Post-extraction Granuloma

November 12, 2023

Tooth extractions are not the most comforting procedures for the patient to undergo. The usage of syringes to deposit anesthetic agents, the feeling of numbness and the experience of getting your tooth pulled out through forceps, might not be as painful, but enough to cause discomfort for the rest of the day.

Tooth extractions are carried out for multiple reasons. They need to be removed for carrying out orthodontic treatment, arch space complications, overretained tooth, grossly carious teeth, abscessed teeth with poor prognosis, teeth associated with cysts or tumours, etc.

When tooth extractions are carried out, the patient is likely to experience some post-operative pain as the effect of anesthesia wears off. Patients may also develop a swelling, which arises as a normal defensive response by the body. The pain can be controlled by analgesics and the swelling is countered with cold application. The swelling and the pain usually regresses within three days.

What is post-extraction granuloma?

Many complications may arise following a tooth extraction, of which we shall be discussing about post-extraction granulomas. When a tooth is extracted, the socket is healed and the patient is rid of any painful symptoms within a week. However, after four to five days of extraction, if a patient complains of a swelling associated with the extraction socket, then a post-extraction granuloma can be suspected.

A granuloma is an inflammatory condition that arises when a foreign body, that cannot be eliminated by the body's immune system, needs to be isolated. A form of white blood cells called the macrophages play an active role in the formation of these granulomas.

Post-extraction granuloma caused by foreign body

Upon examination of the post-extraction swelling, if clinical and radiograph findings reveal the presence of a foreign body, then a post-extraction granuloma is confirmed. This foreign body can be remnants of the extracted tooth, chunks of restorative filling materials in cases where a filled teeth was extracted, bone chips, calculus, gauze pieces, etc.

These foreign bodies interfere with the normal healing of the extraction socket. This leads to formation of inflammatory tissues that eventually become pus-filled soft tissue masses (suppuration). The post-extraction granuloma thus formed may or may not be painful. Discharge of pus might take place upon compressive forces in the area of the extraction socket.

Incidence of post-extraction granulomas

Chances of post-extraction granuloma are higher in the areas of posterior teeth (molars). These teeth have more than one root, making the chances of a dislodged tooth fragment higher. Moreover, third molar extractions can often hamper with the dentist's accessibility to that area and increase the chances of chipping of tooth fragments. It thus makes the third molar a common candidate for the development of post-extraction granuloma.

Grossly carious teeth may get removed in multiple pieces due to the fragile nature of the decayed tooth structure. It is thus possible for one of these remnants to get lodged in the extraction socket. This can ultimately result in a post-extraction granuloma.

Treatment

The only way to treat the post-extraction granuloma is to remove the foreign material. Upon removal of the foreign material, the area needs to be thoroughly cleaned and irrigated. This is usually done with a combination of saline and betadiene. The patient is then kept on a regular follow-up to check the healing status of the socket. Patients may also be prescribed analgesics after the foreign body is removed.

In order to prevent the chances of development of a post-extraction granuloma, a dentist must take a radiograph (x-ray) after the tooth extraction is carried out. An x-ray can help in detecting the presence of a remnant tooth structure or a foreign material if there is one present.

The patient should also ensure that after a tooth extraction, he or she complies with oral hygiene procedures. This is because extraction sockets may house food debris and calculus which can in turn lead to post-extraction granulomas.

Post-extraction granulomas are thus inflammatory lesions that need to be investigates for if post-extraction complication persist after five days. Since there is no other treatment other than removal of the foreign material, a patient must not neglect or delay any such procedure. Healing of the socket after the removal of the foreign body is usually favorable and does not cause any discomfort.

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