Thursday, May 25, 2006

Eruption Hematoma (gums turning blue?)

When teeth erupt, they slowly move through the gum tissue. Usually this is no big deal although some babies are quite fussy when "cutting" new teeth. As children get older, usually around 6 years old, new teeth begin to erupt then as well.


Sometimes teeth, incisors in the front of the mouth or molars in the back, can end up turning the gums a blue or gray color. This is called an Eruption Hematoma. This is due to the gums becoming thin in front of the erupting tooth and some minor trauma causing a bruise in that area. Often it doesn't take much of a trauma to do this, just normal eating or biting on a toy. It does not hurt. Just like a bruise, it will tend to go away on it's own once the new tooth erupts. No treatment is needed. It is a good idea to get your dentist to look at it to rule out anything else.

Occasionally, the area will appear swollen. If you feel it, it seems to be squishy or a fluid filled area under the gum. This is called an "Eruption Cyst". Again, it usually resolves once the new tooth comes in. Rarely, the area gets pretty big or has been there longer than we would like. In those cases we can assist the eruption with surgical exposure of the new tooth. It's pretty easy to do if needed.

24 comments:

Betsy said...

Thank you Dr. Brandon! My 9 year old daughter has braces, and her top lateral incisors are finally beginning to come down, but have not erupted yet. While looking at the swollen gum, I thought the underlying tooth was black (oh no!) But I was relieved to see your picture of an eruption hematoma - I am sure that's what she has. Phew.

Anonymous said...

Hey Dr. Brandon If someone has had gum surgery do to the depicote which is an epilepsy medication is there a chance that that person might possibly get Eruption Hematoma or have to have the person's gums cut down again in the future.

Dr. Dean Brandon said...

Some medications can cause enlarged gum tissue (especialy Dilantin). It tends to happen over time. Good oral hygiene helps reduce the rate of enlargement. I don't see this much in young children, usually teens or adults. Most physicians are aware of the drugs that are especially prone usually changing the medications over time anyways.

Some kids have thicker gum tissue right where a tooth is trying to come in that is usually due to a baby tooth being lost quite early due to trauma or something (not medications) and the tissue has become thicker over time and the tooth just can't come in. Those cases are where we might need to make a surgical "window" (very easy) and then the tooth comes in fine with no further complications.

Anonymous said...

Excellent info! My 12mo old has a blue spot on her gum near where the left first molar would be coming through. When I first noticed it I thought perhaps she had just managed to chew on some blue paper (paper is her most covetted food). However, it has persisted for several weeks and is now 'soft' to the touch, so I'm fairly certain it's a hematoma.
It's a difficult thing to google when you don't know what you're looking for, so I'm glad someone linked to your site in a baby forum (just try 'blue gum', and the hits aren't too promising).

Anonymous said...

my daughter is 6y and has a tooth growing. but i noticed that her gum where her tooth is growing is purple and swollen is that the same as the eruption hematoma .

Dr. Dean Brandon said...

Well, I can't say, but it is likely. Get it checked out.

Anonymous said...

After what period of time would you consider "surgical assistance" when evaluating an eruption hematoma (molar) in a 1 year old ? just looking for a minimum general rule of thumb before considering surgery ? a month? several weeks? My son (15 month) has exactly this.

Dr. Dean Brandon said...

I don't go so much by time as circumstance-meaning if it is quite large and interferes with eating, etc. we might do something. If it's 6-12 months beyond the normal time of eurption, I get concerned. Still, I can't remember the last time we did this in an infant/young child---it's more likely needed in a 6-7 year old, but even then, not often at all.

Sophia said...

My 13 month old son has a large bump, that looks like a hematoma, but it is white instead of blue. Is this the same thing? We just moved to a new area and are without a dentist just yet. Should I rush to find one for him?

Dr. Dean Brandon said...

Sorry fo the delay, I've been out of the country.

I have seen white bumps called Epstien's pearls or dental laminar cysts or Bohn's nodules. Not common, but...could just be a new tooth? "Eruption cysts" are not colored blue.

I can't advise, but I'd get it checked out.

Bobby said...

Dr. Brandon,

I am a periodontist quite versed and experienced in surgical procedures. My friend has a young daughter almost 8 who has a large eruption hematoma involving the upper centrals. This has been present for more than a year. Her pediatric dentist is reluctant to intervene surgically. He thinks she needs hospitalization and an oral surgeon for a mega $$$ procedure. I can do this for them. Basically, what are the soft tissue objectives in relation to the incisal edges of the centrals. I'm thinking along the lines of an envelope, soft tissue wedge removal and fluid drainage, just enough to expose about the incisal quarter of each. The lower incisors are slamming the inflamed area constantly. Are the teeth merely trapped by a combination of fluid and fibrous tissue? There is usually no ankylosis, right? The normal eruptive process should continue with no further intervention, right? As usual the child is okay, yet the mother is a basket case. Her anxiety spills over to the child. I'm thinking Noctec and local. The child is as healthy as a horse. Thanks,

A. Robert Romans, DDS, MS
904-443-7000

Dr. Dean Brandon said...

