Medical Forum / General / Dentistry / January 2006
Live molar 'root' poking through gum
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axmonti@hotmail.com - 15 Dec 2005 18:42 GMT Good day,
I've searched and searched on this subject to no avail - I'll try to keep this short.
A few weeks ago, I woke up with a sore gum and tongue - right beside my last molar (I've never had wisdom teeth). The next day, my molar started to hurt when I bit down on something, and the gum was quite sensitive. The following day, I couldn't bite down on anything without pain, and my lymph nodes were swelling a bit (no gum swelling though). That night I went to a medical clinic, and the physician gave me Erythromycin and asked me to see a dentist. Two days later, the pain was gone, but I noticed that my second last molar was 'higher' than the other teeth. That molar has a filing, but I've never had a root canal or anything like that. I also noticed some 'crowding' on my front lower teeth.
A week later, I saw the dentist. He took x-rays and poked around and said that everything appeared to be normal. He indicated that the physician probably mis-diagnosed the problem, as the flu was going around (which explains the swollen nodes), and I probably just bit down on something hard and 'strained' the ligaments of my molar. He noted that there was no gum swelling, no gum boils, no bad taste, and no sign of root infection, etc. He placed some cold material on my molars and indicated that the nerves were indeed alive and well.
A week later, I noticed a 'dent' on my gum (about 3-4 mm below the gumline) right beside a small bony 'bump' that I've had for years. A day later, I was poking around my gums with a cleaning pick, and I was able to put the pick right inside a small hole in my gum. I could feel something hard with the pick, so I picked some more, and out popped what I can only describe as a small piece of 'sea coral'! If I pick inside the hole now, I can still feel something hard, but it seems more firmly attached (I think it's the bony bump). I don't know if it's far enough down the gumline to be a tooth root, but it certainly is bone or tooth-like. Throughout all of this, I've felt no additional pain, but my nodes are still a bit sore (though less than before). My front teeth are still 'crowded', though it seems no worse than before.
So, my question to the dental community is: What is happening to my tooth and gum? I'm not sure if I trust the dentist I saw, but I figure I'll probably have to see someone at some point. Could an original infection have caused the tooth to raise slightly, breaking off a piece of rough tooth material from the side of my tooth? Could I really have an infection that is rotting the roots and breaking off chunks that migrate to the surface? Why would my x-ray look so normal, and why wouldn't my gums be swollen or sore at all. Could I have bitten something hard that caused a piece of broken root to migrate through the gumline? The dentist who I saw indicated that I should come back if I start experiencing pain again, and that if it was an infection, he'd expect me back in about a month. Should I just wait to see if the broken piece of tooth was causing all of this?
Any and all comments are greatly appreciated.
Thanks, Andrew.
Mark & Steven Bornfeld - 15 Dec 2005 19:45 GMT > Good day, > [quoted text clipped - 53 lines] > Thanks, > Andrew. Could be foreign body, or tartar, or...almost anything. This sounds like something that should be immediately obvious to a competent dentist, but only speculation if I or another guess. BTW, don't go picking around your gums with a "pick".
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
axmonti@hotmail.com - 15 Dec 2005 22:10 GMT Thanks for the reply Steve. Believe me, I wish it was just a popcorn shell or something simple like that. When I poked around, it really felt like whatever was in there was part of my tooth. I don't have a good idea what tooth roots look like below the surface of the gumline - can they resemble coral-like structures? Could this be bone material? Have you seen anything like what I describe before?
- Andrew.
Mark & Steven Bornfeld - 15 Dec 2005 23:05 GMT > Thanks for the reply Steve. Believe me, I wish it was just a popcorn > shell or something simple like that. When I poked around, it really [quoted text clipped - 4 lines] > > - Andrew. OK, I'll guess. You may have fractured a cusp on a molar, and it may either be hanging on to the gum, or else you may have dislodged a large lump of tartar. Understand that this is a wild guess; if there is any way for you to post a photo somewhere it would help. But it's unlikely this is a big mystery.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
axmonti@hotmail.com - 15 Dec 2005 23:09 GMT Update: there's definetly a larger piece making its way through! My theory is that when I bit something hard, a piece of my tooth broke off and became infected. The antibiotics cleared up the infection, but the broken root is making its way through my gum. It's not painful or bleeding, but I'm wondering what to do with the hole it leaves behind! Does any of this make sense to the dental professionals out there?
- Andrew
axmonti@hotmail.com - 15 Dec 2005 23:15 GMT Sorry Steve,
I must have been typing while you were posting. I think you hit the nail on the head with the fractured cusp. Now, what do you normally do in these situations? Does the tooth have to be extracted, or can it recover from a chunk being broken off?
