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Is it normal to develop a sharp bony protrusion near a previously extracted site?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At May 8, 2021
Reviewed AtSeptember 7, 2023

Patient's Query

Hi doctor,

I am 64 years old, and I have extremely large, lower, bilateral, buccal exostoses in the outer area and not behind the teeth. It is present as quite a large "ledge" for all my adult life. I had the lower molar removed three months back. I have developed a spicule-type bony sharp protrusion from a part of that area. It is not in front of the extracted site but more in front of the next tooth. The gum over that exostoses is relatively thin since surgery. I am concerned about any infection, but my dentist saw the picture and was doubtful. Is it normal to have such a thin mucosa exposing the bone? Please help.

Hi, Welcome to icliniq.com.

It is good that you know about your exostosis, which is usually uncommon as a finding for many patients. The exostosis or tori are just bony outgrowths with a rare genetic cause. Unless they interfere with your daily activities like talking, chewing, or wearing dentures, they are of no threat. If it is causing an issue or if the soft tissue covering the exostosis is thin as in the picture (attachments removed to protect the patient's identity) and causing inflammation, please follow proper oral hygiene twice a day. Keep the area well cleaned. Try to avoid masticatory stress (chewing stress), pressure due to night grinding, or teeth clenching in that area. Regularly rinse your mouth with warm salt water to keep the tissue free from infection, and use a mouthwash like Listerine every night. Rinse 5 ml and spit it out. You can also use a pain out gel or an analgesic gel like Lidocaine 2 percent to prevent any pain in that area. The main motive is to keep that thin tissue over the exostosis free from infection. Please practice proper hygiene twice a day. You can follow up within a week after practicing good oral hygiene tips, and if still, the issue does not resolve, you can take an antibiotic if you feel the area is too inflamed. You need an antibiotic like capsule Augmentin 625 mg (Amoxicillin and Clavulanic acid) for three days, only if you have an infection. Even if your dentist is doubtful whether it will cause infection or not, if you feel it interferes with your daily life, then please get them removed by your local dental surgeon. I hope that helped. Regards.

Patient's Query

Thanks for the reply, doctor,

My main concern is the actual bone "shard" poking through the skin, and I find it unsettling to feel the exposed sharp bone on that area without mucosal covering. I have researched the after-effects of tooth extractions. However, is it unusual for these to occur so far from the extraction site? The area in question is crunchy and sharp. I can deal with the pain, but how common is this? It is not a thin tissue, but there is no tissue at all in one area. Thank you, doctor.

Hi, Welcome back to icliniq.com.

I understood the problem. If you have to deal with the crunchy, sharp poky area, that you feel like a ledge without any tissue covering as you said, it is indeed a hard feeling throughout the day. You would be well advised to undergo an osseous surgery or, in other words, surgery by your oral and maxillofacial surgeon (dentist specialized in tooth extraction). They will expose that chunk of bone, eliminate the ledge and smoothen the hard bony tissue, suturing soft tissue flap over it, thus eliminating this problem. The procedure will be done under local anesthesia for around half to one hour, depending on the extent of the exostosis. You only need to follow some post-operative extraction instructions similar to tooth removal like rinsing with Chlorhexidine solution twice a day, warm salt water gargle, and eating soft food for around a week. So the only option that remains is to get an appointment from your local oral surgeon to get the exostosis entirely removed because you suspect that it is growing as well. An experienced oral surgeon upon examination will let you know whether it is just an exostosis or a similar growing lesion. If the lesion is suspected not to be an exostosis( which is simple for a surgeon to remove), they will send it for biopsy and plan accordingly. The picture (attachments removed to protect the patient's identity) looks like you have the exostosis for years. Still, if you have pain and the feeling of growth in the mouth, then it is advisable to get it checked locally by the surgeon, pending which the decision of biopsy or extraction will be taken. There is a rare possibility for it to be osteochondroma or osteoblastoma. But if it is a unilateral and slow-growing lesion, a biopsy is required for further investigation. A physical check is needed to detect the lesion's texture, which only a surgeon can feel in person. As you said, the bone can be exposed because of receding soft tissue (that slowly increases with age). After removal, it needs to be sutured back as a flap on top of the eradicated portion. Do visit the surgeon soon if the problem persists. I hope that helped. Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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