If your wisdom tooth hole opened back up after it had already closed, that is a tell-tale sign of a complication with the healing process. Something has gone awry during your recovery after the extraction and it should not be ignored because you will need to seek treatment with a dentist.
Your wisdom tooth extraction may be complete but your overall treatment is not. Expect more follow up appointments in order to rectify this complication.
Clinical case
In case you were wondering if it was possible for a wisdom tooth hole to reopen, the answer is yes it is possible. Although it is incredibly rare for the extraction socket to close after healing only to open back up afterwards because we've literally only had one case of it happening at our dental practice.
Clinical case report:
We extracted wisdom tooth 32 on the lower right side.
The wisdom tooth hole closed after 3 weeks.
Patient was complaining about residual pain throughout the healing process.
After 3 weeks, a new hole in the gums emerged on the tongue side of the extraction site.
Exposed bone was growing out of that new hole.
The image above shows the case that we are talking about. The extraction socket is on the left in bright red. To the right of it is a white spot where the gums are disappearing and the bone is now being exposed. That's right, the wisdom tooth hole is reopening.
This is one of the most bizarre cases that we've ever seen. We tried scouring research studies to figure out what was the cause but it was to no avail. There was no information about the cause for it but we do have a theory.
Signs & Symptoms
If the third molar extraction hole opens back up, that is a definitive sign of a complication. We'll be giving you a full list of potential symptoms that may accompany this condition.
Signs & symptoms:
Hole opened back up where wisdom tooth was removed.
Hole in the gums or missing gum tissue.
Exposed bone (will look very yellow).
Residual pain.
Gum hole that gets bigger and not smaller.
Inflammation or redness around the gingival hole.
Vs healthy wisdom tooth hole
A fully recovered wisdom tooth hole that is healthy does not have a hole that reopens. Once the gums heal, the hole should stay close permanently for the rest of your life.
Signs of a healthy socket:
Hole that gradually gets smaller.
No pain.
No purulence.
Socket color progression from red to white to black.
Causes
We could not find any scientific studies or case reports on wisdom teeth holes that reopened. However, we do have a theory as to how this phenomenon happened.
Our theory for how a wisdom tooth hole opened back up has to do with a complication with the bone remodeling process during socket healing.
Normal bone remodeling:
Jaw bone goes through cycles of bone absorption and bone deposition.
Overall there should be a net addition of bone into the wisdom tooth socket.
What went wrong:
Excessive amount of bone deposition cause bone to grow through the gums.
Bone piercing through the gums will cause a hole to form.
Growth of the bone will cause the hole to enlarge over time.
Ultimately, the hole is reopening post-surgical removal of the wisdom tooth because extra bone is growing through the gums. In other words, the socket is not following the standard socket healing protocol.
What this condition is not
This condition is unique and should not be mistaken for a dry socket nor for MRONJ.
Dry socket. A dry socket is characterized as an extraction hole that is devoid of a blood clot. While this condition may be painful, it is beyond the stages of a dry socket which tends to arise within 24-96 hours.
MRONJ. The full name for MRONJ is medication-related osteonecrosis of the jaw, which is when the socket fails to heal and bone is exposed. That is completely different from a socket which has healed but then reopened.
A reopened socket that has previously healed is neither of these two conditions.
Also to be crystal clear, this condition is different from a hole in the cheek after the third molars were removed. We are talking about a hole that has healed and then reopened.
Treatment
In our case where our patient had a wisdom tooth socket hole that opened back up, it resolved after removing the excess bone.
Removal of defective bone. The entire lingual plate of the bone that was healing abnormally had to be removed from the jaw. After the complete removal of it, the hole reclosed uneventfully over the next week.
Palliative care. Taking pain medication to reduce the discomfort.
Initially, we attempted to shave away some of the excess bone that was growing out of the new hole but that did not make it go away. The body kept adding in more bone and the hole grew larger.
It was only after a large section of the bone was completely removed that it resolved.
When can it happen
For wisdom teeth holes that have closed and then opened back up, it will occur about 4-6 weeks after your extraction.
Why it takes 4-6 weeks for it to happen:
The initial socket closure takes approximately 4-6 weeks for the gums to close.
The reopening has to occur after the hole has closed so it must occur after socket closure.
In summary, this condition is only considered as such after the initial closure of the third molar hole and that takes roughly 4-6 weeks.
Wisdom tooth hole opened back up years later
It is impossible for a wisdom tooth hole to be opened back up years later. If it were to happen, it would most likely be 4-6 weeks after your wisdom tooth removal procedure. Once the jaw bone has completely healed, there is no reason for it to develop such a complication.
However, if you do notice some sore of hole opening up in your gums, it would most likely be some other type of dental condition.
Other potential conditions:
Dental abscess. An untreated abscessed tooth will eventually develop a sinus tract that forms a gum boil on the surface of the gums. This pimple is actually a giant hole that leads to the tip of the infected tooth.
Immune system deficiency. Another potential cause would be if you had a immune system deficiency. The area may have gotten infected by bacteria or viruses.
Takeaway
It is quite rare for closed wisdom teeth holes to be reopened but if it does, it is a sign of a complication. Do not wait and see what happens, you should seek out a dentist immediately to have it diagnosed and treated.