Thanks for the accurate guess! I'll post a picture on Flikr if I have a chance... - Andrew.
Mark & Steven Bornfeld - 15 Dec 2005 23:23 GMT > Sorry Steve, > [quoted text clipped - 6 lines] > a chance... > - Andrew. If you put your finger on the fractured segment and can see it wiggling, there is a good chance it hasn't broken off TOO far under the gumline. Typically this happens in a tooth with a large filling. The cusp fractures down and away from the chewing surface of the tooth. While sometimes it fractures way down under the bone and needs to be extracted, there's a better chance it can be pulled out. The tooth will likely then need a crown.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
axmonti@hotmail.com - 15 Dec 2005 23:30 GMT Yes, it's wiggling - but (and this is the important part) it's wiggling through a hole in my gum! My gum seems to be rapidly pushing it out, and soon, it's going to make its way through the gum! The tooth does indeed have a large filling. The fracture is completely under the gumline, as the tooth above the gumline is intact. The dentist already indicated that the tooth had two large cracks and would probably need a crown. Maybe he didn;t realize just how cracked the tooth was.
Any recommendation as to how I should treat the residual hole left in my gum when the broken part comes out?
Thanks again, Andrew.
Steven Bornfeld - 16 Dec 2005 02:44 GMT > Yes, it's wiggling - but (and this is the important part) it's wiggling > through a hole in my gum! My gum seems to be rapidly pushing it out, [quoted text clipped - 9 lines] > Thanks again, > Andrew. Shouldn't be necessary to treat. When the fragment is removed, the gum will heal. Then you can concentrate on fixing the tooth.
Steve
axmonti@hotmail.com - 16 Dec 2005 07:00 GMT Hi Steve,
Here's a couple of images of the gum with piece sticking through:
http://www.flickr.com/photos/amonti/
Not much progress tonight - I think that the piece has 'settled' a bit. Any commentary on the images is appreciated.
- Andrew
> Shouldn't be necessary to treat. When the fragment is removed, the gum > will heal. Then you can concentrate on fixing the tooth. > > Steve Whamatus - 16 Dec 2005 16:37 GMT OK that looks like a lingual sequestra to me.
These things sometimes develop spontaneously. If I am correct, treatment would be removal with anesthesia, or let nature take it's course.
I doubt very much that this is tooth structure.
JMHO
>Hi Steve, > [quoted text clipped - 11 lines] >> >> Steve --
Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
axmonti@hotmail.com - 16 Dec 2005 18:31 GMT Thanks for the response! This morning, the gum seemed to be closing up around the piece that was sticking out. I wasn't sure what a lingual sequestra is, but after reading this article, I'm going to have to agree with your assessment(http://www.ada.org.au/media/documents/Products_Publications/Journal%20Archives/2 003%20Archive/March/0303Fara.pdf
My question is this: will it eventually come out on it's own accord, ir will the surround gum close in on it? Also, could the original infection that I had have caused this to occur, or should I be checking myself for some other disease (I just had a complete physical, and I am otherwise healthy).
Thanks again, Andrew.
Whamatus - 17 Dec 2005 00:30 GMT >Thanks for the response! This morning, the gum seemed to be closing up >around the piece that was sticking out. I wasn't sure what a lingual >sequestra is, but after reading this article, I'm going to have to >agree with your >assessment(http://www.ada.org.au/media/documents/Products_Publications/Journal%20Archives/2 003%20Archive/March/0303Fara.pdf Haven't checked the site yet.
>My question is this: will it eventually come out on it's own accord, ir >will the surround gum close in on it? Usually yes, the question usually becomes how long are you willing to wait for nature to take its course.
>Also, could the original >infection that I had have caused this to occur, or should I be checking >myself for some other disease (I just had a complete physical, and I am >otherwise healthy). I question if you ever had an infection there. It is quite possible that the amount of inflammation that you had was merely from the sequestra (dead bone) being rejected by the body as a foreign object.
Seriously doubt that you have a systemic problem. This is extremely likely only a local phenomenon. Have seen a lot of these, I remove them if it bothers the patient enough.
Once the sequestra is exfoliated (gone) the gingiva (gum) will heal over as if nothing ever happened.
>Thanks again, >Andrew. Yer welcomed dude, / --
Whamatus Bemoana wubbabubbazG@RBAGE at yahoo dot com
axmonti@hotmail.com - 22 Dec 2005 06:35 GMT Oh for Pete's sake! You guys are going to string me up for changing my theory so often. Tonight I noticed that the bone was sticking out more than ever before, so I pushed on it, and now it is quite moveable in all directions. I'm going back to Whamatus' lingual sequestra assessment. There's a noticeable 'dimple' in the gum just beside one edge of the bone. Could this be where the bone used to be?
