When are stitches needed? – purpose, disadvantages. | Types of dental sutures. Which types dissolve away? How long does it take? When should
non-resorbable stitches be removed? | The gum flap and suture placement procedure. Gum tissue flaps and suture placement.Some tooth extractions require the creation of a gum tissue flap, so to gain better access to the tooth being removed, or the bone that surrounds it. And then the placement of one or more sutures (stitches), whose purpose is to stabilize soft tissues loosened up during the procedure until the needed degree of healing has had a chance to occur. Our coverage.This page explains the use of dental flaps and sutures when they’re included as a part of the tooth extraction process, like wisdom tooth surgery. We’ve divided its coverage into the following subtopics:
Most people who visit this page are interested in the subject of stitches, so we’ll cover them first. Suture needle and thread. 1) Types of stitches – suture materials.There are two general categories of suturing material that dentists use. The big difference between the two is that one type “resorbs” (dissolves away on its own) and the other doesn’t, and therefore needs to be removed at some later date (see below). a) Stitches that dissolve.Resorbable (absorbable) stitches offer the advantage that they don’t need to be taken out later on. Your body breaks them down and disposes of the byproducts. These types of stitches are sometimes called “catgut” or just “gut” sutures, related to the fact that some are actually made from intestines of animals (usually sheep or cattle). Beyond natural materials, various synthetic compounds are used to make dissolving stitches too (polyglycolic acid, glycolic and lactic acid copolymer, glycolide and epsilon-caprolactone copolymer, polydioxanone). How long does it take resorbable stitches to dissolve? The amount of time it takes for disintegration depends on the type of suture material placed and what type of treatment it has received.
So if you weren’t told at the time of your surgery, in order to know exactly what to expect you’ll probably need to touch base with your dentist’s office. What will you notice as your sutures dissolve away? As the strength of your stitches deteriorates, it may seem as if they’re getting loose or coming untied. There’s usually a point where they have become so fragile that their exposed portions just break off and fall away. Within your tissues, the completion of the absorption process by your body will take many weeks. Once again, the kind of suture material used and the treatment it has received are factors. Other issues include the type and conditions of the tissue in which the stitches have been placed, and even the general health status of the patient. Plain gut sutures take on the order of 70 days to be fully resorbed within tissues, and chromic gut ones over 90 days. ▲ Section references – Fragiskos, Dunn b) Stitches that don’t dissolve.In comparison to stitches that dissolve away, nonresorbable (nonabsorbable) sutures are made out of materials that the body can’t degrade and dispose of. This includes: silk, polyester, polyvinylidene fluoride, polypropylene and nylon. This means that the duration-of-strength characteristics of nonabsorbable sutures is much longer than absorbable ones. Silk still retains 20% of its original strength at 6 months, nylon only looses 20% of its strength each year, and polypropylene lasts essentially indefinitely. ▲ Section references – Wray When should they be taken out? Since their strength characteristics far exceed the duration of their needed service, nonresorbable sutures must be removed. This appointment is usually scheduled somewhere between 7 to 10 days after the stitches were originally placed. (Fragiskos) Of course, their removal will be based on the purpose they serve. As such, the scheduling of the appointment to remove them will simply be per your dentist’s instructions. ▲ Section references – Fragiskos Resorbable vs. Nonresorbable stitches – Which kind is better?Clearly this is a decision for your dentist to decide. But in case you’re wondering about some of the key advantages and disadvantages of each … Resorbable stitches.
Nonresorbable stitches.A type of nonresorbable suture material that’s frequently used with oral surgery is braided silk. As advantages, and as compared to resorbable materials:
▲ Section references – Hupp 2) How stitches affect wound healing (positively and negatively).As a point of interest, here are some of the effects that placing sutures in a wound can have. Different than you’d expect, they’re not all entirely positive. Functions and effects of placing stitches – a) An aid in wound healing.A primary function of stitches is stabilizing movable soft tissues (like a tissue flap that’s been created during a surgical extraction). The loose gum tissue between two extracted teeth has been sutured together so to stabilize it. Note that no attempt has been made to pull the gum tissue across the empty sockets. Related to this purpose they can:
▲ Section references – Hupp b) An aid in wound hemostasis (bleeding control).Placing stitches in an extraction site tends to create soft tissue compression. This pressure in turn can help to minimize the amount of postoperative bleeding that occurs, help to bring the wound’s bleeding under control more quickly, and generally aid with blood clot formation. In theory, crisscrossing sutures across a tooth’s socket might serve as an aid in blood clot retention (an important factor for the healing process). However, in practice the benefit of doing so tends to only be minor. But suture placement may be used to help retain clotting aids that have been placed into the socket. ▲ Section references – Hupp c) Wound healing inhibition.This is probably something you didn’t know about stitches. They actually tend to interfere with the wound healing process.
