white stuff coming out of gums after bone graft surgery
 

Hi,

I was told I had to have a bone graft done on my lower left jawbone (#18) due to an extraction of a wisdom tooth I had done over 10 years ago. Why didn't they catch this sooner, I don't know. I have been asking that from my regular dentist and perio specialist before I made the decision to have the surgery. I felt like they did not want to point fingers at one another for an oversight. I did not have any pain at all before they told me this news. After the dentist cleaned the area and injected some clear liquid into the pocket my gums had formed and after the perio specialist poked around the area, an infection formed which forced me to have an emergency surgery.

After the first month, I noticed some white stuff coming out between my gums and tooth. It was soft, not hard like the bone graft material. Yes, I had some bone graft material come out but was told this was normal. OK, so I did not worry until this white soft stuff came out. I went to the perio specialist who did the surgery and was told it was scare tissue and removed it. Was told not to worry. I asked if I could brush on the site with an electric toothbrush and was told at this point I could do anything, eat on that side, brush, floss, just go back to my regular activities. I was also told to push down on the gums with a toothbrush he gave me. When he did this to my gums it bleed and hurt. I was told to do this and eventually the bleeding will stop. I did what was instructed.

I thought I have seen the last of the white stuff but no. It continually comes every now and then. I simply remove it with the toothbrush he gave me. I am in no pain but wonder if this is normal.

I'm I losing the bone graft material he put in there?
Is this white stuff suppose to keep coming out like this?

I hope this bone graft is successful because I had to pay all of this out of pocket ($ 2,000). I don't know what I will do if I had to have another one. I may not have it done due to the fact I barely could afford this one.

Has anyone had a similar experience? Any advice or suggestions would be greatly appreciated.

-P

Hi,

I'm wondering if the white stuff coming out of the gums in that area is pus. Do you have a bad taste at all?

Bryanna

No, I don't have a bad taste in my mouth. The white stuff looks like soggy bits of rice. I smash it with my fingers and there is no odor from it. It appears every now and then. I am wondering if this is the bone graft material that turned from being a hard grainy type substance to this soggy like material. Is this normal? I have more check ups with the perio specialist who did the surgery, but I feel as if he is not concerned about it enough. I don't want to go through this again, in say 3 or 4 months down the road. I'm not in any pain physically just financially. This surgery was a surprise and unexpected. I still cannot believe I had to get it. I only had one cavity in my life.

Any suggestions or advice is greatly appreciated.

Hi p_v13,

Bone graft material is generally hard and does not resemble anything soft or soggy. Also, it is not very common to have bone graft material seep out of a surgical site a month or so post op. So I'm not sure what this is. Sometimes the dentist will put a collagen plug in the site on top of the bone graft... this acts sort of like a blanket to protect the graft and keep it in place during the initial healing phase. This plug is white and spongy.. but the plug actually becomes one with the initial blood clot that forms immediately after the surgery. So I would be surprised if that's what you were seeing.

If it is pus and there is an infection there... you don't have to have pain or swelling because the bacteria has found an opening to seep out. If it is infection and that area closes off, then you would get pain and swelling. However, I am not sure what you have.

By any chance.... could it be plaque? Are you brushing thoroughly in that area?

Bryanna

Hmmmm...interesting. the white spongy plug that you described seems to fit what i am seeing from time to time but then again i am unsure. it's not a large amount that come out but it's enough to alarm me. Also, why does he have me push on the gum lines with a tooth brush? is this suppose to help get the blood to circulate or what? in some areas it is still tender and i do not push hard on the gum lines like he showed me.

Yes, i have been doing my best to keep the area clean. i floss, brush with an electric tooth brush, and rinse with warm salt water. also i clean the area again with chlorohexidine he gave me. I do all of this 3x a day and whenever i eat something. should i be doing more? Any suggestions?

Oh, i wanted to know if part of your gums are suppose to feel numb. when i floss i cannot feel my gums in a certain area. i believe this is the part where he put the stitches in order to hold the flap of gum over the bone graft. will the numbness go away or is this permanent? Should I be alarmed?

Thank you for answering my questions. i greatly appreciate them.
P

Hi p_v13,

The collagen plus that I mentioned is one piece. It does not separate from itself and it becomes engorged with blood from the initial clot. So I'm thinking it's probably not that.