I uploaded a couple of additional photos, and the change is certainly noticeable: http://www.flickr.com/photos/amonti/
It's been almost a week, so according to most lingual sequestra accounts, it should be another 2-3 before it comes out. This is why I wouldn't make a good dentist; I can't just come up with a theory and stick to it. I can't wait to see what I think of next.
Thanks again, Andrew.
Dartos - 22 Dec 2005 13:57 GMT If it is indeed loose, it should/will come out. Pretty unusual at any rate.
Dartos
> Oh for Pete's sake! You guys are going to string me up for changing my > theory so often. Tonight I noticed that the bone was sticking out more [quoted text clipped - 13 lines] > Thanks again, > Andrew. axmonti@hotmail.com - 22 Dec 2005 15:54 GMT For those of you who are wondering why the visible piece of bone is so white in the pictures, I'll have you know that I'm currenly using Crest Bone Whitening toothpaste with tartar control - for the patients who want little pieces of bone sticking through their gums to be fresh and white.
I figure a little humor never hurts in these situations!
- Andrew.
Mark & Steven Bornfeld - 22 Dec 2005 16:21 GMT > Oh for Pete's sake! You guys are going to string me up for changing my > theory so often. Tonight I noticed that the bone was sticking out more [quoted text clipped - 13 lines] > Thanks again, > Andrew. I agree. It's probably a sequestrum. If you can move it it's about ready to come out. If you can't grab hold of it with a pair of clean tweezers, go to your dentist.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
axmonti@hotmail.com - 29 Dec 2005 06:11 GMT OK, so I noticed that the piece of bone was *really* movable, so I pulled it out, but it practically fell out. There was a bit of bleeding, but it stopped rather quickly, and I was left with a relatively clean depression in my gum. It's filling in nicely now, but there is still a rather sharp bony ridge where the piece was previously attached. I had to pick out a couple of smaller chips, but I'm hoping it's all out now. I'll post a picture of the piece (it's about 5mm x 2mm or so) soon.
Thanks for everyone's opinion!
- Andrew.
> > Oh for Pete's sake! You guys are going to string me up for changing my > > theory so often. Tonight I noticed that the bone was sticking out more [quoted text clipped - 25 lines] > Brooklyn, NY > 718-258-5001 Whamatus_B - 31 Dec 2005 17:05 GMT Hurray !
Give that man 5 'attaboyz' ! Way to go, cowboy.
After the fact, do you consider yourself astute or insane ?
Jes Wunderin', -W_B
>OK, so I noticed that the piece of bone was *really* movable, so I >pulled it out, but it practically fell out. There was a bit of [quoted text clipped - 38 lines] >> Brooklyn, NY >> 718-258-5001 -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
axmonti@hotmail.com - 01 Jan 2006 08:52 GMT I consider you a very astute dentist for nailing the "lingual sequestra" on a very early picture - thanks a bunch! My gum is filling in nicely, but I probably have a few more weeks before the dimple is completely gone. Look for picture of the bone at http://www.flickr.com/photos/amonti/.
Not that my dentist's opinion wasn't amusing (although I still haven't figured out how bone thickens with repeated stress). The fact that a piece of bone broke off in my mouth following some sort of infection or injury doesn't give me a good feeling, but if there aren't any other mitigating factors, then I'll just chalk it up to "one of those things".
Most important of all, I learned that I should stick with a decent single malt whiskey. Maybe I should open that Glenfiddich Special Reserve that's been languishing in a can in my cellar?
- Andrew.
> Hurray ! > [quoted text clipped - 53 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com W_U_B - 01 Jan 2006 21:04 GMT >I consider you a very astute dentist for nailing the "lingual >sequestra" on a very early picture - thanks a bunch! My gum is filling >in nicely, but I probably have a few more weeks before the dimple is >completely gone. Look for picture of the bone at >http://www.flickr.com/photos/amonti/. Thanks for the kudos axmonti. Please remember that even a broken clock is right twice a day.
BTW those are very good pix. My only criticism is that there is no ruler to judge the size of the sequestra.
Out of the blue, am thinking ~`5 x 3' millimeter. Mebbe larger.
The intra-oral pix make most dentists look like amateur photographers. Again, I congratulate you on such clear and concise pix.
