A tooth extraction is a routine dental procedure performed for reasons like severe decay, infection, or overcrowding. Many people expect to receive stitches to close the resulting wound. The absence of sutures, however, is a common and normal part of many extraction recoveries. This decision is based on the complexity of the tooth removal and how the dentist determines the site will best heal.
Criteria for Using Sutures
The decision to use sutures is based on factors related to the procedure’s invasiveness and the wound’s size. Simple extractions, where the tooth is visible and removed without surgical incisions, often do not require stitches. These wounds are typically small, and the gum tissue naturally closes around the site.
Conversely, surgical extractions, such as the removal of impacted wisdom teeth or a tooth with fractured roots, often involve creating an incision in the gum tissue. Stitches are then used to bring the manipulated gum flap back together and hold the tissue edges in close contact. This mechanical closure helps control bleeding, protects the area from external debris, and creates a stable environment for healing.
If the extraction did not require the dentist to lift or cut the gum tissue, the resulting socket is left to heal by a natural process called secondary intention. Sutures are primarily a tool for repositioning and securing soft tissue that has been moved or cut during the procedure. When the gum margins are already close together and the wound is clean, the body’s natural clotting mechanisms are sufficient for wound closure.
How the Extraction Site Heals Naturally
Whether or not sutures are placed, the first step in the recovery of an extraction site is the formation of a blood clot within the socket. This clot acts as a biological shield for the underlying bone and nerve endings, serving as the foundation and scaffold for new tissue growth.
Over the next few days, the body begins the process of organization, where the initial blood clot is gradually replaced by a soft, delicate new tissue called granulation tissue. This tissue often appears whitish or yellowish and is a healthy sign of healing. The presence of this tissue indicates that the body is successfully filling the space left by the tooth.
Following the formation of granulation tissue, the epithelial cells from the surrounding gum tissue begin to migrate inward, slowly closing the surface of the socket. This process seals the wound over the course of the first one to two weeks. The bone within the socket will continue to fill in over the next few months, fully completing the repair of the extraction site.
Essential Care for an Unstitched Site
Because an unstitched site relies entirely on the successful formation and retention of the blood clot, post-extraction care must protect this initial barrier. For the first 24 hours, the primary goal is to maintain gentle pressure by biting down on the gauze pad to encourage stable clot formation. Avoid rinsing or spitting during this initial period, as this can easily dislodge the forming clot.
Actions that create suction or negative pressure in the mouth must be strictly avoided for at least the first week. This is the most common cause of clot disruption and the painful complication known as dry socket. This means refraining from using straws, smoking, or forceful spitting.
The heat and chemicals from smoking are particularly detrimental, significantly delaying healing and increasing complication risks. After the first 24 hours, gentle salt water rinses can be started to keep the area clean and promote healing, typically using half a teaspoon of salt dissolved in warm water.
The mouth should be tilted gently to let the water flow over the site, rather than vigorously swishing or spitting out the solution. Stick to soft foods like yogurt, mashed potatoes, and scrambled eggs, and avoid any hard, crunchy, or sharp foods that could irritate the vulnerable socket.
When to Contact Your Dentist
While some mild pain, swelling, and oozing are expected during the first few days, certain symptoms indicate a complication and require professional attention. The most recognizable sign of a problem is intense, throbbing pain that begins around three to five days after the extraction and does not improve with medication. This kind of severe pain often signals a dry socket, which occurs when the protective blood clot has been lost, leaving the underlying bone exposed.
You should also contact your dental professional if you notice signs of an infection. These can include increasing swelling that worsens after 48 hours or a persistent, foul taste or odor that is not relieved by gentle rinsing. Any fever or discharge of pus from the extraction site is a clear indicator that the body needs assistance fighting off bacteria. Heavy, persistent bleeding that cannot be controlled by biting down on gauze for several hours also warrants an immediate call.