Just because you had your wisdom teeth removed, it doesn’t mean that you’ll get stitches afterwards. Certain situations will require it while others do not so if you didn’t get any it could very well be normal. If you were worried that your dentist might’ve forgot, you can rest assured.
We’re going to explain why you might not have needed stitches and also situations which do call for them. Hopefully yours is of the former and not the latter… because if that is the case your dentist may very well have forgotten!
Why didn’t my dentist give me stitches after wisdom teeth removal?
Routine extractions of fully erupted wisdom teeth often do not need stitches afterwards. The reason is simple, there is actually nothing to stitch up from taking out fully erupted third molars. Well technically you can still put sutures in the wisdom tooth hole but it won’t really benefit your healing not one bit.
There’s nothing to stitch
This may be an odd concept for you to understand but there really isn’t anything to stitch up after taking out a fully erupted wisdom tooth. For these teeth, the surrounding gums are nice and taut. That means there is no excessive gum for you to pull together for sutures after removing the tooth.
You can try sticking your finger into your mouth and see if you can pull the gums loose. Bet you can’t because they’re tight and not loose. If you can imagine, once you take the tooth out, there is no excess gum afterwards.
The best analogy that we can come up with is to use the headless horseman as an example. If you extract his head (remove it) from his body, can you stitch up the shirt that he is wearing to close up the hole? You can’t because the hole for where the head comes through is NOT loose.
If the shirt was loose with excess fabric like a turtle neck, then you’d be able to stitch it together. The same concept applies to your gums and wisdom tooth. You would need an excess amount of gums like a turtle neck shirt to be able to place sutures!
The only benefit to using sutures is if you’re able to achieve primary closure. That is when you’re able to stitch the wound up completely and close the gap. Alternatively it can also help but not as much if you’re able to bring the edges of the wound closer together. Even if it doesn’t touch, it will minimize some of the scar tissue formation.
If you’re unable to close the wound with sutures, placing stitches don’t actually have a benefit for doing so. As a matter of fact, whimsically placing them will cause tissue inflammation instead.
If you look at the chart above, there is a column for “tissue reaction” for the sutures that are listed. The sutures themselves cause inflammation because our body recognizes them as a foreign body, which they rightfully are.
However, your dentist will still use them if the benefit outweighs the inflammation that they will cause. The situations which merit it are when you can get primary closure!
When would you need stitches?
Surgical extractions of wisdom teeth where you need to reflect a full thickness gum flap will definitively require stitches. A full thickness flap is when your dentist makes an incision and pulls the gums off of the jaw bone in order to expose more of the tooth.
Of course this peeled away gum flap will need to be stitched back down so that it is not flapping around in the mouth afterwards. Imagine if you had a large flap of gum just hanging around in your mouth.
Situations that require a full thickness flap:
- Extracting impacted wisdom teeth
- Removing a tooth that has broken down to the gum line
- Routine extraction that has turned surgical
Impacted wisdom teeth removal
If your wisdom teeth are impacted, you can basically expect to leave the appointment with stitches in your mouth. The more impacted they are the more likely it will be.
As an example, for a full bony impacted third molar which is completely submerged below the gums, you won’t be able to see the tooth at all. Your dentist won’t be able to see it either. The only way they’re going to be able to get access to the tooth and remove it is by making a full thickness flap. They must reflect and retract the gums in order to expose the tooth.
After the tooth gets taken out, the flapped gum will need to be stitched back together.
Tooth that has broken down to the gum line
Severely decayed teeth can be so broken down that there isn’t any tooth structure that is left above the gum line. Since there is no tooth for your dentist to grab with their forceps, they will need to make a flap.
By peeling the gums back, your dentist can see more of the broken tooth. They can also drill away some of the bone to expose more of the tooth for the forceps to grab.
Routine tooth removal that has turned into a surgical extraction
There are times where a routine extraction can turn into a surgical one due to intra-op complications. For whatever reason, the crown of the tooth can fracture off down to the gum line. We hate it whenever this happens because now the procedure is going to take more time.
Once that happens your dentist will need to make a flap and start removing some of the jaw bone via drilling. That is literally the only way to get the tooth out.
If you didn’t get any stitches after your wisdom tooth extraction, it was most likely because the tooth was fully erupted. It means that it was a routine tooth removal that did not require making an incision and reflecting the gums.
You may be bummed out about not getting stitched up but it is actually good news. Your procedure was probably not as complicated and your healing should be quicker than the more complicated cases. You have one less thing to worry about and take care of because the aftercare instructions for the extraction are long enough as it is.