>Not that my dentist's opinion wasn't amusing (although I still haven't >figured out how bone thickens with repeated stress). The fact that a >piece of bone broke off in my mouth following some sort of infection or >injury doesn't give me a good feeling, but if there aren't any other >mitigating factors, then I'll just chalk it up to "one of those >things". Yep, as I said before, 'idiopathic'. Admittedly a 'catch all' phrase, but accurate nonetheless. BTW that's an ugly freakin' sequestra. No wonder it hurt. No infection though, foreign body reaction, much like a splinter.
>Most important of all, I learned that I should stick with a decent >single malt whiskey. Maybe I should open that Glenfiddich Special >Reserve that's been languishing in a can in my cellar? > >- Andrew. Well that would be at least a 'good start'. <hehe> Try a search for 'single malt scotch whisky' Am currently on the hang of "The Balvienie" styles. Was onto some of the Islay varieties earlier.
Let me know when you are shipping the bottle of Cask 191.
Remember that a true connoisseur will disdain any 'blend'.
>> Hurray ! >> [quoted text clipped - 42 lines] >> >> >> >> Steve -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
axmonti@hotmail.com - 02 Jan 2006 09:44 GMT I finally found my dissection kit ruler and have uploaded three more shots to http://www.flickr.com/photos/amonti/. I really couldn't take a picture with just any ruler!
You will see that the piece is very nearly 5mm x 3mm (another excellent guess). I also uploaded a shot of the residual 'dent' in my gum. Yes, it is healing nicely, but I really didn't expect my lymph nodes to become as swollen as they did. They are still a bit annoying, but better each day.
If you look at the properties of the pictures on Flickr, you'll see that I'm using a Sony Cybershot DSC-S70 - which isn't my main camera, but it has an excellent macro program. I used a cheapie Maxill dental mirror, and stood in front of a wall mirror. That way, I could see the camera's display in the mirror and line-up the shot. The only thing I couldn't seem to do is set the focus exactly on the dental mirror. I've seen some dentists use a fiber optic camera to show patients cracks in their teeth and such. I'm thinking that a system such as that would help immensely. I hope the photos serve as a decent guide for anyone else in the same situation (the ADA article is very good as well).
As for Cask 191, I figure that the bottles will be long gone before I've saved up enough to place my order!
- Andrew.
Whamatus_B - 03 Jan 2006 17:39 GMT >I finally found my dissection kit ruler and have uploaded three more >shots to http://www.flickr.com/photos/amonti/. I really couldn't take >a picture with just any ruler! Good !
>You will see that the piece is very nearly 5mm x 3mm (another excellent >guess). I also uploaded a shot of the residual 'dent' in my gum. Yes, >it is healing nicely, but I really didn't expect my lymph nodes to >become as swollen as they did. They are still a bit annoying, but >better each day. It should heal nicely now with very little permanent defect.
>If you look at the properties of the pictures on Flickr, you'll see >that I'm using a Sony Cybershot DSC-S70 - which isn't my main camera, [quoted text clipped - 7 lines] >for anyone else in the same situation (the ADA article is very good as >well). Your pix are excellent very clear. Yep, those intraoral shots are tough but they are the best self-done that I have seen.
>As for Cask 191, I figure that the bottles will be long gone before >I've saved up enough to place my order! Same for me !
>- Andrew. --
Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
Whamatus_B - 22 Dec 2005 16:55 GMT After reviewing your descriptions of your dilemma, I must reiterate my cyber-conclusion that you have a 'green stick' fracture of the bony protuberance lingual to the 2nd molar.
It is a *very* *minor* surgery to fix this problem. Anesthetize the lingual nerve, incise the tissue well above the sequestration but below the attached gingiva, rongeur the bony 'splinter', then file with either a bone file or rotary surgical 1702, then suture with 4/0 gut.
It should take all of 7½ minutes.
The mucosa will heal uneventfully within 7 - 12 days.
If 'axmonti' is willing to come to Casper, WY... I might just do it for free,. OK, in trade for a bottle of Cask 191 that we may each drink a dram. My siste,r A_C, may be intrigued by this option
The other option is to let mother nature take its course and quit frakin' with it.
The astute patient may even take a *sterilized* needle nose plier and remove the offending dead bone splinter without fear of infection. Of course, one considering 'self surgery' must "Cowboy Up" before attempting such a task. It *is* do-able.
The mucosa will not heal until the necrotic bone is removed or expelled.
>Oh for Pete's sake! You guys are going to string me up for changing my >theory so often. Tonight I noticed that the bone was sticking out more [quoted text clipped - 13 lines] >Thanks again, >Andrew. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
Amatus Cremona - 22 Dec 2005 17:12 GMT Cask 191 ? I'll drive up from Oklahoma.
