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Ahel [ 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. If so, they may find their way into the empty socket and get left behind. Bone fragments, spurs, bony flakes. 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: 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 Likewise, tooth fragments themselves will be non-sensitive to touch but their surrounding tissue may be. Post-extraction bone sequestrum and tooth 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 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. 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. Since these objects have no beneficial value, and in fact are instead a complication, your body's goal is to eject them. 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. 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. 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. 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. The paragraphs below explain why. 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. The bone that makes up a tooth's socket is fragile and aspects of it can be broken during the extraction process. Your dentist will thoroughly flush out your tooth's socket to remove any loose debris. 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. If they don't survive, they will become bone sequestra. 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. A broken root tip remaining in the tooth's socket. 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. 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. 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. 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. If so, the use of some type of anesthetic might be in order. A dentist has two types of numbing agents that might be used: 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. 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.
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