Lost or loose stitches after an extraction – What should you do? (2024)

Lost stitches after oral surgery.

Loose and lost stitches – What to do?

Despite your dentist’s skill in placing them, and your best efforts in taking precautions, you may notice that sutures (stitches) that were placed following your oral surgery procedure, like wisdom tooth or even just regular tooth extraction, end up loosening or coming out before anticipated (for dissolvable stitches) or scheduled (for non-dissolvable ones).

What should be done?

The needed response for your predicament, if anything, typically boils down to judgments based on just a couple of issues. They are:

• The reason why your stitches were placed. (Yes, they are placed for more than one reason.)
• The time frame during which they fell out/loosened up.
• The type of suturing and the number of stitches originally placed.
• What has occurred as a consequence of the stitches’ failure.

In our discussion below, we give examples of how each of the above issues might be considered and weighed by a dentist when deciding what steps are now indicated for their patient.

It’s your dentist who must decide what treatment is required.

After reading this page, you should be fairly knowledgeable about the topic of lost and loose stitches, and have a basic understanding about why replacement may or may not be necessary.

But in regard to the governing factors listed above, it should be obvious to you that there are always going to be some issues that you, the patient, simply won’t be in the position to fully know the answer to.

Because of this, it’s important for you to report what has transpired to your dentist so they can make a determination about your specific situation.

• As your doctor, it’s their opinion that’s the definitive one in making decisions about your post-extraction care.
• It’s also their obligation to respond to your postoperative needs, so don’t hesitate to contact them.

Note.

Differences would be especially likely in cases where the sutured tissue flap is a “free” graft (taken from one site and placed in another), or those where a “barrier membrane” has been positioned. (These are terms your dentist would almost certainly have used in describing your procedure to you.)

What should you do if you’ve noticed stitches that have fallen out or come loose?

If you’ve discovered any complications or irregularities with your sutures, it’s important for you to take precautions with your surgical site until you’ve consulted with your dentist and they’ve determined your status.

Precautions you should take immediately.

You shouldn’t do anything that has the potential to traumatize your wound, dislodge its healing tissues, or trigger renewed bleeding.

This includes avoiding the exploration of your surgical site, like with your finger or tongue. Making extreme mouth or facial movements that might place tension on its healing tissues. Or when eating foods, especially hard or crunchy ones, allowing them to drift over to the region of your surgical site and traumatize it.

Examples and general rules of thumb about premature suture loss.

1) Loss of stitches placed to create soft tissue stabilization.

Placing stitches as a way of providing surgical flap (gum tissue) stabilization is the application that patients seem to be most familiar with.

The need for this function is most important during the first days following an extraction. Then, with each additional day of healing that passes, the strength/reattachment of the manipulated tissues to the bone underneath gradually increases, thus lessening this requirement.

The biology of the matter.

How this transition takes place was evaluated by a study by Werfully (2002).

It documented the speed and degree to which gum tissue reattaches to the bone underneath during the healing process in dogs. (The assumption is that this process would be similar in humans.)

We’ve reproduced one of the graphs from the study here. The curve of the graph shows the increase in tensile strength of the wound over time.

Notice on the graph –

As an interesting point, notice that at 7 to 10 days post-op, which is the usual time frame when stitches are removed, the strength of the tissue flap is still only about half as strong as it will ultimately become.

Apparently, however, this is enough strength that short of an excessive challenge to the healing tissues they’ll typically remain satisfactorily in place.

A paper by Pippi (2017) confirms this point in stating that at 7 to 14 days post-op, flaps are still susceptible to mechanical trauma. And that only after 4 to 5 weeks of healing has the tissue completely reattached to bone and teeth so that no differences with adjacent tissues exist.

YMMV

It must also be stated that the precise shape of the curve shown in the graph above will vary with each person. That’s because conditions within their body will dictate their rate of wound healing. Factors include: age, nutritional status, body hydration, blood supply to the wound, immune response and systemic medical conditions.

▲ Section references – Werfully, Pippi, Dunn

What happens when your stitches loosen, fall out early, hang loose, etc…?

In cases where tissue stabilization is a primary concern, as the graph above shows, the point in time at which the suture(s) failed can be an important factor.

• If the event occurred just a few days before their removal was originally expected/scheduled anyway, losing them early may not be much of an issue.

  (Notice on the graph how the strength of the tissue’s attachment on days 4, 5 and 6 rapidly approaches the evidently satisfactory level reached on day 7.)

• But if they were compromised early on, like before day 3, disruption of the flap is much more of a possibility because its healing simply hasn’t progressed very far. And in this event, your dentist may decide that stitches lost early on need to be replaced.

Considerations and concerns.

When one or more stitches are lost or have loosened up, a number of considerations will come into play.

a) Can the extraction site be favored?

The degree to which the now unstitched/unsupported tissues are subject to disruptive forces is a concern.

• It may be possible that by practicing great care for the few days needed until the healing process has created a satisfactory level of strength, the patient can nurse their situation along and their fragile wound will remain undisrupted.

• This won’t be possible in all cases however. Conditions may be such that adjacent tissues (lips, cheeks and the muscles in them) create enough pull on the wound that even with just routine and minor movements it will still be subjected to forces greater than it can tolerate. Flap stability can also be compromised due to increases in normal wound swelling.

▲ Section references – Kurtzman

b) How crucial was the stitch that was lost?

The suturing technique and placement layout the dentist has used will be a major consideration.

• The stitches that have been placed may be interrupted (individual) or continuous (a series of stitches tied off with a single knot).

  If interrupted, losing one or a few of many might be tolerated. If continuous, a single knot coming untied will ultimately affect the entire row.

• With the potential for loss in mind, a dentist might have incorporated some degree of redundancy into their suturing plan as a precaution. Only they will know.

c) Signs of tissue movement or detachment.

If stitches have come out early or loosened up, especially before day 3 post-op (see graph above), there will be greater potential for the flap to shift, or a portion of it to become detached. As a result:

• There’s some potential that you may discover an edge of tissue that’s come loose.

  Gum-to-tooth interfaces gain reattachment strength at a slower rate than gum-to-underlying-bone interfaces. (Werfully – linked above.) So a stitch lost in this region might prove to be more problematic.

• Often what is noticed is the formation of a dehiscence. This is the situation where two edges of your wound that were stitched together have now come apart. As a consequence, since there is now a space between the two edges, the completion of new tissue formation will take longer.

  The treatment needed will be based on the extent of the dehiscence and its subsequent healing progress. If it is limited in width, no treatment will be required. Large gaps may need to be resutured. If the dehiscence’s healing seems stalled, the wound may need to be surgically refreshened. (Annibali)

Renewed bleeding.

It’s possible that tissue displacement events will trigger renewed bleeding. In fact, soft tissue not firmly bound to underlying bone is often the cause of persistent postoperative bleeding from a surgical site (with the needed remedy being suture placement). (Koerner)

Significant displacement events are most likely to occur when stitches are lost during the first few days postoperatively. Bleeding escaping from underneath the flap presents itself as flow from the edges of the incision and gingival margin (the edge of the flap that lies along the teeth). (Pippi)

In cases where this complication occurs, your dentist should be notified. As first aid, application of pressure to the wound via moisten gauze is the typical solution. But the pressure must be applied in an orientation that doesn’t further disrupt the positioning of the flap. Since your dentist is familiar with the configuration of your wound, let them provide you with specific instructions.

▲ Section references – Annibali, Koerner, Pippi

Tissue tears.

In some cases, stitches can rip through the tissue in which they’ve been placed. This type of failure can be associated with excessive suturing tension, tissue flaps that are especially thin, the use of thick suture thread, placing sutures too close to the incision line or flaps placed under tension by adjacent tissues and muscle movements or developing swelling. (Pippi – linked above.)

With the stitches now disrupted, the same concerns discussed above apply. Additionally, the tissue lacerations will constitute a secondary, although minor, wound. Associated tenderness, and a small amount of bleeding at the time of the event, would be expected.

More details about loose stitches.

While possibly not immediately apparent to most patients, loose sutures provide no benefit to wound healing and actually create some risk. The treatment that’s indicated is removing them. (Pippi – linked above.)

Here’s why.

In terms of function, loose or hanging stitches provides no stabilizing effect at all, which means that all of the possible problems and concerns discussed above apply to this situation.

As an added concern, it’s possible that the loop of a hanging suture might be snagged (like while brushing your teeth), with the pull resulting in tissue laceration as the suture thread tears free. So unlike a lost one, loose stitches hanging in your mouth have some potential to cause further physical damage, and that’s why they should be removed.

FYI –

• In regard to a need for replacing loose sutures, all of the factors and concerns discussed above will apply and will need to be weighed by your dentist when making their decision.
• Its common for sutures to start to show signs of looseness as the level of swelling in the tissues in which they’ve been placed starts to subside. On inspection, it will be obvious that the suture is no longer under tension. Instead, its will appear slack or as a loop hanging in your mouth.

  The thread of slack or hanging dissolvable stitches may no longer be fully intact and therefore totally nonfunctioning, thus making the decision to remove them just that much easier.

• If not providing a service, the physical presence of a suture is actually counterproductive to tissue healing.Healing inhibition.. This fact makes the case for removing loose or hanging stitches just that much easier to make.
• In the case of loose single (interrupted) sutures, removal is quite easy and painlessHere’s how. and might be considered as a DIY solution if you have adequate access and visibility.

2) Loss of stitches placed to control postoperative bleeding.

