Surgical extractions: Suturing gum tissue flaps (placing stitches). / Removing stitches. / Types of sutures.

Once the tooth extraction process has been completed the dentist or oral surgeon will need to reposition the gum tissue flap they have created and suture (stitch) it back into place. First the dentist will check and insure that the edges and surfaces of the bone that will lie underneath the flap are rounded and smooth. If they need adjusting, the dentist will recontour them with their dental drill or else a hand instrument called a "bone file" (a rasp-type tool). With either method you, the patient, will feel the vibration or touch of the smoothing process but otherwise it will be painless.

The dentist will now position the tissue flap back to pretty much its original position and then place whatever sutures are needed. The number of stitches that the dentist does place will vary with each individual case, simply depending how many they feel are necessary to adequately stabilize the flap. The stitches will run from the tissue flap to adjacent, stable (undisturbed, firm) gum tissue.

Placing sutures is similar to sewing with a needle and thread. The dentist will use a suture needle that has suture material (silk, nylon, "gut", etc...) attached to it. This is usually a pre assembled, prepackaged set up.

The dentist will grasp and manipulate the suture needle with a pair of hemostat-like forceps. The curved nature of the needle allows it to glide into and then back out of the tissue more easily than a straight needle could. The patient will feel the tugging pressure of the suturing process and as each individual stitch is tied off, but there will be no pain.

Effects of stitches on wound healing.

Just as a point of interest, here are some of the effects that placing sutures in a wound create.

» Stitches can enhance wound healing.

Stabilization of the tissue flap that lies over an extraction site will enhance the healing process. It will help to minimize any dead space that might otherwise exists between wound parts and minimize the overall size of the wound. Additionally, stitches help to strengthen the wound during the early stages of healing and provide for a more predictable healing process and end result.

» Sutures can help to minimize wound bleeding.

Placing sutures in a wound creates some degree of soft tissue compression. This pressure will help to minimize the amount of bleeding that takes place.

» Stitches also have an inhibitory effect on wound healing.

There is one aspect of sutures that has an inhibiting effect on the wound healing process. To the tissues in which they are placed, sutures are a foreign object and they will be recognized as such. Their presence will trigger inflammation and "foreign body" reaction, which will delay the healing process to some minor degree. Stitches are placed in wounds for specific reasons. If these reasons do not exist, you're actually better off without them.

Types of stitches.

There are two general types of sutures that a dentist or oral surgeon might elect to use. This classification is based on whether they are "resorbable" (absorbable, dissolving) or "nonresorbable." The ability to dissolve away is a function founded on the type of material that the stitches are made from.

Resorbable stitches ("gut" sutures) have the advantage that they do not need to be removed. They will simply come out (dissolve, disintegrate) on their own, usually within a week of being placed (depending upon the type of material from which they have been manufactured).

In comparison, nonresorbable (nonabsorbable) sutures are made out of materials (such as silk or nylon) that will not dissolve. This means that nonresorbable stitches must be removed. Depending on the dentist's determination, an appointment for suture removal is typically scheduled for somewhere between six and ten days after the stitches were originally placed.

Removing nonresorbable (nonabsorbable, non-dissolving) stitches.

Removing sutures placed after oral surgery is usually easy, quick and pain free. In most cases (depending upon the dentist's determination) the patient is appointed to return to the dentist's office to have their stitches removed somewhere between six and ten days after they were placed.

To remove the stitches, the dentist will simply use a pair of scissors and clip the suture thread. They will then grab one of its free ends (the knotted end) with a pair of "cotton pliers" (dental tweezers) and pull it out. There is no need for anesthesia. You might feel a tug on the stitch as the dentist positions it so it can be cut. But otherwise you probably shouldn't feel a thing.