The necessity for sutures, or stitches, is directly related to the complexity of the tooth extraction procedure and the resulting size of the wound. A tooth extraction involves removing a tooth from its socket. When the procedure is straightforward and involves minimal disruption to the surrounding gum tissue, the wound can often close naturally. More involved extractions require the clinician to manipulate the gums and sometimes bone, making sutures a required step to manage the site and promote proper healing.
Distinguishing Extraction Types
Tooth removal procedures fall into two categories, which determine the likelihood of needing stitches. A simple extraction is performed on a tooth that is fully visible and has erupted normally above the gum line. The clinician uses specialized instruments, such as elevators and forceps, to loosen the tooth from its socket before removing it. This type of extraction rarely involves making an incision into the gum, meaning the resulting socket is small and can heal without tissue closure.
A surgical extraction is a more involved procedure required for teeth that are not easily accessible, such as impacted wisdom teeth or teeth broken off at or below the gum line. This approach requires the surgeon to make an incision into the gum tissue to create a soft tissue flap, allowing access to the underlying tooth and bone. Often, the tooth must be sectioned into smaller pieces, or a small amount of bone must be removed to facilitate the extraction. Due to the incision and tissue manipulation involved, surgical extractions almost always require sutures to properly reposition and secure the gum tissue.
Clinical Factors That Require Suturing
Sutures are used following an extraction to manage the soft tissue and stabilize the newly formed blood clot, which is foundational for bone healing. A primary function of stitches is to approximate the edges of the gum tissue incised during a surgical procedure, holding them together to reduce the size of the open wound. This closure protects the underlying socket from food particles and bacteria, minimizing the risk of post-operative infection.
Sutures also play a significant role in preventing dry socket by helping to secure the blood clot within the extraction site. The blood clot acts as a biological dressing necessary for the formation of new bone and tissue. If the clot is dislodged prematurely, the underlying bone and nerve endings become exposed, leading to pain. If the procedure required bone grafting material, sutures are essential for securing this material beneath the gum line to ensure successful integration.
The material used for the stitches influences the patient’s recovery process. Absorbable sutures, made from materials like polyglycolic acid, are designed to be broken down by the body over one to two weeks, eliminating the need for a follow-up appointment for removal. Non-absorbable sutures, such as those made from silk or nylon, must be manually removed by the clinician, typically seven to fourteen days after the surgery. These non-dissolvable stitches are chosen when the tissue requires longer-term support to heal properly.
Managing the Healing Site
The first 24 hours after an extraction focus on allowing a stable blood clot to form. Patients are instructed to maintain pressure on the extraction site by gently biting down on a gauze pad for 45 to 60 minutes, which helps control initial bleeding. Swelling can be managed by applying an ice pack to the cheek near the extraction site in 15-minute intervals during the first day.
Patients must avoid any action that creates negative pressure in the mouth for several days to prevent dry socket. This means strictly avoiding using a straw, spitting forcefully, and smoking, as suction and chemical irritants can dislodge the blood clot. For the first few days, a diet of soft foods like yogurt, mashed potatoes, and smoothies is recommended to prevent trauma to the healing site.
Patients with non-absorbable sutures must return to the office for removal once the tissue has adequately healed. Maintaining gentle oral hygiene is important; while the extraction site should be avoided with a toothbrush initially, gentle rinsing with warm salt water can begin 24 to 48 hours after the procedure to keep the area clean.