Updated: Aug 27
Lately when you've been looking in the mirror, you've seen seeing a flap of gum that is covering your wisdom tooth. That flap of skin seems like loose gum because when you try to touch it, it moves. It also tends to swell up from time to time.
You may be wondering what that piece of gum that is covering your wisdom tooth is and if it was normal to have it? Worry not because this article will go over what that is and whether or not you need to do anything about it. You'll learn everything that you need to know about a dental operculum.
Table of Contents:
What is a dental operculum?
That gum flap over your wisdom tooth is called a dental operculum or simply operculum for short. It is literally just a piece of gum that covers over the back portion of your third molar. The color is similar to the rest of your gums but sometimes it can turn red and fill up with blood when it gets inflamed.
The size of the hanging gum tissue may vary from person to person. For some it can be small but it could also be quite large for others. There isn't really a set limit to the size and shape of it.
Here are some commonly used descriptions for the operculum:
Flap of skin on third molar
Piece of gum covering wisdom teeth
Loose gum over wisdom tooth
Hanging gum tissue on top of third molar
Why do wisdom teeth have gum flaps?
Operculums are the result of insufficient jaw space for the wisdom teeth to fully erupt or if they happen to be impacted. Both of these situations end up with a piece of gum hanging over the molar.
Insufficient jaw space
If there is insufficient jaw space, you may still end up with an operculum even if the wisdom teeth are growing out straight. When we say not enough jaw space, we mean that the length of your jaw isn't long enough. The ultimate result is that the tooth gets partially stuck in the gums in the back of your jaw.
Here is a photo demonstrating what we mean by gums in the back of the jaw. There is a certain amount of space behind the last molar before it runs into the gums.
As you can see in this clinical picture, this patient barely even has enough space for the second molar! If they had wisdom teeth, which would be behind this second molar... it would definitely be stuck in the gums and have a very large gum flap.
Impacted wisdom teeth
Another situation where you can get a flap of gum over the wisdom tooth is if the tooth happens to be impacted. The angle of impaction may prevent the third molar from fully erupting and thus end up with a permanent piece of gum covering over part of the tooth.
You can't wait this out either because it is impacted, it will never fully erupt. You can wait your entire life for the tooth to erupt but the operculum will wait an eternity with you.
Is it a problem to leave the gum flap over a wisdom tooth?
An untreated dental operculum will cause chronic gum inflammation over the wisdom tooth flap. It is almost inevitable because the flap is a loose hanging piece of gum tissue that is prone to trapping food and plaque.
Whenever something gets stuck underneath of the flap, the gums will swell up and become very inflamed. It can get extremely painful whenever that happens and is one of the most common reasons for why patients come in as a dental emergency.
This condition is often referred to as pericoronitis, which literally means inflammation around the crown of the wisdom tooth. There is inflammation around the tooth because the operculum is trapping plaque and food! Normally that is not an issue but the way the flap is position makes it nearly impossible to clean the food out. This is a recipe for pain.
Signs and symptoms of an inflamed operculum:
Basically if you leave the operculum as it, it will periodically just swell up and cause you pain whenever you happen to get anything stuck underneath of it. This will continue throughout your life until you decide on a permanent solution to treat it.
Treatment for dental operculum
There are a couple of options for treating the wisdom tooth gum flap with varying levels of permanence. Some of them are more invasive while others are more conservative. However, the more invasive procedures tend to be more permanent and the vice versa is true.
Temporary solution - Palliative treatment
The most conservative but also temporary solution for getting rid of wisdom teeth gum flap pain is by treating it palliatively. The entire purpose of this procedure is to alleviate the pain without trying to fix it permanently.
This is what the treatment consists of:
Deep cleaning. The reason the operculum is inflamed is because food or plaque is trapped underneath of it which you aren't able to clean. Your dentist on the other hand IS able to clean it for you because they have various tools that enable them to do it. They will clean as deep as possible underneath the flap and around the tooth.
Antibiotic irrigation. After cleaning the piece of gum over the third molar, your dentist will most likely flush it out with an antibiotic solution.
Antibiotic rinse prescription. You will leave the office with a prescription for an antibiotic mouth rinse to use twice a day. This rinse will reduce the gum inflammation and help it heal faster.
If you do all three of these procedures, the swollen operculum should subside over the next week or two and return to normal. After that you should try your best to keep the area clean by paying extra attention to brushing it so that it doesn't happen again.
