Updated: May 3
On the day of the tooth extraction, the hole looks blood red but over the next few days, the color starts to change into what looks like white stuff. As long as you're not feeling any pain, that white colored material is usually a good sign. Although if you are having pain, it could mean something else and that could be bad.
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What is the white stuff in the tooth extraction site?
The white stuff in the tooth extraction hole could be a good sign or it could also be a bad sign but it depends on what symptoms you're having. If you're not having any pain, then it could be a normal part of the healing process but if you are having pain then it could mean something else like an infection.
No pain - Granulation Tissue
If you're not feeling any discomfort, the white stuff could very well be granulation tissue which is a part of the normal healing process.
Initially after the tooth is removed, a blood clot needs to be formed in order to stop the bleeding. The clot is red in color and you may notice it developing a few hours after the procedure.
Over the next few days, the blood clot gets replaced by granulation tissue which helps the extraction socket heal and close over. The granulation tissue is white in color but most people refer to it as the "white stuff". It doesn't look pretty but it required for healing because it contains a lot of important components.
Blood vessels - brings important nutrients to the socket.
Collagen - matrix for the scaffolding to close the hole.
White blood cells - to prevent infections.
Fibroblasts - cells that produce the collagen.
Keratinocytes - cells responsible for the re-epithelization of the outer layer of skin.
Endothelial cells - vascularizes the wound by forming new blood vessels.
What to do about it
You don't have to do anything in this situation, except to help keep the area clean of food and debris. Make sure you brush your teeth after every meal and rinse vigorously with a mouth rinse so that food doesn't get stuck in the hole. The cleaner you can keep the hole, the faster it will heal.
All you need to do is just give it time and the healing process will naturally take care of itself. Eventually the gums will grow over the hole and cover up all of the white stuff.
The tissue looks mostly white and the color comes from the collagen. There are also specks of red within the white tissue, which comes from the new blood vessels that are forming. Overall what the appearance of it looks like is white with red dots speckled over it. It doesn't look pretty and that is also why we refer to it as the ugly duckling phase.
If you wait a few more days, the gums will start to heal over more and cover up the hole. At that point you'll see less of the white stuff and it'll start to look more like a small black hole because light can't get through to it.
Pain is present
If you do see white stuff in the hole but you are having pain, that could be a bad sign because something could be wrong. Here are some common complications after tooth removal that can look like white stuff.
The most prominent symptom of a dry socket is excruciating pain that comes from exposed bone. The bone which is exposed looks white in color because that is the natural color of it. You can tell if you have this if you're having more pain than before you had the extraction.
Normally, the bone should be covered by a blood clot which eventually gets replaced by granulation tissue. All of this covering prevents the bone from being exposed but in a dry socket, the blood clot is missing. Since the clot is missing, the granulation material will fail to develop as well. Ultimately what it feels like is unbearable tooth pain as soon as food or other debris touches the exposed bone.
The highest chance of this happening is in impacted lower wisdom teeth removals.
What you should do
You should definitely go back and see your dentist for treatment. There is no permanent cure for it but there are ways to lessen the pain and speed up the healing time.
Induce bleeding. Your dentist can try to restart the healing process by making the socket bleed to get fresh nutrients into the site. This may involve drilling small holes in the bone or scraping the bone.
Irrigating the socket. The socket may need to be flushed out with either saline or an antibacterial solution.
Stitches. Putting in some stitches to make the hole smaller could lessen the pain. Less surface area for the bone to be exposed to the outside surface.
Placement of medication. There are certain dry socket pastes that can be placed in the hole to ease up the pain. The pastes usually have a pain relief property to it.
Mouth rinses. Since the pain comes from food touching the bone, it would be beneficial to keep the hole clean by rinsing frequently.
Pain medication. Don't forget to take some pain medication such as ibuprofen or acetaminophen to dull the pain.
Infection with pus
If you have an active infection in the extraction socket, the white stuff that you see could be pus. Pus is composed of dead bacteria and white blood cells. The color of pus is typically white and here is how you can tell if it is pus as opposed to granulation tissue.
If you touch the extraction socket, the white stuff will ooze out. Normal white stuff, granulation tissue will not ooze out.
There is most likely a foul odor coming from the site. The bad taste and smell in your mouth is coming from the active infection.What you should do
What you should do
You need to see your dentist to have the socket cleaned out and also get a prescription for antibiotics. The socket needs to be drained, cleaned out, and flushed out completely. Afterwards you'll most likely be on an antibiotic for the next 7 days.
Be sure to finish the entire course of the antibiotic so that you get the full effect. It is also important to keep the hole clean while it is going through the healing process. Rinse vigorously with salt water after every meal so food doesn't get stuck in the hole.
Food stuck in the hole
Having food stuck in the hole won't be as painful as a dry socket nor an infection. What you may feel is just mild pain or discomfort. Another sign would be if you notice a foul odor coming from the hole. The reason for the malodor is because food that is left in the hole will start to ferment and cause a smell. Therefore if you see white stuff that is only mildly uncomfortable but has a terrible smell, it could just be food that is stuck in the hole.
What you should do
You should try to remove the food in the hole. Here are a couple of at home methods that you can try to get the food out.
Mouth rinse. Rinse vigorously with your choice of mouth rinse. The most common would be a salt water rinse. The pressure from swishing around may dislodge the stuck food.
Water flosser. If you have one of these, you can aim the water flosser into the hole and flush everything out. It shoots a stream of high pressure water that can dislodge all debris.
Gentle brushing. You can try to brush the food out of the hole gentle with just your toothbrush. Alternatively you can try to swab it with a Q-tip.
Can the white stuff be anything else?
Alternatively, the white stuff could also be a bone graft and membrane that was placed over the socket to promote healing. The bone graft material and the membrane are usually both white in color, in order to mimic real bone.
If your dentist did a bone graft for you, you should already know what it is. You should've also been told to leave the area alone and not play around with it. Here is a video of a tooth extraction with a bone graft. As you can see, everything is white in color with the exception of the blood that is red.
Last but not least, the white material could very well just be plaque. The same type of plaque that you find covering your teeth that can harden into calculus. This plaque can also form over the extraction site and give it a white appearance.
Plaque is basically a thin biofilm of bacterial which are normally present in your mouth. If you brush, floss, and rinse regularly the film of plaque shouldn't stay very long over the extraction site.
The vast majority of time, the white stuff that you see after a tooth extraction is granulation tissue, which is a part of the natural healing process. Although sometimes, the white stuff could be a bad sign and may indicate that something is wrong.
Here are the signs and symptoms of when the white stuff is a bad sign:
Pus oozing out
Pain is present
Bad breath or malodor
Missing blood clot
If you experience any of the above symptoms, it may not be granulation tissue. If that is the case, you should revisit your dentist to have it diagnosed and treated. You definitely don't want any sort of active infection going on in your mouth after having your tooth removed.
Author: This article was written by a dentist in long island city, Dr David Chen DDS.