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Oral Surgery/chronically inflamed granulation tissue


About a year and a half ago, I had an abscessed lower right molar (number 30). I put off going to the dentist until it was really painful and swollen. I had a pretty prominent gum boil on the buccal side by then. They pulled the tooth.

Since then I've had residual swelling where the gum boil had been. This area started draining about a month after they pulled the tooth and never stopped. The discharge is mostly tasteless, although sometimes it seems to have a slight taste.

I had my teeth cleaned on vacation, and I talked briefly with a dentist. I described my residual symptoms. He didn't really give it a name, but he said that gingival curettage or open flap debridement might clear it up. He said that sometimes it takes 2-3 years to go away, and sometimes it never does.

I did some research and decided (based on his recommended procedures) that I probably have chronically inflamed granulation tissue in my gums (which may or may not still be infected).

I'm starting to worry that I've put off dealing with it for so long that I'll be stuck with it. The lump is bigger than it's ever been. I've also had recent pain in my right ear. I wonder if infection from my draining lump might have migrated through my Eustachean tube to my ear.

I would appreciate it if you would answer the following questions.

1. Does what I've described sound like chronically inflamed granulation tissue?

2. Is this a condition that needs urgent treatment? Or am I okay as long as it's more or less maintaining the status quo?

3. Assuming that I can't get rid of it, what is the long term prognosis? Will infection spread to my ears and sinuses eventually? How do you manage such cases?

Clary, Thank you for your question.
1) I am not really familiar with this diagnosis. If fact, if the infected tooth that was causing the abscess has been extracted the inflammation should resolve very soon. Not in 2 or 3 years. The source of the infection needs to be investigated further. There should not be chronic drainage.
2) No, it doesn't sound like that.
3) The source of the infection needs to be looked out and if this tissue remains in the gums or bone, it needs to be removed. Yes, the infection can spread without treatment. Fortunately, as long as it is draining, it will most likely not continue to spread. DO NOT PUT ANY HEAT ON IT.
4) I think you should see a specialist (board certified Oral and Maxillofacial Surgeon). They will be able to diagnose what is going on. I hope that helps. Please keep me updated.

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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