Usually what I see is that the gingiva has become quite tough (fibrous) and the eruptive force of the teeth is not enough to overcome the resistance. They kind of bulge out, but never come in. If it seems too long of a time to me or looks like it would benefit from it, I do "exposure to aid eruption". This is nothing too fancy. I use an electrosurge (although I sometimes use a scalpel) and remove some of the tissue on the incisal edge. Usually I can see the tooth right away. I don't take away too much of the gingival tissue, but I get enough so it won't heal back over and the new tooth has a chance to erupt. The incisors seem to fly right on in once the gingiva is exposed like that.

It's really nothing too fancy. If the tooth seems really high up in there, there might be something else going on and a more extensive exposure might be required with even orthodontics to get it down (in case of impaction etc.) What you have described doesn't sound anything like that which is a whole other thing. Maybe it's the way I select cases, but I have never had one where the teeth didn't come right on down with a simple exposure alone.

It is good to have patient cooperation with sedation if necessary, but most kids do well with just nitrous and a little local anesthesia. If there is a lot of anxiety, you might try versed or whatever you usually use in such cases. You might need a little Ativan for the parent too!

Bobby said...

Dr. Brandon,

Thank you for your excellent answer. That was what I surmised clinically and evisioned surgically. I advised my friend to bring his daughter by for a quick exam. He agreed, but the dominant wife disagreed. She plans to keep the appointment in mid-January with the oral surgeon to have simple procedure under heavy sedation for $,$$$ with the first digit more than one (1). The total will probably approach (3). This, my unseen friend, is one of the major problems with today's dentistry. Thanks for your help. I am impressed with your demeanor and your knowledge.

Happy New Year,

A. Robert Romans, DDS, MS (Bobby) 904-443-7000
bobbyfrdtmj40@bellsouth.net

Anonymous said...

my 1 year old daughter's top gums have come down over her front teeth. She has four top teeth that are no longer visible, only tips, as the gums are covering them. She is teething on the bottom but I see nothing coming in on top. My doctor has never seen anything like it. They are not infected but look really awful.

Dr. Dean Brandon said...

I can't say really . Some seizure medications can cause gingival hyperplasia. baby teeth seem to come in in odd orders and sometimes quite delayed, but, really, I would get a pediatric dentist to take a look.

jlbernhardt said...

My son has large swolen purple/blue spots on both of his top molars (17 mo old). He also has hemophilia, Factor IX. None of his doctors are very concerned, nor do any of them want to see him as of now. Is this that common?
I've never heard of this before and I would consider myself "one of those moms" whos been through just about everything with her kids!
Thanks for this page, I feel a little better about the situation now!

Allie said...

I am 14 years old. I was at a friend's house yesterday when her mom realized my gums on the top and bottom were blue. She looked at her daughters' gums. The 14 year old had red/pink gums, but the 10 year old had purplish gums. Mine are way darker but I was wondering if this could still be the same thing even though I have lost all of my teeth except for one which does not have a tooth under it.

Dr. Dean Brandon said...

I do not know. There is such thing as natural pigmentation variations in some races that can vary from individual to individual. If you are concerned, let your dentist take a look.

DeAndrea said...

My 13 month old son has an eruption hematoma over an erupting molar along with many other teeth erupting, and the molar on the opposite side already out. I noticed it about 2 weeks ago, and it has not changed in apperance at all. He has been extremely fussy, and taking tylenol way too often. The pedi dentist (who I have only talked to on the phone) says it will resolve itself. Should he be examined? It looks exactly like the first pict on your blog. Any input would be appreciated! Thanks!!!

Dr. Dean Brandon said...

Anything that hasn't resolved in two or three weeks I usually recommend evaluating, but if it is as you (and he) say, then if it is an eruption hematoma, well they do tend to go away after a while.

Anonymous said...

Dr. Brandon My 5 yr daughter has a space between her 2 front teeth and it looks like the tissue that connects the upper lip and gum comes way low and this is the reason for the large space between front teeth. Should we get that cut? If so at what age do you recommend this? Are braces in our future to close gap? Thanks

Dr. Dean Brandon said...

That tissue between the two upper teeth is called a frenum. It is a normal structure that usually moves up out of the way as the child gets older and the new teeth erupt. It usually never needs treatment. After an orthodontic consultation, there are a few cases where these things need surgical intervention usually in conjunction with orthodontic treatment after the maxillary cuspids erupts (age 12 usually).

Momof2boys said...

Thank you Dr. Brandon for your valuable photos of eruption hematoma and cysts. I was able to correctly identify this condition in my fifteen year old son thanks to your information. I understand these resolve most of the time without treatment. My son suffers with chronic severe neutropenia. He is severely immune compromised. Would you suggest any other course of action for him? Thank you so much.

Dr. Dean Brandon said...

I am pleased you have found this blog helpful. However, just to be clear, I do not intend anything here on this blog to be used for a definitive diagnosis for any particular patient or anything like that. It is always best to consult your dentist and/or physician, especially when other health conditions are involved. Good Luck.