While none of these events overshadows the benefit that placing stitches provides, it does mean that they shouldn’t just be placed as a matter of routine but instead only for good reason. And if these reasons don’t exist, you’re actually better off without them. ▲ Section references – Javed 3) Dental flaps.Some extraction procedures (such as removing impacted wisdom teeth) require the creation of a gum-tissue flap.
(This page outlines extraction situations where the creation of a dental flap might be needed.) The gum tissue flap procedure.Here’s the process that a dentist uses to “lay” a flap when performing a surgical tooth extraction. 1) They’ll first need to use local anesthetic (“Novocain”) to numb up your gums in the region where the flap will be created.
2) They’ll then use a scalpel to score the outline of the flap, cutting all of the way through the gum tissue down to the bone. (This is termed creating a “full-thickness mucoperiosteal flap,” indicating that all of the soft tissue layers covering the bone will be peeled back.)
A dental flap provides access to both a tooth and its surrounding bone. 3) Once the flap’s outline has been scored, your dentist will reflect it back (peel it away from the bone). Here’s how they’ll do it:
4) At this point, the three sides of the flap are loose and free. The underlying bone surface is entirely exposed.
▲ Section references – Koerner Why are tissue flaps so large?A tissue flap stitched back into place following an extraction. Notice how the flap’s base is wider than its free margin (edge). When compared to the width of the space from which your tooth has been removed, the tissue flap for your procedure might seem quite large. Here’s why:
▲ Section references – Koerner 4) Closing flaps. / Placing stitches.Here’s an outline of what your dentist will need to do when “closing” the flap they created for your extraction process. 1) To start, your dentist will thoroughly flush your wound with saline solution or water. They’ll also evaluate the surface and edges of the exposed bone to make sure it has smooth and rounded contours.
2) The flap is usually positioned back into pretty much its original position. Stitches will be placed to hold it there.
Placing sutures to tack a tissue flap back into place. 3) Placing stitches is similar to sewing with a needle and thread.
4) Your extraction site has now been closed and your procedure completed.
▲ Section references – Koerner, Fragiskos Types of suturing.The stitching pattern that your dentist uses will vary depending on the size and needs of the wound being closed. a) Interrupted sutures.This is the simplest, and most frequently used, type of suture placement following oral surgery procedures. The term “interrupted” simply means that each stitch is placed and tied off independently (one-at-a-time placement). The advantage being that if one comes loose or unties, the integrity of the wound’s other sutures won’t be affected. b) Continuous sutures.“Continuous” stitches are the situation where a single line of suture thread is woven multiple times through the flap being anchored, with the whole placement being secured by the same knot(s). Putting in stitches this way can be a lot quicker. But if any portion of the suture comes loose or breaks, it affects the integrity of the entire unit. ▲ Section references – Fragiskos Return to page surgical extractions. ►
Page references sources: Dunn DL. Wound closure manual. Chapter: The suture. Fragiskos FD. Oral Surgery. (Chapter: Principles of Surgery.) Hupp JR. Guide to suturing with sections on diagnosing oral lesions and post-operative medications. Javed F, et al. Tissue Reactions to Various Suture Materials Used in Oral Surgical Interventions. Koerner KR. Manual of Minor Oral Surgery for the General Dentist. (Chapter: Surgical Extractions.) Wray D, et al. Textbook of General and Oral Surgery. (Chapter: Wound healing and suture materials.) All reference sources for topic Tooth Extractions. Comments.This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page. Comment – Extent of stitches.Hi, I had a molar extracted 4 days ago. Swelling has finally gone done & I’m in much less pain, however is it normal to have stitches anchored to an adjacent tooth because it seems I have a stitch around that tooth. Also, I have white gums laterally where the tooth was pulled. Lisa Reply – Sling suturing is a technique. And as you describe, the suture thread is wrapped around the circumference of the tooth. And yes, sometimes this technique is used to close flaps associated with molar extractions. The white gum tissue you notice might be tissue that was traumatized during the extraction process (as your tooth was rocked back and forth). If your body has decided that it can’t be salvaged, it will reduce the blood flow to it. During the healing process this tissue will be replaced with new. Staff Dentist Comment – Cleaning stitchesI got one of my lower molars extracted about 2 weeks ago and now the stitches in my mouth have begun to smell/taste bad. I can’t brush the