A few days after your wisdom tooth extraction, you've begun noticing what looks like "white stuff" in the wisdom tooth hole. Are you wondering what on earth is it?
That white stuff in your wisdom tooth hole is most likely granulation tissue which is a normal part of the healing process. That should be a fairly accurate guess since healing from wisdom teeth removal is uneventful for most people. However, there is a small chance that complications may arise and if they do, that "white stuff" could be a couple of other conditions.
White stuff in wisdom tooth socket:
Let's try to figure out what exactly is that white substance inside of your wisdom tooth socket.
Granulation tissue
After the extraction, every wisdom tooth hole should have granulation tissue in the socket at some point in time. It is a natural part of the healing process and is a required step for the hole to close and the gums to grow over it.
How to tell if the white stuff is granulation tissue:
The appearance is white in color.
No malodor
No bad taste
No pain
Cannot be removed by rinsing.
What granulation tissue is composed of:
Fibroblasts - cells that form collagen.
Keratinocytes - cells that re-epithelialization of the epidermis.
Endothelial cells - revascularization/angiogenesis (form new blood vessels).
Myofibroblasts - wound contraction and closure (tooth hole getting smaller).
Immune cells - neutrophils and macrophages, which protect against infections.
Normal progression of a healing socket
After the tooth is removed and before the socket closes, the wisdom tooth hole goes through three iterations in its appearance.
Blood clot. The formation of a blood clot to stop the bleeding will dominate the first two days after wisdom teeth removal. The color looks red, burgundy, or wine-like.
Granulation tissue. The next 3-6 days shifts towards the formation of granulation tissue, which focuses on closing the socket. It literally looks like white stuff.
Black hole. Finally what comes after the granulation tissue would be a "black hole" appearance. If you see a black hole in the wisdom tooth socket, it means you're towards the final stages of healing. It looks black because the gums have closed enough that light cannot easily reach into the hole. Since it is devoid of light, the socket will just look black.
Granulation tissue treatment
No treatment nor action is required from you if it turns out to be simply granulation tissue. Since it is a normal part of the healing process, its presence is to be expected. You do not need to do anything for it if you have it.
Nonetheless it would still be prudent to practice good oral hygiene and follow the wisdom tooth extraction aftercare.
Brush and floss everyday.
Rinse vigorously with salt water after every meal.
Stick with soft foods for first few days.
Take all prescribed medications.
Dry socket
A dry socket is a potential complication after a tooth extraction where a blood clot fails to develop and leaves exposed bone. This is a very painful dental condition since the uncovered bone is exposed to all stimuli in the mouth. It may look like white stuff since bone is typically white to light yellow in color.
How to tell if the white stuff is a dry socket:
Excruciating pain. The pain feels unbearable but it can throb and also radiate.
Missing blood clot. Tooth socket is missing a blood clot.
Exposed bone. You can visibly see the jaw bone.
Bad breath. Food getting stuck in the hole can ferment and cause bad breath.
Unpleasant taste. Lodged food that is many days old can cause a bad taste.
Lack of blood. Socket is devoid of blood.
Delayed healing. The extraction socket will close very slowly.
Dry socket treatment
You will need to see a dentist if it turns out to be a dry socket. There is no cure to make it go away but palliative treatment is available which can lessen the pain.
Induce bleeding. Drill various small holes into the jaw bone to stimulate the formation of a blood clot.
Curettage and irrigation. Alternatively, your dentist may curettage (scrape) the inside of the socket to clean it and hopefully it may induce healing.
Place stitches. Placing stitches may make the hole smaller and prevent food from getting into it. Ultimately it may help reduce pain.
Dry socket paste. A special eugenol based medication in the form of a paste that can be placed inside of the socket. It was designed to be soothing and help alleviate socket pain.
Mouth rinse. Frequently rinsing with salt water or chlorhexidine can keep the area clean and free of debris. This may help reduce pain and promote healing.
Pain medication. Alveolar osteitis is painful and what better way to alleviate pain than to take pain medication. Ibuprofen, acetaminophen, or even opioids can help reduce pain.
Food
There is always the potential that the white substance you see is simply food stuck in the wisdom tooth hole. That's not unusual because you have a gaping hole where the tooth was taken out. Small particles and foods can easily become lodged into the socket. Perhaps you were eating something that was white in color? Cauliflower or rice?
How to tell if the white stuff is stuck food:
Happened after a meal. You only noticed it after you ate.
Feels irritating. It feels uncomfortable like something that is stuck.
Malodor. Gives off a bad smell or taste. Probably because food is fermenting.
Can be removed by rinsing. It comes out when you rinse vigorously.
Stuck food treatment
There are plenty of at home remedies which you may use to try to dislodge the food.
Salt water rinse. Vigorously rinsing with salt water should dislodge most stuck food.
Plastic syringe or irrigator. Your dentist may have given you a little pipette to flush out stuck food in the hole.
Water flosser. Aim the water flosser to shoot pressurized water into the socket.
Gentle brushing. Gently brushing the area may help remove the food.
Cotton swab. You can try to swab it away with a q-tip.
Infection
A tell tale sign of an infection is if you see "white stuff" oozing out of the wisdom tooth hole. That white substance is purulence or otherwise known as pus, a collection of dead bacteria and white blood cells.
How to tell if the white stuff is an infection:
White fluid that oozes out of the socket
Foul odor
Terrible taste
Pain
Swelling
Inflammation
Treatment for an infection
If the wisdom tooth socket is indeed infected, you will need to return to your dentist to have it treated. Unfortunately there are no home remedies to fix a post-extraction infection.
Incision and drainage. When left untreated, it will develop into an abscess. Once it does you will need it to be drained by making an incision and then squeezing it out.
Curettage. If you catch it early, it may not need to be drained. Your dentist can clean the inside of the gums and socket out.
Irrigation. Flush out the wisdom tooth hole with saline.
Antibiotics. Take prescribed antibiotics and use a medicated mouth rinse.
Plaque
That white substance inside of the wisdom tooth socket could very well be just plaque. Plaque is literally a thin white film of bacteria otherwise known as biofilm.
How to tell if the white stuff is just plaque:
Thin white film
Can be easily removed by rinsing or brushing.
Not painful
May or may not smell
After brushing with certain toothpastes, sometimes you can get a white stringy stuff that forms which is also plaque. This white film can develop over your wisdom tooth hole.
Treatment for plaque
Nothing special about plaque in an extraction socket. You remove it the same way that you do from your teeth.
Brushing. Gently brush the area with your toothbrush and favorite toothpaste.
Flossing. You can't avoid flossing!
Rinsing. Rinse vigorously with your favorite mouthwash or use a salt water rinse.
Summary
The white stuff that you see in your wisdom tooth hole after the extraction is most likely just granulation tissue. It is a normal part of the socket healing process and is nothing to be concerned about.
However there is a chance that it may be something else, which is why you should go through all the possible listed conditions above. Some of them may require treatment while others do not.
Just for the record, we've actually never had any of our patients ask us about white stuff in their wisdom tooth hole. What we get called for after taking out wisdom teeth would be bony spicules, dry sockets, and inexplicable pain.
Nonetheless, whenever you're in doubt the best thing to do would be to contact your dentist, the one who did the procedure. If you're in Long Island City, you can get a consultation with one of our dentists.