Did your dentist tell you it's ok to use your electric toothbrush? Some dentists suggest not to use it for the first 6-8 weeks post op. Gentle flossing is needed, but don't use the floss too aggessively. Gentle, "thorough" tooth brushing with a very soft bristle toothbrush twice a day, floss once a day unless food debris gets stuck in between the teeth someplace, and salt water rinsing 2-3 times a day. That is really all that is necessary for post op care after your type of surgery.

Every time you brush along the gumline in both the front and back of your teeth, you should have the bristles of the toothbrush at a 90 degree angle along the gumline. Use gentle circular motions around the front and back of every tooth as this mechanical action will remove plaque and massage the gum tissue. Then use the brush in a back and forth horizontal motion along the biting surfaces to clean them.

I think the white stuff is either a little bit of pus or plaque....... that's my guess based on your description of things. When do you go back to see the dentist?

Bryanna

Thank you for your suggestions. I thought that using an electric toothbrush was too soon but asked him more than once if it was ok. I was told yes I could do anything. He didn't seem too worried about the white stuff when he looked at it and gave me the impression that I was worrying for nothing.

I have a 2 month check up with him Dec. 9. I will mention again that I still see the white stuff every now and then. I will also ask if it is plaque or pus. Hopefully he can give me an explaination as to why this is happening. I do not want to go through this ordeal again. I have never had any problems with my teeth before and this one threw me.

If it is plaque or pus, will he just give me more antibiotics and clean the area? Will that get rid of the white stuff? Again, I am not hurting but I do not want to wait til I get to that point and suffer major pains and problems.

Thanks again for your advice. I will let you know what he said.
-P

Hi p_v13,

If it is plaque, he will instruct you on how to clean the area more thoroughly. If it is pus, then he will have to determine why it is infected and prescribe treatment and/or antibiotics accordingly.

Hopefully it is something that is easily remedied. I know this whole thing has been an ordeal for you especially since it was so unexpected! Try not to worry about it.... just keep the area very clean without over cleaning =)

Please let us know what he says on the 9th!

Bryanna

I had my appointment today and thought I share what the Doc had to say. I mentioned all of my concerns especially the white stuff coming out of my gums. He said not to worry about it. I am doing exactly what I am suppose to be doing. As long as I do not have any pains that is keeping me up at night then all of the things happening are normal. He examined me and gave me another "special toothbrush" to continue cleaning the area with. He is satisfied with the progress and will see me in 3 months. By then he will x-ray to see the progress of the bone graft.

It appears I am on the right track with my oral health. Thanks for your replies and suggestions. You have been very helpful.
-P

Hi p-v13,

Well that's great news!! Just curious, did he say what the white stuff was?

Bryanna

He mentioned it was scare tissue and possible fat. he said this was a spot that when he closed the area, my gums did not quite meet.

does this sound logical?

-P

He may be referring to granulation tissue. That frequently forms at the site of a surgical wound. If it continues to grow there, it may have to be removed because it will cause a deep pocket. That's why he is suggesting you use various forms of cleaning methods to reduce the formation of the granulation tissue. Makes perfect sense!

Bryanna


QUOTE=p_v13;724289]He mentioned it was scare tissue and possible fat. he said this was a spot that when he closed the area, my gums did not quite meet.

does this sound logical?

-P[/QUOTE]

[/QUOTE]


thank you so much for all of your responses Bryanna, it really helped put my mind at ease with all of the doubts i had about having the surgery in the first place. it's nice to have a second mind to pick on such matters.

happy holidays to you and your loved ones!
-P

You are very welcome...... it's been a pleasure chatting with you.

All the best to you and your family also!!

Bryanna



thank you so much for all of your responses Bryanna, it really helped put my mind at ease with all of the doubts i had about having the surgery in the first place. it's nice to have a second mind to pick on such matters.

happy holidays to you and your loved ones!
-P[/QUOTE]

Hi Bryanna,

I'm 3 weeks into my tooth extraction/bone graft. I just noticed today that there appears to be the same white soft material visible that p_v13 mentioned, however for me it's not coming out, it's just kinda hanging there inside the socket, but extremely visible. Could this be the plug you mentioned? It's very very soft, almost squishy. Otherwise though, my gums feel really good, and look to have a good color as well. No signs of swelling, and no real pain to speak of either. I'm just scared of what it means if it does fall out. Do I worry about the plug coming out?

