Are bone fragments coming out of my gum after wisdom teeth removal normal?

Why bone comes out of a healing socket

Removing an impacted wisdom tooth often involves cutting or removing bone to get the tooth out. Some small pieces at the edge of the socket lose their blood supply. Bone that is no longer viable does not simply dissolve. The body walls it off and gradually works it out through the gum, the same way a splinter is pushed out of skin.

The result is a small hard white or yellowish sliver that you feel with your tongue as a sharp edge, sometimes weeks after you thought you had finished healing. It can be sharp enough to irritate your tongue or cheek, which is usually how people notice it.

A retrospective study of 1,432 lower third molar extractions found sharp mandibular bone irregularities in twelve cases, around 0.84 percent, and reported that patients were often asymptomatic or complained only of a slight aching sensation, which the authors said justified a conservative approach.

What to do and what not to do

The default is to leave it alone and let it emerge. A fragment that is nearly out often falls away on its own within a few days.

The rule that matters is not to help it along with anything rigid. Pulling at a piece still anchored in bone can tear the gum, restart bleeding, and turn a nuisance into a wound.

• Leave it alone and let it work its way out.
• Rinse gently with warm salt water after meals to keep the area clean.
• If it is loose and clearly free, it is fine if it comes out while eating or rinsing.
• Do not pull it with fingers, tweezers or floss.
• Do not cut the gum or push at it with anything sharp.
• Call the office if it is painful, if it is cutting your tongue or cheek, or if it has not moved in a couple of weeks.

When to have it looked at

Two situations are worth an appointment rather than patience. First, if the fragment is causing real pain or repeatedly cutting your tongue or cheek, the office can smooth or remove it, usually in a short visit. Published guidance on these bone irregularities notes it is important to determine by palpation whether the piece is loose, since a loose fragment can act as a foreign body and is better removed, and that removal may be advisable even when the bone is not loose if it is causing pain.

Second, if it comes with signs of infection. Pus, a foul taste that will not rinse away, fever, or swelling that starts increasing again all move this from watchful waiting to a phone call. Sequestra can also occur in the setting of infection or delayed healing, which is a different situation from an ordinary sharp edge.

Tell your surgeon if you take a bone medication such as a bisphosphonate or a denosumab type drug, or if you have had radiation to the jaw. Exposed bone in those patients is assessed differently and should never be watched at home.

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