 Signature /
Amatus
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> > After reviewing your descriptions of your dilemma, [quoted text clipped - 51 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com axmonti@hotmail.com - 22 Dec 2005 17:35 GMT Wow - that's pretty amazing over the Internet! Your assessment would explain why I only feel a 'jagged' edge on one face of the bone - the other seems to be well-implanted in the gum, and I was always trying to figure out how far back the other end of the break was. If I recall green stick fractures, a thin slice of bone splintered off from the rest of my jaw, but I can't tell whether or not you think it's still connected to bone at one end (it feels like it). It seems exactly like a bone splinter sticking out. This raises a few questions:
What the hell caused this in the first place? I'm assuming that's what my original pain was all about - I obviously broke a bone in my jaw somehow, but I certainly couldn't tell you how. Is is possible that I bit down on something hard, or (I hate to ask) could it be due to teeth clenching or grinding? How common is this?
If it is still connected at one end, how would it ever be expelled on its own? Wouldn't the rest of the splinter have to necrotize, break off, then be expelled? Will the other part of the bone ever be the same? Can you provide a comment on how nature would handle this?
Ha! I love how you use 'astute' in place of insane, but in your practice, I guess you've seen it all! I'd be more tempted to take my Dremel tool (with a sterilized burr bit) to the bone before yanking on it with pliers. I'm just not that good at suturing, and I've never sutured a gum.
As for Cask 191, I thought I should send you something for the free assessment, so I checked out the Website:
http://www.balvenie.com/shop/cask191.html
No to be crude, but holy freakin sh.t! Even a dram would be about $500! Oh well, how about this:
http://www.johnniewalker.com/en-us/OurLabels/BlackLabel
Although Casper seems quite beautiful (where Richard Cheney and his bride-to-be grew up?), several years ago, I opted to take route 20 to Devil's Tower and the Black Hills (from Yellowstone) instead of Route 26 though Casper, so I missed your City completely. Not that Independence Rock wouldn't be interesting as a follow-up trip. Thanks for the invitation regardless!
- Andrew
Amatus Cremona - 22 Dec 2005 18:22 GMT  Signature /
Amatus
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> Wow - that's pretty amazing over the Internet! Your assessment would > explain why I only feel a 'jagged' edge on one face of the bone - the [quoted text clipped - 40 lines] > > - Andrew Can you make it Gold Label ?
axmonti@hotmail.com - 22 Dec 2005 18:35 GMT Ha - sure! I've never tried Gold (or Blue) Label, since my taste buds aren't that discriminating. It's usually Red for me.
Just yesterday I 'splurged' and picked up some Appletons rum - boy is there ever a big difference over cheap swill (which I didn't think was too bad a second before I tried Appletons).
Maybe Gold Label would have the same effect?
- Andrew.
Amatus Cremona - 22 Dec 2005 18:39 GMT yup
 Signature /
Amatus
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> Ha - sure! I've never tried Gold (or Blue) Label, since my taste buds > aren't that discriminating. It's usually Red for me. [quoted text clipped - 6 lines] > > - Andrew. Whamatus_B - 30 Dec 2005 19:31 GMT >Ha - sure! I've never tried Gold (or Blue) Label, since my taste buds >aren't that discriminating. It's usually Red for me. [quoted text clipped - 6 lines] > >- Andrew. Do yourself a favor and move up to single malt.
-- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
Whamatus_B - 30 Dec 2005 19:31 GMT >Can you make it Gold Label ? Blended Scotch ? Yuk.
-- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
Whamatus_B - 30 Dec 2005 19:31 GMT >Wow - that's pretty amazing over the Internet! Your assessment would >explain why I only feel a 'jagged' edge on one face of the bone - the [quoted text clipped - 10 lines] >bit down on something hard, or (I hate to ask) could it be due to teeth >clenching or grinding? How common is this? We tend to call these types of things 'idiopathic', which is just a fancy way of saying 'we don't know'.
>If it is still connected at one end, how would it ever be expelled on >its own? Wouldn't the rest of the splinter have to necrotize, break >off, then be expelled? Will the other part of the bone ever be the >same? Can you provide a comment on how nature would handle this? Eventually the dead bone breaks off and the tissue heals.
>Ha! I love how you use 'astute' in place of insane, but in your >practice, I guess you've seen it all! I'd be more tempted to take my >Dremel tool (with a sterilized burr bit) to the bone before yanking on >it with pliers. I'm just not that good at suturing, and I've never >sutured a gum. Rotary instruments used in the mouth should be restricted to use by a dentist. Dremmel tool ! Now *that's* insane ! 8^D
>As for Cask 191, I thought I should send you something for the free >assessment, so I checked out the Website: [quoted text clipped - 3 lines] >No to be crude, but holy freakin sh.t! Even a dram would be about >$500! Oh well, how about this: Yeah, kewl huh ? I'll be expecting that bottle to arrive on my doorstep right after the evening news reports that hell froze over. ;-)
>http://www.johnniewalker.com/en-us/OurLabels/BlackLabel Nice try, but I don't drink blended scotch.