However, you should be aware that in our experience, this condition does periodically return from time to time. That is the reason why we classify this treatment as only a temporary solution.
If you are unable to make it to the dentist, there are a couple of tips which you can use to possibly reduce the inflammation and alleviate the pain. They all involve ways to clean all of the plaque and food which may have been trapped underneath the gums.
Water flosser. If you have one of these, you can aim the water flosser into the gum flap and try to flush it out. You may get lucky and wash it out with the pressurized water.
Brushing. You can try gently brushing over the operculum. It may or may not get the food out but just try not to brush too hard and injure the gums.
Salt water rinse. Sometimes vigorously rinsing with salt water can flush out the offending plaque or food trapped under the gums.
Coconut oil pulling. Oil pulling can be quite effective in reducing gum inflammation and it also increases the chances of you getting out whatever may be stuck underneath the gum flap since you're rinsing for 15-20 minutes!
Semi-permanent solution - Operculectomy
In lieu of palliative treatment, there is a semi-permanent solution called an operculectomy. This is a surgical procedure which removes the operculum but leaves the tooth intact.
What to expect for the procedure:
Administer local anesthetic to numb the tooth and the gums.
Excise the gum flap with either a scalpel or a laser.
Clean and flush out the surrounding area.
Prescribe pain medication and an antibiotic rinse afterwards for use.
A video of the procedure if you prefer visual over text:
Here is a clinical case from this study with a before and after photos of an operculectomy:
For all of those who are rejoicing that their wisdom tooth does not need to be removed in order to get rid of the operculum, you should be aware that this is only a semi-permanent solution. The reason why it is not completely permanent is because there has been instances where the operculum can return by growing back.
The efficacy and success rate has been pretty good for most of the clinical cases but it is not 100% since there have been relapses. As long as you are aware that it is not perfect, you can opt for this treatment if you're not ready for the wisdom tooth removal.
Permanent solution - Wisdom tooth extraction
The only permanent solution with a 100% success rate of getting rid of the gum flap is by extracting the entire wisdom tooth. This is your everyday typical wisdom tooth removal and you don't have to do anything extra for it.
What to expect during the procedure:
Administer local anesthetic to numb the tooth and gums.
Reflect the soft tissue with a scalpel.
Expose the tooth by pulling back the gums.
Elevate the wisdom tooth with an elevator.
Grab the tooth with forceps and pull it out.
Clean the socket to remove any infection.
Smooth down bony spicules with a bone file.
Irrigate the socket to remove debris.
Place sutures to close up the hole in the gums.
We've never heard of any instances of the operculum returning after having the entire tooth removed. For that reason alone, we classify this treatment as a permanent one.
Of course, not everyone is thrilled to have their third molar removed even though it does get rid of it forever. Those who are not ready for it yet will usually opt for the palliative treatment route.
Aftercare for removal of gingival operculum
After operculum removal, either by extraction or operculectomy, you will need to wait for the gums to heal. All you need to do is to do things which promote healing so that you can recover faster. You will leave the office with pain medication and an antibiotic rinse, which you should definitely use.
Here are all of the things which you should do afterwards:
Take pain medication as needed.
Use the antibiotic rinse twice a day for 2 weeks.
Rinse with salt water after every meal. This keeps the area clean and also reduces inflammation with the gums.
Maintain good oral hygiene by brushing at least twice a day for two minutes each.
Avoid foods that are too spicy or acidic for the first few days.
Once the gums heal over, you shouldn't have anymore instances of periocoronitis. That still doesn't mean you should slack off with your oral hygiene though because food can get stuck anywhere in your gums and not just the operculum. When that happens you can end up with a gum abscess.
It is not unusual to have a gum flap over your wisdom tooth but it may indicate that your jaw may not have enough space or your tooth could be impacted. Regardless of the reason why you have that piece of gum hanging over your molar, it could cause you several inconveniences such as swelling up whenever food or plaque gets trapped underneath it.
The only way to get rid of the problem is by doing an operculectomy or having an extraction. Both of which are surgical procedures that will require anesthesia. However, if you're not ready for that there are palliative treatments that your dentist can perform for you or home remedies which you can try at home.
Just be aware that non-sugrical treatments are only temporary solutions to alleviate the pain. In other words, the operculum swelling will return at a future date.
Hopefully that answers all of the questions which you may have had about this gum flap. If you're unsure of what to do you should schedule a consultation with your general dentist.