Sorry for all the questions :)

Hi nienna,

The "plug" is a collagen membrane and that has already been absorbed.

White stuff inside of the socket could be new tissue growth, food debris or plaque. If you are doing well in general, just keep rinsing with warm salt water until the site closes over. A pinch of salt in a cup of warm water 3 times a day is adequate.

Thanks so much Bryanna :)

When I woke up this morning, a little bit of it did come out. I honestly couldn't tell what it was, especially since I did eat white noodles the night before, it is entirely possible that it's simply food debris LOL!!

It does appear to look to healthy and healing, I was more worried that my gums were maybe receding too much, causing bits to fall out. It's so hard to tell when you know so little about it :o

Bryanna (or anyone who knows),
I had oral surgery 9 days ago. Got #30 extracted and was supposed to get an implant, but the bone wasn't sufficient enough apparently so he did a bone graft and I will have to go back in 3 months for actual implant.
I also just noticed some white stuff around the area. It appears that what the member said above about it being tissue from where the gums didn't come together could be it but just want to make sure. It looks like it was between where the stitches were. I still have to take 800mg Ibuprofin (not taking any opiates) every 5-6 hrs but seems to be getting a little better. Just wanted to see if this is the norm or what. I see the doc again in a week and will ask him too.
Thank you

Here is a pic of the area if it helps.
https://scontent.ftpa1-1.fna.fbcdn.n...e9&oe=56DB5862

Hi Rick,

Thanks for posting the picture!

The photo is a bit blurry but I can see the "white" areas of gum tissue. The white appears to be rather thick or lumpy in consistency. Is it actually gum tissue or accumulation of plaque? Can you gently remove it with a slightly moist q-tip? Or does the white substance seem to be coming from inside of the socket like pus would? I can also see that there is quite a bit of dark red inflammation along the lingual (tongue side) of the ridge that travels down toward the floor of your mouth. By any chance was the extracted tooth previously root canaled?

What are rinsing with and how often? Are you sticking to a soft food diet or eating regular food? Are you avoiding chewing on that side of your mouth?

Bryanna

-I just touched it with the end of a floss stick and the white area seems kind of hard. Could it be that much plaque so quickly? I didn't scrape at it too much. It kind of looks like its coming from the side of the socket. Not directly in the middle where the tooth was.
-Yes the tooth was root canaled previously and treated once also.
-I used Peridex oral rinse for a few days until it ran out. Now I'm using salt water 3 times/day.
-I'm pretty much eating like normal but chewing on the other side of the mouth.
Thank you!
Rick

OK I took my contact lenses out so I could see better up close(getting old haha) and i noticed that the white coming up through the gums appears to be white material with little blue dots or perforations. I'm assuming it is the membrane. Is this normal? I will call the doc tomorrow and let him know just to be on the safe side.

Rick,

Please refrain from using anything pointy or sharp in the area of the extraction site. A moist cotton q-tip would be the "sharpest" thing to use there :) Be sure to keep rinsing with warm salt water 3-4 times a day and continue to avoid eating on that side.

The white area could be bone graft material or a piece of the membrane. It could also be hard tartar... which does not happen too often. It is best to call the surgeon tomorrow and let him know about this and also mention that the lingual (side near the tongue) is very dark red and inflamed. This may be normal depending on the severity of the initial infection and the surgical technique he used, but it's better to find out for certain.

So the tooth had been root canaled previously, okay I thought so based on your description of the extensive bone loss. The additional treatment on the tooth... was that an apicoectomy?

Bryanna

I'm not sure what it was called. So I went to the oral surgeon today and the white thing was in fact the membrane that was coming up. He did a CT scan and an X-ray and said everything looks great. He removed the membrane, washed the area up a little and that was it. Supposed to go back in 3 weeks for check up. Hope it heals up and I won't have any more problems.

Rick,

Thanks for giving us an update.

Good to hear that the surgeon thinks it looks to be healing okay. Hope the site feels better with that membrane out and everything from this point on goes uneventfully :)

Bryanna

It can be fibrin or necrotic-white graft tissue
 

The white film can be fibrin or necrotic-white graft tissue.
If the graft tissue was thick to start with, the superficial layer will slough off but the deep parts will survive. (The most outside portion of the graft would not survive due to lack of blood supply. It becomes necrotic-white and comes out.)