>Although Casper seems quite beautiful (where Richard Cheney and his >bride-to-be grew up?), several years ago, I opted to take route 20 to [quoted text clipped - 4 lines] > >- Andrew -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
Steven Bornfeld - 16 Dec 2005 20:43 GMT > Hi Steve, > [quoted text clipped - 6 lines] > > - Andrew Well, the molar looks intact. Could be a foreign body. Sequestration usually occurs after an extraction. I actually can't see anything protruding out of the gum--just see the ulceration. This should be checked. It doesn't look ominous, but I'd want to see what it is in person.
Good luck, Steve
>> Shouldn't be necessary to treat. When the fragment is removed, the gum >>will heal. Then you can concentrate on fixing the tooth. >> >>Steve axmonti@hotmail.com - 16 Dec 2005 23:22 GMT Thanks Steve. I know the picture looks deceiving, but the white items in the middle of the ulceration aren't gum - it's rock-hard! One of them has a slight depression in the middle, which makes it look like part of the ulceration.
Unless anyone has any other suggestions, I'll post a follow-up once something transpires. I'm thinking that the piece of bone/tooth will come out eventually, or the gum will heal over. Either way, look for a follow-up picture in a few weeks.
- Andrew.
CWatters - 17 Dec 2005 22:00 GMT > Unless anyone has any other suggestions, I'll post a follow-up once > something transpires. I'm thinking that the piece of bone/tooth will > come out eventually, or the gum will heal over. Either way, look for a > follow-up picture in a few weeks. Meanwhile I'd avoid any films staring Sigourney Weaver :-)
Whamatus - 17 Dec 2005 00:40 GMT >> Hi Steve, >> [quoted text clipped - 15 lines] >Good luck, >Steve Have seen this phenomenon several times, and sometimes months after WT surg (but not years, hmmm...). The lingual cortical bone is sometimes very thin and green stick fractures unbeknownst to the surgeon can occur. Suspect that occlusal trauma plays a part in the eventual death of part of the splinter. (constant movement doesn't allow the fracture to completely heal)
Do agree that it should be looked at, possibly by a OMFS. Sure looks like a foreign body reaction to me, and that is a relatively common place that I see sequestra formation.
Perhaps Dr. King will chime in.
>>> Shouldn't be necessary to treat. When the fragment is removed, the gum >>>will heal. Then you can concentrate on fixing the tooth. >>> >>>Steve / --
Whamatus Bemoana wubbabubbazG@RBAGE at yahoo dot com
axmonti@hotmail.com - 17 Dec 2005 03:01 GMT I've never had WT surgery - in fact, I've never had wisdom teeth!
In my original post, the original dentist who I was also doubted that there was ever an infection, since I lacked most of the telltale signs. It seems unlikely for a piece of bone to spontaneously break off (to me at least).
The article that I referenced indicates that any trauma that causes blood loss to the bone can cause it to be sequestered. I just don't want it to be a bone cyst or anything like that. I saw the x-ray as well, and everything looked perfectly normal. Mind you, he wasn't looking for a bone shard on the opposide side of the x-ray. My lymph nodes are still a bit swollen and tender, but the article also indicates that swollen nodes is a common finding with this sort of problem. I tried to see another dentist today to no avail. I'll check with the original dentist next week.
- Andrew.
> Have seen this phenomenon several times, and sometimes months > after WT surg (but not years, hmmm...). [quoted text clipped - 13 lines] > wubbabubbazG@RBAGE > at yahoo dot com weathermansays@yahoo.com - 17 Dec 2005 13:46 GMT Keep us updated Axmo. I found this post by chance and have a similar problem -- what seems to be a piece of bone between two of my bottom teeth (bicuspid and molar). The dentist says it's too hard to be an abcess. It's not poking thru my gum...yet! This gives me something to tell the dentist when I see her again -- no one can figure out what the lump is.
