump beneath my nose and the 2nd oral surgeon had pushed down and moved the lump into the right part of my jaw bone and just below my nasal cavity. I could feel the round hard spot that felt as though it was sitting out of place. About two to three days later the things pushed into those areas ended up back in a lump beneath my nose between the nasal bone and upper jaw bone. The 2nd surgeon kept telling me that all surgeons make mistakes and none were perfect, until he was asked to look at the lump left above the upper jawbone and beneath my nose. Suddenly he then said what most concerned him was the area he tried to reset. It feels as though the bone that connects the nose to the jawbone is broken and missing on the right side. And the lump that whatever is moved is very hard and painful. I can feel the bone on the left side but not the right My one concern is that when the 1st surgeon pulled the upper right front tooth that he had broken that connecting bone, and just continued on as if it wouldn't or didn't matter. The 1st oral surgeon met me two days before surgery ( due to allergies of numbing meds it had to be done in the hospital) but treated me as if I were drug addict and even though I told him I wasn't asking for them just the surgery, he didn't care. When I woke up after surgery the recovery nurse said he had never seen any surgeon treat a patient this way ever. So now I have fractures in every socket on the bottom pushing through the gums. Do you have any idea what the lump may be or how it can be moved temp, but goes back to a lump in a few days? The word mistake wasn't mention anymore after seeing the lump and moving it, he only said he was concerned. I have no dental coverage beyond what was done, but cannot get plates as I am. My biggest concern is what may be the lump and why does it feel as if there is missing bone in that area? The second surgeon never explained what but knew as soon as he looked at it? I am not able to eat nor have been and need to have a clue what this lump mean to address the insurance company. If you have any thoughts , please send me them and that way I know what I am facing?

DCC

We have no specific information to relay. But in general terms ...

You state:
My one concern is that when the 1st surgeon pulled the upper right front tooth that he had broken that connecting bone ...

and you also state:
why does it feel as if there is missing bone in that area?

Sometimes when a tooth is extracted some of the tooth's bony socket comes out with the tooth (the bone is attached to to tooth more firmly that is was to adjacent bone). No dentist can predict when this will happen, it is an unfortunate occurrence.

In these cases, the jawbone will heal but bone tissue won't grow back to fill the void. So with this scenario, it would feel as if that area was missing bone. (This is why in the next scenario we explain, the dentist would be tempted to leave a segment of fractured jawbone in place if they thought there was a chance it would heal.)

--
Sometimes during an extraction a portion of the jawbone comprising the tooth's socket will fracture. It's possible for the piece to physically be loose.

You state:
... and just continued on as if it wouldn't or didn't matter.

Right at the moment of the extraction procedure, the dentist has to make a judgment call as to whether the fractured bone should be left or removed. It primarily has to do with their interpretation of whether the piece still has a good blood supply or not. If it does, it may heal. If it doesn't, then it will turn into a sequestrum like discussed on this page.

In the case of jawbone fracture the dentist might try to splint the loose piece in place. This immobilization will aid the healing process.

When teeth are present, a wire might be wrapped around adjacent teeth to splint them and their associate bone segments together. In cases where there are no teeth, we're not sure how immobilization is accomplished. But also, if there are minimal chewing forces involved (as in the patient has no teeth and therefore is on a liquid and soft foods diet), we're not sure what the requirement for immobilization is.

---
As far as the object you feel, we have no suggestion as to what it is. To be loose and live bone tissue it would need to have an attached blood supply, which wouldn't seem possible.

If it were a portion of broken tooth or a bone squestrum, we would think there would be more symptoms that just being a loose object. Overall, we really don't know what it is you observe.

---
As one of your protections provided by the HIPPA act, you are entitled to a copy of your medical records. That would include from both of the oral surgeons you have seen.

Best of luck with this.

Reacurring bone spurs after removal

I had oral surgery and had both top and bottom teeth extracted for my dentures. 2 weeks ago had bone spurs removed, they have now came back in the same spots, same size before. Painful to wear my dentures. What is my next step?

Tammi

Per the topic of this page, we're assuming that you're referring to the removal of bone sequestra that have surfaced (a complication associated with bone trauma experienced during the extraction process).

The time frame over which these types of fragments will appear will in part depend on their point of origin (depth in the socket), time needed to separate from associated live bone, shape, etc..., so it's not unexpected that some will appear at different times than others.

You'll simply need to appoint with your dentist. Let them remove them. And then evaluate you, in the sense of determining that what you have experienced/are experiencing lies within normal limits.

Root/bone with red swollen area

I had a tooth pulled about 3 weeks ago that proved to be a fairly difficult extraction. The dentist said - after close to an HOUR of trying to get the tooth out that i "probably should have went to an oral surgeon"... Now i have this swollen red area that bleeds very easily on the area of tooth removal and pain that radiates from my lower jaw up to my ear... i recently felt a sharp point that i pulled out , i guess it was a bone spur/root shard? But i still have throbbing pain. My dentist is on vacation with no one to cover for him, the office called in an antibiotic without me coming in and i am unsure what this red swollen area is.

Sara

It's going to take evaluation by a dentist to know exactly what's going on.
Your dentist's comment "probably should have went to an oral surgeon" more or less implies that they have an association with one(s). Possibly your dentist's staff could help you get directed to them in their absence.

Trauma associated with difficult extractions may result in bone sequestra. You have evidently removed one, possibly others are still trying to work their way out of your extraction site and as such have delayed the healing process.
The pain characteristics you describe are reminiscent of dry socket formation, although the time frame you have experienced is longer in duration than is common.
While we're unclear of the extent or nature of your swelling, infection could be involved (hence the antibiotic you've been prescribed).
Obvious with this range of possibilities, only a direct examination and evaluation will be able to make the proper diagnosis.

As far as pain control, in most jurisdictions a dentist can prescribe narcotic pain medications via phone for emergency situations.

bone chips

I had two tiny pieces come through my gum. At first i thought it was my jawbone coming through my thin gum, and I was quite worried. I was so surprised when the first little chip just fell out followed by the second a couple days later. Then it all healed up really fast.

Infection

I had all my teeth out because they were loose due to infection. When taking out molars on lower left, he found I had pockets of infection below the roots of teeth. It had destroyed part of my jawbone. He said it looked like the infection had been there for over twenty years. I never had problems with my teeth...no cavities, or pain. I had noticed they were getting loose so went in to see dentist about that. Now bone pieces are coming through my gums near my tongue. Just wonder if I will ever be able to wear my dentures.

Carol

It only makes sense that you should express your concerns to your dentist's office. Let them determine if what you are experiencing with bone sequestra lies within normal limits for what's expected after your procedure (multiple extractions involving teeth with long-standing infection, evidently with associated cyst formation).

Feedback