area, so how do I clean them? I’m not getting the stitches out for two more weeks! RS Reply – It’s possible that what you smell and taste is related to the accumulation of debris and bacteria underneath and around your stitches, or possibly even within their thread strands. If so (at this point, 2 weeks post op) gentle rinsing with a hydrogen peroxide solution should be a way to help to clean them up (dislodge debris, kill bacteria). (3% hydrogen peroxide diluted with an equal amount of water, or use the product Peroxyl.) Pass this suggestion by your dentist to get their OK. Staff Dentist Comment – Nonresorbable StitchesI had an upper molar extracted 4 days ago, the dentist stitched the area using black nonresorbable stitches and asked me to return after 10 days to remove them. The swelling has reduced in my face but the gums are still swollen some. The stitches (which have been irritating my cheek and tongue) seem to have loosened up to the point where the knotted part is now a long hanging stitch. Its irritating me even more now, and is so much more sore since coming loose. Would it do any harm for me to remove the stitch myself? Also the area where the stitches are is now a white gum surface rather than pink – is this normal? FM Reply – These are all pretty simple questions for your dentist to answer. You need to give them a call. In general terms: If an individual stitch that has been placed to stabilize tissues is extremely loose, then we’d agree that it is no longer serving its function, and at least in theory is actually retarding the healing process. But if what seems loose is a part of continuous stitches (where cutting one undoes others), or what has been seen has been misinterpreted, then at just 4 days (according to our tissue healing graph) removal might be problematic. The white gum tissue you notice might be tissue that has been traumatized during your procedure. During the healing process your body may find that some tissue can’t be or shouldn’t be salvaged. As such, it will reduce the blood flow to it. All of the above is just general information. Only your dentist can tell you how these issues apply to your case. Staff Dentist Comment – Stitches in cheek.Hey I had 3 wisdom teeth removed and the dentist stitched the wounds close. It’s looks as if he has stiched them to the cheek. Is this normal? Benjamin H. Reply – You’ll need to check back with your dentist for specifics about your case but generally, there is no clear demarcation between the skin of the cheek and the gums surrounding the area of a 3rd molar. And in order to be able to close the extraction wound, the stitches placed may need to impinge somewhat on what’s interpreted as being cheek tissue. Staff Dentist Comment – How long?Due to Covid-19 Pandemic, dental offices are closed, preventing post surgical exam and suture removal. How long can sutures remain? Michael Reply – It’s not possible to provide an answer for your specific case. Surely someone must be answering emergency calls for your dentist and you can discuss matters with them. In general terms: Following oral surgery, non-absorbable stitches are usually left in place for 7 to 10 days, here’s why. It’s common that toward the end of the stitches’ intended lifespan, they have started to loosen and sag (just part of the evidence that they no longer are needed). And especially if so, they are usually easily removed, as explained here. Not removing them leads to the potential that some of the suture material will remain within the tissues as it fragments and deteriorates. And while not usually resulting in a significant complication, isn’t the ideal scenario. (More details here.) Staff Dentist How long do dissolvable stitches in gums take to dissolve?The time it takes for dissolvable or absorbable stitches to disappear can vary. Most types should start to dissolve or fall out within a week or two, although it may be a few weeks before they disappear completely. Some may last for several months.
How can I make my dental stitches dissolve faster?However, some general care tips for dissolvable stitches include:. showering according to the doctor's instructions.. patting the area dry gently after showering.. keeping the area dry.. changing any dressings as and when the doctor advises.. avoiding using soap on the area.. What happens if stitches don't dissolve after tooth extraction?If you received stitches during your surgical extraction, the stitches will dissolve on their own in about two weeks. You can rinse with warm salt water to help them dissolve. If they do not go away on their own, they may need to be removed by a surgeon or dentist.
What should I do after tooth extraction with stitches?48 hours after surgery, rinse mouth with warm salt water every 1-2 hours. Avoid using any mouthwash containing alcohol as it can irritate the wound. Keep your mouth clean by brushing areas around the surgical site, but be sure to avoid sutures. Touching the wounded area in any fashion should be prevented.
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