Tooth extraction is a common procedure that usually goes off without a hitch. Even with surgical extractions, this treatment is standardized to the point where it has become routine. This does not mean, however, that complications with tooth extractions do not arise. Although not common, sequestra are one such complication that can be painful and potentially serious. Here’s what you should know.
What is a dental sequestra?
Dental sequestrum (singular) or sequestra (plural) can occur after tooth extraction if a bone that is damaged during the procedures dies and breaks off into fragments or shards.
A study of almost 1,200 patients found that the incidence of sequestra after tooth extraction is fairly low, with just four patients (.32%) experiencing this complication. Sequestra are much less common with a simple tooth extraction. Surgical extraction with bone sectioning has a higher chance of sequestra in gum as a complication.
Bone fragments after tooth extraction (like sequestra) are recognized as foreign objects in the body. As such, the body’s goal is to eject them. The sequestrum will make its way to the surface of the gums through the path of least resistance: the healing wound. This can cause pain and prolong or inhibit healing.
The bone will begin to present itself through the gum and may feel like a semi-smooth lump. This lump may be movable. If the sequestrum is sharp, it will pierce the gum. This is the stage when most patients begin to worry the bone fragment with their tongue. They may also panic at the thought that their bones are migrating through their gums.
For most patients, these sequestra begin to appear in the weeks following their tooth extraction.
What happens if a tooth root is left in the gum?
If a tooth root is left in the gum, one of two things will happen. In the best-case scenario, this bit of dead bone will cause no trouble, simply migrating out of the gum whenever it’s good and ready.
However, if the tooth has been removed due to gum disease or infection, it is possible that the remaining tooth root can cause trouble. There can be additional damage to the tissue of the gums as well as an opportunity for infection to spread. Your dentist will be able to evaluate this possibility to present you with your options.
Symptoms of bone sequestrum after extraction
Symptoms of bone sequestrum after extraction vary due to each patient’s individual circumstances. Some common signs to look for include:
- Redness and slight swelling around the bone fragment
- Tenderness in the gum
- Whitish ulcer around the sequestrum
Even if the fragment feels enormous, most often it is quite small. Your tongue may find a sharp edge but because of the bone fragment’s size you may not be able to see it. Use a strong, bright light and shine it into the area where you think the sequestrum might be. You may see a small, pinprick of bone, surrounded by reddish and possibly slightly swollen tissue. Only your dentist can identify it conclusively as sequestra, but you may be able to see the dead bone fragment as it moves through the gums.
The edges of the sequestra may be round or sharp. Usually the bone itself is tan or white, and the surface is not quite smooth (but also doesn’t have obvious bumps).
How can I treat dental sequestra?
If you are one of the lucky ones, especially if the sequestrum is sharp and pointy, the bone fragment will make its way through the gum on its own.
However, finding a sharp, pointy piece of bone emerging from your extraction site can be disconcerting, to say the least. Talk to your dentist. They can examine the sequestra and remove the shard for you. If the shard is small and already on its way out, removal may be possible with either no anesthetic or a topical anesthetic. If the fragment is big or reluctant to come out, you can ask for a local anesthetic like lidocaine to ensure a pain-free experience.
Either way, your dentist will use dental tweezers to grasp the protruding sequestrum and quickly pull it out.
In some cases, the bone fragment may be dead but not yet detached. If it is not causing pain and is not at risk for infection, you can wait until it detaches and moves towards the gum surface for easier removal.
Surgical extraction
If the fragment is causing pain, slowing your healing process, or threatening infection, surgical removal may be necessary. Your dentist will use a local anesthetic to numb the gums before making an incision. Using tweezers, they will grasp the bone and remove it. The incision will be thoroughly flushed and inspected. A stitch or two may be necessary, depending on how deep the incision was.
An X-ray can determine if a more involved surgical extraction is necessary, but even then it can be challenging. In the beginning stages when the dead bone is still attached, it will look very similar to healthy bone. Only when the bone separates and begins to migrate to the surface will an X-ray clearly indicate sequestra in gums.
There are also some cases when uncomplicated spontaneous sequestrum occurs. These are unrelated to tooth extraction and occur as a result of local tissue trauma. This trauma can be a one-off event or it may be a result of long-term but low-grade trauma to an area of the jaw.
When the blood supply to the tissue diminishes as a result of trauma, it is unable to protect the bone below it. This causes parts of the bone to die and break off, resulting in sequestra. This type of sequestra can be treated as above.
While sequestra may not be cause to get in touch with your Scottsdale emergency dentist, it’s good to know we are here when you need us. If you are experiencing any post-extraction complications, give AZ Dentist a call and visit us at one of our Phoenix area dental clinics.