Oral sutures are threads used by surgeons to hold gum tissue together following procedures like wisdom tooth extraction, dental implant placement, or gum grafts. They keep the surgical site closed, promoting healing by primary intention, where the wound edges are closely approximated. Finding a loose or undone suture can be unsettling, but it is usually manageable and requires immediate communication with your provider. Dissolvable stitches are designed to loosen and fall out naturally, typically within one to two weeks, as the underlying tissue heals.
Immediate Triage and First Steps
First, assess the situation to determine if it is a true emergency, such as heavy, uncontrollable bleeding or severe, unmanaged pain. Bleeding that does not slow down or stop after 30 minutes of sustained pressure requires immediate medical attention. For non-emergency situations, gently clean the area with a warm saltwater rinse, mixing about half a teaspoon of salt into a cup of warm water.
Swish this solution very gently without spitting vigorously, as excessive force can dislodge the protective blood clot. If you notice light bleeding, apply light, sustained pressure using a clean gauze pad or a moist tea bag, biting down gently for 30 minutes.
The tannic acid in a tea bag can help constrict blood vessels and promote clotting. If the loose suture material is dangling or fully detached, resist the temptation to pull on it. Pulling on the suture can disrupt newly formed tissue, slow recovery, and potentially reopen the incision.
Contacting Your Dental Provider
Contact the oral surgeon or dentist who performed the procedure as soon as you notice the suture is loose or gone. Provide specific details, including the date of surgery, the affected site, and the extent of any bleeding or discomfort. Clarify whether the suture is completely missing or just feels loose, as this helps them determine the urgency of a follow-up visit.
In most cases, your provider will examine the site and decide if a new suture is necessary, which is typically a simple, quick procedure. The emergency room (ER) should only be considered for uncontrolled hemorrhage, difficulty breathing or swallowing, or signs of a severe systemic infection like a high fever with chills. For all other concerns, including localized swelling or pain, your dental provider is best equipped to offer guidance.
Managing the Healing Process Without Sutures
If your provider determines the wound does not need to be re-stitched, the site will heal by secondary intention. This means the wound edges are not approximated, and the defect closes by forming granulation tissue from the base up. While this method may take slightly longer and involve a more intense inflammatory response, oral tissues are generally resilient and heal effectively.
To protect the exposed wound site, maintain a soft diet and avoid using straws or creating suction, which could dislodge the protective blood clot. Practice gentle oral hygiene, carefully brushing away from the surgical area, and continue warm saltwater rinses to reduce infection risk. Monitor the area for signs of infection, including pain that worsens, pus or discharge, or a persistent foul taste or odor. These symptoms, along with a fever above 100.4°F, require prompt communication with your dental provider.