I had a molar removed. Why is a sharp bone spicule forming?

Question

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 has been 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 the exostoses has been 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.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

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 the suggestions below:

Maintain proper oral hygiene twice a day and keep the area well-cleaned.
Try to avoid masticatory stress (chewing stress), pressure due to night grinding, or teeth clenching in that area.
To keep the tissue free from infection, regularly rinse your mouth with warm salt water, 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 two 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.

You can follow up within a week after practicing good oral hygiene tips, and if still, the issue still 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 it removed by your local dental surgeon.

I hope this information helps provide some insight into your symptoms.

Please do not hesitate to reach out if you have any further questions or concerns.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understood the problem.

If you have to deal with the crunchy, sharp, poky area, which 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 smooth the hard bony tissue, suturing a 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 had 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 that it is an 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. Visit the surgeon soon if the problem persists.

I hope that helped.

Thank you.