Sutures, or stitches, are common in many oral surgical procedures, such as tooth extractions or gum surgery. Their primary purpose is to stabilize tissue edges, securing them over the surgical site to encourage optimal healing and protect the underlying blood clot. In the mouth, these sutures are almost always made from specialized materials designed to dissolve naturally. This eliminates the need for a follow-up appointment for removal, reducing patient discomfort and anxiety. The process is controlled by the body’s natural processes, allowing the wound to remain closed until sufficient healing has occurred.
The Mechanism of Absorbable Sutures
The dissolution of stitches occurs through two primary biological pathways, depending on the material used. Synthetic sutures, the most common choice today, break down through hydrolysis, a chemical reaction. This process involves water molecules penetrating the polymer chains of the material, gradually cleaving the chemical bonds. For materials like polyglycolic acid (PGA) or polyglactin 910, continuous exposure to saliva and tissue moisture initiates this predictable degradation.
Natural absorbable sutures, such as those made from purified animal collagen (plain or chromic gut), use enzymatic degradation. The body’s proteolytic enzymes metabolize and digest the suture material over time. This enzymatic action is less predictable than hydrolysis, as the rate of breakdown depends on the local tissue environment. Synthetic materials are favored because their breakdown speed and loss of tensile strength are more consistent across different patients.
Expected Dissolution Timeline
The total time for oral sutures to disappear generally ranges from five days to three weeks before they fully fall out or are no longer visible. The most significant factor determining this timeline is the specific type and gauge of the material selected. Plain gut sutures lose strength and are often fully absorbed within the first week, sometimes as quickly as three to five days. Chromic gut, which is treated with salts, slows the enzymatic process, extending the dissolution period to approximately ten to fourteen days.
Synthetic sutures are engineered for prolonged support, often maintaining integrity for one to three weeks before they noticeably weaken and fall away. Patient-specific factors also play a role, particularly the constant presence of saliva, which accelerates the degradation of certain materials. Additionally, the thickness of the suture thread, known as the gauge, impacts the rate; a thicker material requires more time to break down fully than a finer one.
Post-Procedure Care and Complications
Proper post-procedure care ensures the sutures remain intact for the necessary healing period and dissolve without complication. Patients should avoid any activity that creates suction in the mouth, such as using a straw or vigorous spitting, as this can prematurely dislodge the blood clot or loosen the stitches. A soft diet is recommended for the first few days, and patients should refrain from chewing hard, sharp, or sticky foods that could snag or tear the suture material.
Maintaining oral hygiene is important, but direct brushing of the surgical site must be avoided initially. After the first 24 hours, gentle rinsing with warm salt water can help keep the area clean and reduce bacteria without disrupting the stitches. Patients must resist the urge to prod or pick at loose threads with the tongue or fingers, as this can pull the stitches out before the wound is adequately healed.
Most dissolutions occur smoothly, but patients should monitor for specific warning signs of complication. These include a persistent fever, increasing swelling or redness around the surgical site, or the presence of pus or discharge. Persistent, throbbing pain not relieved by medication, or sutures that remain visibly intact past the three-week mark, warrant immediate contact with a dental professional. Premature loss of the stitches accompanied by bleeding that does not stop is another sign that the wound may have opened and needs reassessment.