No one ever likes to have a tooth extraction done. Unfortunately, there are times when the loss of an adult tooth is unavoidable. As in any surgery, there are many risks such as infection, lasting numbness of the tongue or lips, etc. However, this particular question deals with the healing process after a tooth extraction takes place. Discussing this problem without also discussing the complication of a dry socket would be inappropriate because the two are very closely related.
A tooth is held in place in a healthy socket by millions of microscopic cables, collectively called the periodontal ligament. An analogy may be that of a very firm trampoline, held stiff by multiple springs. The tooth is the canvas, and the bone is the frame. In between the springs is where cells and fluid that keep the springs oiled reside. In order to perform a tooth extraction, the dentist must sever these very tightly bound springs. This is most commonly done by “stretching” the bone, which is somewhat pliable under continuous pressure. However, bone is also brittle, so some small slivers of bone may flake off and either imbed in the soft tissue during the surgery or fall into the empty socket, becoming masked by blood that flows into the socket.
Blood flowing into an empty tooth socket is nature’s method of filling in the hole that was once covered by the tooth. As soon as blood begins to flow into the socket, a substance called fibrinogen in the blood forms a net over the socket called fibrin. The fibrin traps blood cells and protects the exposed bone in the socket. Once the bone is covered, new skin can begin to develop, which usually takes about three days to fully cover the bone. In other words, the fibrin clot must remain intact and functional for at least three days. If the fibrin clot is destroyed or is physically dislodged somehow, like from the suction of smoking or the use of a straw, the bone becomes exposed with no protection. Nicotine from cigarettes chemically breaks down fibrin, and suction from smoking or drinking through a straw can physically tear the fibrin away from the trampoline frame. Thus, a very painful problem is created: a dry socket. Treatment usually involves placement of some type of artificial clot into the socket to protect the bone until skin can cover it.
Once skin completely covers the bone, the fibrin clot breaks down naturally after three days and is shed because it has served its purpose. The skin grows and thickens rapidly over several weeks, and bone begins to fill in underneath it. During this time, some of those little pieces of bone that may have broken off during the extraction can migrate to the surface and be sloughed off. If they get stuck in the developing tissue, they can be very sharp and painful. Often a dentist can just remove them quickly with a pair of tweezers.