Expert: Mark Bornfeld DDS - 4/8/2005

Question
I had all 4 of my wisdom teeth removed about 2 weeks ago (all were fully grown, and only 1 was slightly impacted), and it went well, and about 1 week afterwards I had the stitches removed. The doctor said everything looked good, adn the gums were healing very well, I was cautious with what I ate, and rinsed with salt water and brushed well, etc. My question is this: 1 of the gum "holes" left over (not the impacted one..a "good" one) seems to be closing from the side with what looks almost like a keloid. It looks like its growing from the side of the hole towards the other side instead of from the bottom towards the top(which is what I thought would happan). It seems slightly discolored, nothing alarming, just whitish instead of pink. It doesn't hurt if I gently poke it with a toothpick, and if I push it gently to the side, I can just see the bottom, and it looks redish and tender like it's healing(i can't think of a better way to explain it). Is this normal? Is this how the hole closes? or am I possibly getting some strange tissue growth in the hole. If this is in fact normal, does it continue to grow sideways, and then sort of "seal" itself to the other side? (I'm a bit of a hypochondriach)Thanks!

Answer
Dear Gahl,

The extraction socket tends to heal from all the wound surfaces-- the sides of the socket heal laterally, while the floor of the socket heals vertically. Healing occurs by a process referred to as "organization," whereby granulation tissue (a growth of fibrous connective tissue and blood vessels) penetrates the blood clot, accompanied by a growth of epithelial tissue over the top of the socket. In fact, what you are probably looking at is the clot itself, which is unrecognizable as such because the red coloration has leached out through exposure to saliva. It would not be keloid, which would take significantly longer to form than the two weeks since your extraction.

I admire your academic curiosity about wound healing, which is a fascinating and complex subject. However, I would discourage you from manipulation of the socket. To the extent that you disturb the clot, you may delay the healing process. You do not need to make a conscious effort to detect aberrant healing. You are probably past the point of experiencing this, but if there is something amiss, you will get more obvious symptoms which you should bring to the attention of your dentist. Otherwise, you should let nature take its course.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY