What happens if you have a stitch come out? | What should you do? | Is replacement necessary? | Factors your dentist will consider when evaluating your situation and deciding what treatment is needed. | What to do about loose
stitches. Lost stitches after oral surgery.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 or scheduled. 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:
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.
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 complications 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 rate at which tissue flaps reattach to underlying bone. 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 being 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. YMMVIt 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 fall out early or loosen?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.
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.
▲ Section references – Kurtzman b) How crucial was the stitch that was lost?A single (interrupted) suture. The suturing technique and placement layout the dentist has used will be a major consideration.
The number of stitches and method of suturing will be a consideration. 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:
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 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, a loose stitch 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, the possibility exists that the loop of suture thread might be snagged (like by your toothbrush), with the pull resulting in tissue laceration as it tears free. So unlike a lost one, a loose stitch has the potential to cause further physical damage and that’s why it should be removed. FYI –
COVID-19 / Treatment access considerations.Related to the 2020 Coronavirus pandemic, just stopping by your dentist’s office for a quick evaluation and removal of loose stitches may not be such a simple matter (like in the instance they have closed their office). It’s your dentist’s obligation to provide the post-operative care that your case requires. So in situations where an appointment cannot be arranged, telephone contact should at least still be possible. Once your dentist has evaluated your situation, they very well may give you the green light on proceeding with the removal on your own. And you’ll probably find the process painless and easy enough. But in all cases, delaying until you have their OK makes the correct choice. 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:
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
Page references sources: Annibali S, et al. Local complications in dental implant surgery: prevention and treatment. Dunn DL. Wound closure manual. Chapter: Wound healing and management. Fragiskos FD. Oral Surgery. (Chapter: Perioperative and Postoperative Complications.) Koerner KR. Manual of Minor Oral Surgery for the General Dentist. Kurtzman G, et al. Suturing for surgical success. Pippi R. Post-Surgical Clinical Monitoring of Soft Tissue Wound Healing in Periodontal and Implant Surgery. Werfully S, et al. Tensile strength, histological and immunohistochemical observations of periodontal wound healing in the dog. 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 – Stiches came out.I had a stich that was loose. Now it is gone. What do I do? Kat Reply – You haven’t given us much information to go by. And we will state that in all cases you should contact your dentist and seek their advice, and attention if they feel it’s needed. In general terms, the main issue involved is simply how long the now missing stitch had been in place. In most cases, sutures that need to be removed (i.e. those that don’t dissolve away on their own) are taken out 7 to 10 days after they were originally placed. So that gives you an idea of what the preferred length of time having a stitch in place is (no matter what kind). So, if your lost stitch had been in place for 6 days or longer, the event is probably a total non-issue. Although you would still want to favor the area so not to disrupt or dislodge the fragile healing tissues. From what you describe, we can see how this might be the case with your situation. It’s common that as the healing process extends into the first several days that some sutures tend to get noticeably loose (swelling goes down, the healing tissues start to recontour). If your lost stitch had been in place less than 6 days, you’ll need your dentist to pass judgment on your situation. A common breakpoint dentists use is 3 days. If one is lost after that point, possibly enough healing has taken place to retain the gum tissue in place. Especially if it isn’t provoked (by finger, tongue, extreme mouth movements, eating, etc…). Losing a stitch with no accompanied (new/renewed) bleeding likely represents a situation of less concern but it will take an evaluation by your dentist to determine this. Staff Dentist Comment – Wisdom teeth stitches.I had my wisdom teeth removed six days ago, and I had the dissolving stitches. I guess I rinsed my mouth too vigorously last night because I remember spitting out and seeing a stitch I down the sink. Tonight, I felt a lot of pain on my upper left corner wisdom tooth, and I used a mirror and saw that the skin flap was hanging down, and the bone fragments and what was left of the hole, as it had mostly healed, were exposed. Should I be worried? I’m really worried about accidentally biting off the skin flap, because its hanging so low. Should I schedule an emergency meeting with my surgeon? Thanks E P Reply – You should call your surgeon’s office and have them make the decision about a need to be seen by them. As this page describes, a purpose of placing stitches can be tissue stabilization during the early phases of the healing process (7 to 10 days). And at a point 5 to 7 days out, it’s not uncommon for some types of stitches that resorb on their own to have already significantly deteriorated. So, the stitches have probably provided all of the service that they’re capable of or intended to have. You don’t mention that any bleeding occurred, implying that the tissue had healed in this loose or drooping form, as opposed to being ripped from