Wisdom tooth removal is a common oral surgery, often recommended to preserve oral health. Patients frequently notice variations in post-operative care, particularly regarding whether stitches are placed after extraction. This article explains why dental surgeons might choose not to use stitches and what this decision means for the healing process.
Factors Influencing Stitch Decisions
The decision to use or omit stitches after wisdom tooth extraction depends on several surgical considerations. For smaller, less invasive extractions, sutures may not be necessary. An open extraction site can promote natural drainage, helping prevent fluid and bacteria accumulation, and allows the blood clot to form undisturbed.
Conversely, stitches are used for larger incisions, complex extractions requiring bone removal, or when a surgical flap of gum tissue is created. Stitches help control bleeding by bringing tissue edges together and securing the gum tissue back into place after it has been moved during the procedure.
The Healing Process Without Stitches
When stitches are not used, healing begins with the formation of a blood clot within the empty socket. This blood clot serves as the initial protective barrier and scaffolding for new tissue development.
Following blood clot formation, granulation tissue begins to develop, filling the socket from the bottom upwards. This soft, pink tissue is rich in blood vessels and indicates healthy healing. As the socket continues to fill, the gum tissue, known as epithelium, starts to grow over the top of the healing site, gradually closing the wound. This process, called epithelialization, seals the extraction site.
Over several months, the bone within the socket undergoes remodeling, gradually filling the space where the tooth once was. While soft tissue healing, including epithelialization, often completes within a few weeks, bone regeneration takes considerably longer.
Essential Post-Extraction Care
Protecting the blood clot in the empty socket is important for proper healing. Patients should avoid activities that could dislodge the clot, such as drinking through a straw, vigorous rinsing, or smoking. These actions create suction or pressure that can disturb the clot, potentially leading to complications like a dry socket.
Managing discomfort is an important aspect of recovery, often addressed with prescribed or over-the-counter pain relief medications. Swelling and bruising, common after extractions, can be minimized by applying ice packs to the outside of the face for the first 24 to 48 hours. Oral hygiene should be maintained gently; after the initial 24 hours, mild salt water rinses can help keep the area clean, but vigorous swishing should be avoided.
A soft food diet is recommended for several days to prevent irritation or damage to the healing site. Foods that are hard, crunchy, or require significant chewing should be avoided. Patients should contact their dentist if they experience severe pain, excessive bleeding, unusual swelling that worsens, or signs of infection such as fever.