Granulation tissue is a fundamental component of the body’s natural repair process, forming after an injury or surgical procedure, such as a tooth extraction, to close the resulting defect. This new tissue acts as a temporary framework, bridging the gap left by the wound before the final layer of skin or gum tissue can form. The mouth presents a unique healing environment due to constant moisture, temperature fluctuations, and mechanical activity from eating and speaking. Understanding what this healing tissue looks like in the oral cavity helps distinguish normal recovery from a potential complication.
The Biological Role of Granulation Tissue
Granulation tissue is built during the proliferative phase of healing to fill the open space of a full-thickness wound, a process known as secondary intention healing. Its primary function is to provide the necessary structure and blood supply for the site to eventually close.
Fibroblasts, the cells responsible for creating connective tissue, begin to synthesize a loose extracellular matrix, which acts as the initial scaffolding. Within this matrix, a high density of new, delicate capillaries is formed through a process called angiogenesis. This rich blood supply is crucial as it delivers oxygen and nutrients required to sustain the rapidly dividing cells and fight off potential pathogens at the wound site.
The provisional matrix initially contains a weaker form of collagen, Type III, to stabilize the area. Over time, as the wound matures, this initial collagen is gradually remodeled and replaced by the stronger, more organized Type I collagen, which is the main component of mature scar tissue. This dense cellular activity and vascular network mean the presence of granulation tissue is a positive sign that the body’s natural repair mechanisms are actively working toward closure.
Visual Characteristics of Healthy Oral Granulation Tissue
The appearance of healthy granulation tissue in the mouth changes depending on the stage of healing, often filling the base of an extraction socket or ulcer. Initially, the tissue is highly vascular and may appear a bright, beefy red or deep pink color, similar to a ripe strawberry. This intense coloration is due to the dense network of new blood vessels forming to oxygenate the healing site.
The texture is described as bumpy, granular, or cobblestone-like, which is where the tissue gets its name. This irregular surface is created by the loops of new capillaries and the developing matrix. The tissue should appear moist and soft to the touch, not firm or rigid, and it may bleed easily with only minor irritation because the new capillaries are still fragile.
In the oral cavity, after a few days, the color may shift from bright red to a paler pink or even white or off-white appearance. This color change is normal and indicates that the granulation tissue is maturing and beginning to be covered by new epithelial cells. The whitish appearance is often mistaken for pus or debris, but healthy granulation tissue does not have the creamy, thick consistency or foul odor associated with infection.
Identifying Signs of Abnormal Healing
While a pale, white appearance can be a sign of maturing healthy tissue, certain visual cues suggest that healing is not progressing normally. A sign of infection is the presence of pus, which appears as thick, yellow, or greenish discharge, often accompanied by a persistent foul odor or taste. The surrounding gum tissue may show excessive, spreading redness and increased swelling that does not subside after the first few days.
Another abnormal sign is hypergranulation, where the tissue grows excessively high and protrudes above the level of the surrounding gum margin. This overgrowth is often shiny and can impede the final stage of healing, which requires epithelial cells to migrate across the surface.
If the granulation tissue appears pale, smooth, or underdeveloped instead of granular, it may indicate hypogranulation or poor blood flow to the area. If the tissue is a deep, dusky red or black color, this could signal necrosis, which requires immediate medical assessment.
Any excessive, persistent pain that is not managed by over-the-counter medication, or bleeding that is more than minor spotting after the initial days, should prompt a consultation with a dentist. These signs distinguish a normal healing process from a complication that requires intervention.