the wound. If its exposed surfaces are healed over, stitching it back into place as is will serve no purposed, the tissue won’t reattach. Sometimes loose tissue is trimmed. In other cases it’s just left and your body will get rid of the excess on its own over time. If the tissue wasn’t attached to the bone you can now see, we’re not so sure anything there has really changed. But of course, these are all issues for your surgeon to evaluate. Describing things via phone will probably be enough for your surgeon’s office to know if you need to be seen or not. Staff Dentist Comment – Tooth extraction stitch out.Hi I had2 teeth pulled 48 hours ago and it was stitched up with dissolvable stiches and one has come out there is no bleeding but I’m kinda worried about what to do about it I don’t wanna go back to dentist as it’s expensive. cb Reply – As this page mentions, two main purposes of stitches is tissue stabilization (keep them from moving apart) during the initial stages of wound healing, especially during those first days following your procedure. And also aiding in controlling bleeding. Only your dentist knows why your stitches were placed, so it will take consulting with them to know what needs to be done. If they were to help with controlling bleeding, then possibly what has occurred is of no consequence. In the case of tissue stabilization, at just 2 to 3 days out, they no doubt would want to know. Also, there are other factors that may influence what’s needed, such as was this the only stitch, or one of several in that location? When you do you can ask about what costs you might occur. While we don’t know your circumstances, it seems a bit harsh to hold you (the patient) responsible for what has occurred. Staff Dentist Comment – STICHES CAME OUT IN LOWER FRONT NOW GAPThe dentist pulled out a molar along with a tooth that had broken off at the root. She removed the root and added stitches on top and a small ways down the front of the lower gum. No stiches for the molar which seems ok. The stitches moved about 4 days later and a small root left opening to the sides and down the front. The swelling went down and the split down the front of the gum is getting noticeably longer with food getting in. I went in and the doctor didn’t even come in. She had the assistant tell me to let it heal up to a month. It seems like the sides are healed, but not together and the just put me off again over the phone. KM Reply – The lack of first hand information about your situation makes it difficult to know precisely how to reply but as a basic explanation … In general, a major purpose in placing stitches often has to do with stabilizing the soft tissues during those first days following surgery. Then, as the healing process progresses, the wound strengthens and the sutures become less and less important. As this page states, stitches are often taken out as early as 7 days following their placement. Another function stitches may provide is approximation of tissues, meaning they hold the two cut edges of a wound together (like where a scalpel has been used to incise gum tissue before raising a flap). Doing so speeds up healing (because there is less of a gap between the two parts). With your case, you mention that it seems “like the sides are healed,” suggesting that at this point your dentist has decided that simply replacing the stitches won’t reverse/correct what has occurred (there are no fresh edges to approximate any more, no fresh wound to lay gum tissue over). In a way, your wound is healing as if it didn’t have the benefit of stitches/tissue stabilization. With that case, you’d expect that healing would take somewhat longer. Only time will tell how well your healing process can compensate for the less than ideal situation that’s transpired. At a point after substantial healing has occurred (we’re assuming the 30 days your doctor mentioned), and if anatomically the shape/contours of the healed tissues aren’t ideal (such as they still trap debris), then a corrective surgical procedure might be indicated. Your dentist would have to decide. Check with your dentist first, but gently rolling water through your wound (gentle swishing) to carry off the accumulated debris you’ve noticed should benefit the healing process. Staff Dentist Comment – StitchingMy son just had oral surgery and removed his stitching hours after it’s not bleeding but should we get In contact with the dentist right away Chris G. Reply – There are a couple of factors involved, with the most important one being whether the stitches were primarily placed as a means to control bleeding, or for tissue stabilization during the healing process (or both). Probably only your son’s dentist can answer these questions, so you should report to them what has happened and let them advise you what needs to be done as a result. Staff Dentist Is it okay if my wisdom teeth stitches fall out?Sometimes you may notice that your loose stitch is coming out, or it may fall out completely. You shouldn't worry too much until you have symptoms of infection or your wound has opened or is bleeding.
What happens if stitches come undone after tooth extraction?The suture knots may have come undone which, in itself, is not a problem. However, its best to have the dentist remove the sutures now, as they will collect debris and could present a healing/infective problem for you. Give your dentist a call and have them see you to remove the sutures and check the site for healing.
What to do if a stitch comes loose after wisdom teeth removal?There is no reason to worry if they fall out – so long as there isn't increased bleeding. Absorbable stitches, or sutures, as they are called, vary in type. Some can dissolve in 10 days, and others can take up to six months to fully dissolve. Don't eat hard, chewy foods or use straws, etc.
Is it okay if my wisdom teeth stitches fall out after 4 days?Most sutures will dissolve or fall out on their own after 2-7 days. Depending on the procedure and the number of stitches required will determine how long they will take to dissolve. Different types of sutures may take up to two weeks or more to dissolve.
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