Whamatus - 17 Dec 2005 15:17 GMT >Keep us updated Axmo. I found this post by chance and have a similar >problem -- what seems to be a piece of bone between two of my bottom >teeth (bicuspid and molar). The dentist says it's too hard to be an >abcess. It's not poking thru my gum...yet! This gives me something to >tell the dentist when I see her again -- no one can figure out what the >lump is. I say have the dentist open up the tissue and remove the object whatever it may be. / --
Whamatus Bemoana wubbabubbazG@RBAGE at yahoo dot com
axmonti@hotmail.com - 19 Dec 2005 05:32 GMT If your bump is behind your lower teeth (between your bicuspid and molar), then this may be a very common 'bump' that many people (including me) have. It can be on one side (as in my case), or the other, or both. There are many sites that cover this, and I came across a few looking for information on my ailment. If I find a site that refrences this bump (some had pictures), then I'll post a follow-up. I've had mine for as long as I can remember - there's nothing you have to do to it.
- Andrew
Steven Bornfeld - 19 Dec 2005 13:59 GMT > If your bump is behind your lower teeth (between your bicuspid and > molar), then this may be a very common 'bump' that many people [quoted text clipped - 6 lines] > > - Andrew Sounds like you are describing a torus--in your case a torus mandibularis. The OP clearly does NOT have a torus. The tissue over a torus is usually stretched thin, and therefore is subject to trauma and ulceration, but the location and the appearance in the photo from the OP is all wrong for this. There is generally no reason to treat a torus. One exception is that if they are very large and a denture needs to be made they can get in the way. In this case treatment is removal.
Steve
axmonti@hotmail.com - 19 Dec 2005 14:59 GMT That's what the sites called it - 'torus mandibularis'! Thanks Steve. I realize that's not what's affecting the gum by my rear molar, but I have a small 'torus mandibularis' behind my front teeth as well (it's not causing any problems). I had no idea that tori (sp?) could become as large as I've seen on the Web - yikes!
I've take some additional photos of my 'real' problem - just haven't posted them yet. After rinsing daily with a hydrogen peroxide solution and rubbing a topical steroid on the affected area each night, I'm happy to report that the hole in my gum is closing up quite nicely. I'm hoping that the whole episode was simply for my gums to expel a small piece of bone that has become dislodged when my molar shifted slightly due to infection. Now if I could only stop poking at it with my tongue...
- Andrew
axmonti@hotmail.com - 21 Dec 2005 06:27 GMT OK, finally made it to my dentist. He examined the bone (yes, it is bone), then ordered a panoramic x-ray. Nothing remarkable about the x-ray, but he did indicate that I'm the third person in his career who has had this problem. Apparently, if the alveolar bone sustains injury or blood loss, or even has poor blood flow AND the afflicted individual also grinds their teeth, then this can lead to a situation where the bone starts to grow and exceed its original boundaries.
The solution is fairly simple - either wait until the bone stops growing and see of the gum eventually recovers, or see a surgeon and have the bone shaved off (and the gum sutured). In both other cases, my dentist indicated that the individuals chose to have the (minor) surgey without any further complications.
There's very little information on the Web about this. Apparently, when teeth clench or grind, a tiny electrical voltage is created in the bone via the piezoelectric effect. This can stimulate the bone growth. Tomorrow, I'm going to be fitted for a mouth guard to stop my apparent grinding. I say apparent, since I don't realize that I'm doing it, and there's not much physical evidence to back up the grinding theory. Mind you, my Wife certainly has caught me grinding my teeth at night from time to time, so it's entirely possible.
I'll post some additional pictures when I have a chance. The bone is sticking out more now, which is making it difficult for my gums to catch up!
Any further comments? Have any other dentists seen this before?
- Andrew.
Amatus Cremona - 21 Dec 2005 12:38 GMT Is this a dentist with a real degree ?
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> OK, finally made it to my dentist. He examined the bone (yes, it is > bone), then ordered a panoramic x-ray. Nothing remarkable about the [quoted text clipped - 26 lines] > > - Andrew. Dartos - 21 Dec 2005 14:02 GMT Sounds a little off the wall to me too.
The really wierd thing is that I had a patient in yesterday with the very same problem. His was lingual to his lower right wisdom tooth. No history of extractions or trauma in the area. The tooth was in a pretty normal alignment and not impacted.
I just zapped it with the laser and suspect it will heal over.
I know this isn't my patient posting, because I did not give any sci-fi explanations and I would of course make an NTI instead of a regular mouthguard.
:-) Dartos
> Is this a dentist with a real degree ? axmonti@hotmail.com - 21 Dec 2005 15:03 GMT Maybe I should clarify my comments:
My dentist indicated that the original bone growth stimulus was more than likely due to poor blood supply, or unknown trauma to the bone. The excess growth is more than likely as a result of chenching or grinding. Apparently, he researched this problem extensively with the first patient who had this problem. He indicated that there was medical literature and studies to back this up (I could ask him for the references, I guess). I did a quick statistical analysis and figured that 1 out of 50,000 people or so should have this at some point, so uncommon, but not ultra-rare.
