A Painless Pimple on the Gum She'd Had for Eight Months

Quick answer: A small bump on the gum that comes and goes, drains a bad taste, and does not hurt is a sinus tract — a drainage channel from a dead tooth. It is painless precisely because it is draining. It is not harmless, and it will not heal on its own.

The call

Leah, 41, from RBS Gimmel, mentioned it almost as an afterthought at a routine check-up. A small bump on the gum above an upper back tooth, present for about eight months. It occasionally released "something salty", then shrank, then came back. It had never hurt, so she had never mentioned it.

That sequence — swells, drains, shrinks, returns — is the definition of the condition, and she had described it perfectly without knowing it.

What we found

A soft, pale nodule about 3mm across in the gum above the upper right second premolar. The tooth had a large filling and gave no response to cold or electric testing. It was not tender to tapping, which is the norm for these.

To confirm the source, we did the definitive test: we threaded a fine gutta-percha point gently into the opening of the tract and took an x-ray. The point curved down through the tissue and its tip came to rest precisely at the root apex of that premolar. That is unambiguous evidence of which tooth is responsible, and it matters — the tract can open some distance from the offending tooth, and treating the wrong one is a real risk without tracing.

The x-ray also showed a well-defined dark lesion about 7mm across at the root tip. Eight months of quiet bone destruction.

Why it did not hurt is the key to the whole thing. An abscess hurts because pressure builds in a rigid space. This one had made itself an exit through the bone and gum, so the pressure never rose. The infection was completely uncontrolled and completely painless at the same time.

Two other things worth noting. Some tracts drain into the mouth like this one; occasionally they open onto the skin of the face or under the chin, and those get treated for months as skin problems before anyone examines the teeth. And a lesion left this long slowly enlarges — hers was approaching the sinus floor.

What we did

Root canal treatment. First visit: access, removal of the necrotic tissue, thorough irrigation, calcium hydroxide dressing. The tract closed within ten days, before the treatment was even finished — once the source of bacteria is removed, the body seals the channel quickly.

Canals filled at the second visit. Crown six weeks later, because the tooth had a large filling and thin walls.

The outcome

The bone lesion was noticeably filling in at six months and had largely healed at eighteen. The gum where the tract had been shows no trace.

What to do if this happens to you

1. Do not ignore a painless lump on the gum. Painless means draining, not resolved.
2. Mention how long it has been there. Eight months tells the dentist how much bone loss to expect.
3. Ask for it to be traced with a gutta-percha point and an x-ray. It identifies the tooth definitively.
4. Do not squeeze it. It drains on its own; squeezing pushes bacteria into the tissue.
5. Have any persistent lump examined, even if you think you know what it is. Not every bump is a sinus tract.
6. Expect it to close quickly once treatment starts. If it does not, the source has not been dealt with.

A lump on your gum that keeps coming back? Ramat Beit Shemesh Urgent Dental Care will trace it to its source. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.