While a patient may not realize it, their stitches may have been primarily placed to aid hemostasis (the control of bleeding from their surgical site). Here are some examples:

• A common application is one where following a tooth’s extraction a clotting aidExamples. is placed in its socket. Stitches are then used to stabilize and hold the aid in place.

  (As hints that this technique has been used with your situation: The clotting aid that’s been placed (typically a sponge, gauze or foam-like substance) is usually quite visible. The method of suturing used typically crisscrosses over the socket, often a number of times.)

• Another application involves the use of stitches to create soft tissue immobilization and compression. Both of which can help to arrest postoperative bleeding.

In cases involving these techniques, the now-lost sutures may have already served their purpose, even after just a short period of time. As opposed to stitches placed for tissue stabilization that are not usually removed for at least a week, the purpose of those placed in this context is typically fulfilled within just 2 to 3 days.

▲ Section references – Fragiskos

Video transcription.

Hello and welcome to Animated Teeth.com and our page that discusses what to do about extraction site stitches that have come loose or have fallen out before the 7 to 10 days that they’re generally considered needed. In this video, we’ll make mention of some of the more important points that we feel you should know about.

As a start, when it comes to problems with sutures, it’s your dentist, your treatment provider, who unquestionably has the most qualified opinion about what steps should be taken as a remedy.

We can explain for you what’s usually done, and what your dentist will consider when making their decision. But for your situation, they’re the only one who has the all-encompassing view. And therefore, they’re the one who should make decisions about your care.

We’ll also point out that it’s their obligation, as well as no doubt an important aspect of the satisfaction they get from practicing, to make sure that your post-operative problems are tended to. So, take advantage of their assistance.

As background information, it’s important to understand why stitches are placed.

The reason most people think of is tissue stabilization. And a common example of this is the situation where the patient’s gum tissue at their surgical site has been flapped open so the dentist has access to their tooth. This is commonplace with the removal of impacted wisdom teeth.

Afterward, when the wound is “closed,” stitches are used to tack the flaps back into place. Doing so idealizes conditions for the healing process to come.

Sometimes a flap isn’t formally raised but the tissues still have mobility, like in the case where multiple teeth have been taken out in a row. If the dentist thinks that stabilization of these tissues will make the healing process go more predictably, they’ll place some sutures.

Probably less realized by patients is the fact that stitches are sometimes placed to help control extraction site bleeding.

Take the case where, based on a patient’s health history, the dentist has concerns that prolonged post-operative bleeding may become an issue. Placing stitches can be a way of applying pressure to the site, a step that typically aids blood clot formation.

So, in understanding what possibly needs to be done about your lost stitches, if you’ve seen our pages that discuss extraction aftercare you know that bleeding typically isn’t a problem past the first day or so.

So, if you have some stitches come out or loosen up on day two, and they were placed to aid hemostasis which at this point is controlled, that might not be much of an issue. But if they were placed for tissue stabilization, well, that’s a different matter.

Of course, it’s your dentist who knows these kinds of particulars, not you. So give them a call.

Here’s an interesting graph that can give you an idea of how long sutures are needed. It shows how gum tissue flap strength, meaning tissue stabilization, increases over time. Take notice of the two dotted lines. They show when sutures are usually taken out, which is somewhere between days 7 and 10.

Interestingly, you might notice that stitches are typically taken out when the tissue flap’s strength is only about half as strong as it will ultimately get at the end of full healing. So even under normal circ*mstances, you still need to take things easy after they’re removed.

In comparison, if your stitches fall out early, well, the timing of the event means everything. If they loosen up on day 6, and if you take a little care, well, that shouldn’t be a big deal.

If they come out on day 4 or 5 and you exercise a lot of care in not testing or stressing your wound, that’s not ideal but possibly passable. If your sutures come out even earlier, well, you get the idea. And it takes your dentist’s judgment to know what to do.

A lot of their consideration will have to do with what’s already occurred now that your stitches are gone. Is the positioning of your gum tissue still relatively intact? Having noticed pain or bleeding could be signs that it’s not. If nothing has happened yet, is it likely you can protect your stitched site so disruption doesn’t occur?

Even if your lost stitches have resulted in tissue displacement, your dentist may decide that it’s now a historic event and there’s not much to do about it. This would be the case where the separation of the gum tissue, termed a dehiscence, is minor.

In extreme cases, meaning the suture loss has led to substantial tissue changes in the stitched area, resuturing may be needed. And possibly the gum tissue’s edges will need to be surgically freshened.

Only your dentist can make all of these kinds of calls. So, once again, be in touch with them. Hopefully, you’ll find that they feel all is well enough, considering.

We will point out that there is additional important information on this page, so give it a read. And then, don’t overlook that we do have additional pages that cover sutures, like details about how they’re taken out, so look for those.

And last, if you’re having problems, good luck. But what we really mean is call your dentist. They expect you to. That’s their job. Goodbye.

Comments.

This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.