Expert: Frederick R. Liewehr DDS, MS, FICD - 10/4/2007

Question
Hi Dr. Liewehr, I had all of my wisdom tooth removed about 5 wks ago due to a decayed tooth on number 31. So I got a root canal about 3 wks ago and yesterday I went in to have my tooth (#31) prepped for a crown. However after the treatment, I felt a small rough spot inside of my gum where my tongue rests. I believe this "rough spot" is the socket ridge for the wisdom teeth.

My question is, will the gum slowly grow back and cover the protruding socket ridge? If so, how long?  

Answer
I think you are right! When I used to extract wisdom teeth, I always made sure that I fixed this surgically while the patient was still numb. Many dentists do not take care of this, however. In a simple extraction, you have a "sandwich" of bone. The two sides are what we call cortical bone - hard and devoid of a blood supply. In the middle is medullary bone, soft and spongy. If you think of a ham bone in cross section, you will see the outer cortical bone, with the spongy medullary bone in the middle, and marrow in the center. When you remove a tooth, you "wiggle" it in the socket. This compresses the medullary bone, so blood no longer flows in it. As a result, the cortical bone dies. This is nature's way of remodeling the socket. A much better way, however, is to remove it and re-shape the socket during the surgery. If this is not done, you may periodically have what we call "sequestrae" coming out of your bone, which are actually pieces of dead bone. This is not a problem, but can be a nuisance, and really should have been taken care of during the surgery. The process can take months to years.