I found the piezoelectric theories on the Web - mostly from studies trying to grow bone on purpose, but some were trying to determine why clenching and grinding of teeth can cause excessive bone growth. Bone thickening through bone stress is well-documented, and the basis for recommending load-bearing exercise for people with osteoperosis and the like.
Is an NTI considered generally better than a mouthguard? I'm not up on the latest information, so any opinions would be greatly appreciated (I can still cancel the appointment for today).
Amusingly, "zapping it with a laser" sounds a bit sci-fi as well! ;)
Thanks, Andrew.
Sdores - 21 Dec 2005 15:15 GMT If you are grinding your teeth and clenching has he checked to see if a root has broke? The reason I ask is I have had this happen a long time ago and the tooth under the gum was damaged. Just a thought. I hope you get this sorted out and soon. UM MOM Susan, not a dentist
> Maybe I should clarify my comments: > [quoted text clipped - 23 lines] > Thanks, > Andrew. Dartos - 21 Dec 2005 17:42 GMT LOL! I haven't had the laser for quite 2 years yet, so the use is still a little new to me also. This is one of the very few cases like this that I have seen in the last 26 years (that was not associated with a recent extraction). I cautioned the patient that if it does not heal over soon with the laser treatment, I might have to do more bone shaping and suture the area.
I haven't made a conventional bruxism appliance in 5 years (that's when I started using the NTI's).
If the dentist hasn't used them yet, he doesn't know as much as he thinks he does.
JMO,
Dartos
> Is an NTI considered generally better than a mouthguard? I'm not up on > the latest information, so any opinions would be greatly appreciated (I [quoted text clipped - 4 lines] > Thanks, > Andrew. Mark & Steven Bornfeld - 21 Dec 2005 19:14 GMT > Maybe I should clarify my comments: > [quoted text clipped - 23 lines] > Thanks, > Andrew. Plenty of people develop small growths of bone (exostoses). I have never heard that grinding or clenching has anything to do with their development or continued growth. The tissue overlying the exostosis is generally very thin and friable, and prone to continued trauma from chewing. If I am right about this, and if the gum has trouble healing because of continued irritation, it is a fairly simple thing to just shave the bone down a bit and suture the tissue over it or allow it to granulate in.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
Amatus Cremona - 22 Dec 2005 15:13 GMT > Plenty of people develop small growths of bone (exostoses). I have never > heard that grinding or clenching has anything to do with their development [quoted text clipped - 4 lines] > fairly simple thing to just shave the bone down a bit and suture the > tissue over it or allow it to granulate in. I have heard the theory that tori are a response to heavy bruxism. However, I have yet to see any study correlating the two.
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> >> Maybe I should clarify my comments: [quoted text clipped - 35 lines] > > Steve Whamatus_B - 21 Dec 2005 16:36 GMT Sure it is, came from Sears & Roebuck.
>Is this a dentist with a real degree ?
>> There's very little information on the Web about this. Apparently, >> when teeth clench or grind, a tiny electrical voltage is created in the >> bone via the piezoelectric effect. This part is just too funny.
Hey Orthos, what about this ? you could power a small city with your patients appliances ! --
Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
axmonti@hotmail.com - 21 Dec 2005 16:59 GMT ROTFL! A funny mental image popped into my head...
Seriously, microvolts induced in bone via stress have been studied since the 50s. Some research indicated that it was base in the piezoelectric effect, while others believed that it is due to the formation of a PNP junction between biological materials inherent in bone. Here's a long but excellent paper that examines the history of bones and electricity, plus some modern practical applications:
http://www.ortho.lsuhsc.edu/Faculty/Marino/ModBio/78MBch20.pdf
I wish some biophysicists would chime in! I took a year of biophysics (intermediate and advanced) in university, but that's not my area of expertise by any means.
- Andrew.
axmonti@hotmail.com - 21 Dec 2005 18:08 GMT Amatus - not to take this too far off topic: I was born in Rome, and was in Palermo not too long ago. Too bad I didn't know about your hometown - it looks beautiful. Just don't ask me to type in Italian - it's awful, plus I have no way of knowing how to translate, "bruxism-induced alveolar bone growth."
- Andrew.
> Is this a dentist with a real degree ? axmonti@hotmail.com - 21 Dec 2005 19:47 GMT Amatus - not to take this too far off topic: I was born in Rome, and was in Palermo not too long ago. Too bad I didn't know about your hometown - it looks beautiful. Just don't ask me to type in Italian - it's awful, plus I have no way of knowing how to translate, "bruxism-induced alveolar bone growth."
- Andrew.
> Is this a dentist with a real degree ?
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