Suturing sockets - humans?

Re: Suturing sockets - humans?

Suzanne Kelly — Sun, 01 Mar 2015 01:26:18 GMT

I phoned the dentist re the hole, apparently it's normal and will granulate eventually. I guess I was expecting to heal like a dog or cat!

Re: Suturing sockets - humans?

Hannah Wynne Richards — Sat, 28 Feb 2015 18:55:25 GMT

I had 1 wisdom removed. I went as a private patient to the oro-facial surgeon who extracted it (very easily) under local. My own dentist had previously tried, and failed. Quite frankly it hurt more after the failed attempt than after the extraction. The socket wasn't sutured, and healed with no probs.

The tooth was extracted in the afternoon. That morning, my dear, considerate, thoughtful boss had booked a dog dental in for me!

Wynne

Re: Suturing sockets - humans?

Evelyn Barbour-Hill — Sat, 28 Feb 2015 16:20:31 GMT

[quote user="nikki"]I had a molar extracted which they didn't suture. I got a socket infection which has to be the most painful thing I've ever experienced in my life and left me literally banging my head against the wall. I also spent weeks picking bits of bone out of the socket before it finally decided to heal over. Have always wondered why they didn't just suture it [/quote]

That sounds like what's called "dry socket" – alveolar osteitis – which can largely be avoided by competence in extraction (any human dentists reading, don't take offence, I know it sometimes occurs despite your best and very competent efforts and human wisdom teeth can be desperately difficult), and I doubt if suturing a flap over the socket would have made any difference......... might have made it worse, because those necrotic scraps of bone had to come out before it could start to get better.

[quote user="nikki"]I find mostly that the ones I raise flaps and suture heal a lot quicker than those that end up with food stuck in the socket and have to wait to fill in with granulation tissue.[/quote]

Depends a bit upon which tooth, but I repeat that most uncomplicated extraction sockets will be filled with granulation tissue in a week.

Re: Suturing sockets - humans?

nikki — Fri, 27 Feb 2015 23:23:28 GMT

I had a molar extracted which they didn't suture. I got a socket infection which has to be the most painful thing I've ever experienced in my life and left me literally banging my head against the wall. I also spent weeks picking bits of bone out of the socket before it finally decided to heal over. Have always wondered why they didn't just suture it as I find mostly that the ones I raise flaps and suture heal a lot quicker than those that end up with food stuck in the socket and have to wait to fill in with granulation tissue.

Re: Suturing sockets - humans?

taliab — Fri, 27 Feb 2015 21:59:05 GMT

Neither of the 2 wisdom teeth I had out were sutures and both healed pretty quickly. The second one i had out was painful for about 2 months before the nhs could fit me in...and much less so after it was out...it was literally just yanked out (after some local anaesthetic) in a few minutes by my dentist. There was a fragment of bone I could feel for first few days afterward which was weird but think that it eventually broke off and it all healed no problem don't think there is anyway they would have sutures that one. The first one I had out took at least an hour I would say and a lot of drilling to get out...would have been less surprised if they had decided to suture that one. (Different dentists)

Re: Suturing sockets - humans?

Rebecca MacMillan — Fri, 27 Feb 2015 14:54:18 GMT

[quote user="Suzanne Kelly"]

I always suture the sockets if I can when I extract teeth. I had a non surgical extraction of my own mandibular wisdom tooth 6 weeks ago. The extraction was straightforward, but 6 weeks later I still have a hole that hasn't fully healed. Apparently this is normal! It's not painful, but a total nuisance and I've to poke bits of food out at least twice a day. The post extraction pain lasted about 2 weeks ( I'm a wuss). I'd be interested to hear about human experiences with sutured sockets, was the healing quicker/more comfortable?

[/quote]

I had my lower left wisdom tooth extracted and they sutured the gum over the hole. Healed really well. I had some discomfort for a couple of days afterwards, but mainly from soft tissue swelling (my left cheek looked a bit hamster like and mildly bruised), but no pain from the socket itself per-say and no trapped food issues.

Can't say I enjoyed the whole extraction experience very much though! Doing dentistry myself at work made me hyper aware of what they were doing in there, and conscious of the amount of pressure that seemed to be applied to my mandible!!

Re: Suturing sockets - humans?

Anne Seawright — Fri, 27 Feb 2015 11:18:57 GMT

According to my husband, who is a dentist, the situation in humans is similar to that in animals as described by Evelyn above. It depends on the individual case. Broadly speaking he says if a flap is raised or bone removed (or haemostasis limited) then suture, otherwise they leave open.

Re: Suturing sockets - humans?

tess — Wed, 25 Feb 2015 18:00:33 GMT

I had sutures for my wisdom teeth, but that was 20 years ago.

Re: Suturing sockets - humans?

Julian Earl — Wed, 25 Feb 2015 16:36:11 GMT

Being taught how to do flaps on a practical dental CPD course was one of the most useful CPDs I've done and only about thirty years overdue(!!) . My understanding is that bone should never be left exposed so all sockets get flaps sutured over nowadays. As for humans, I've no idea of the answer but I'll ask tmy dentist next week.

Re: Suturing sockets - humans?

Rob Davis — Wed, 25 Feb 2015 15:20:10 GMT

[quote user="Suzanne Kelly"]I had a non surgical extraction of my own mandibular wisdom tooth 6 weeks ago. The extraction was straightforward, but 6 weeks later I still have a hole that hasn't fully healed. Apparently this is normal! It's not painful, but a total nuisance and I've to poke bits of food out at least twice a day[/quote]

I have had both my lower first molars extracted on separate occasions without suturing. I would say they both took several weeks to fully heal (the first one did start to heal better after I'd picked out some bone spicules in the mirror using my root tip forceps!), although the pain was minimal within hours of each extraction (both were extracted because of failed root canal treatments and had previously been decidedly uncomfortable...).

As Evelyn says, there should never be a dogmatic rule on these sort of decisions. I suture any flaps or if it looks like it needs it. Often non-surgical extractions I leave open. It is better not to suture, than to do so with tension, and as mentioned above this is difficult to achieve in some areas. Minimising trauma to the gingiva during the extraction process is also extremely important - I shudder when I remember some of the extractions I performed in years gone by before I new any better....

Re: Suturing sockets - humans?

Evelyn Barbour-Hill — Wed, 25 Feb 2015 14:56:55 GMT

[quote user="Suzanne Kelly"]Also is there a way to suture 109/110/209/210 sockets in dogs? [/quote]

No.

Not in practical terms!

There is this cult dogma, emanating from the USA, that all extraction sites should be sutured over. It is b****x in my opinion. It's by no means standard expert opinion.

There are many sites where flap mobilisation and suturing would be advisable or even essential, and many where it would be completely unnecessary. One has to balance the advantage that might be gained from suturing against the additional trauma. Most uncomplicated sockets (in dog and cat) will be solid with granulation tissue in a week and epithelialised right over in another week.

Where you've extracted several in a row and the gingival edges are flapping in the breeze, suturing is indicated. Another indication is where you are concerned not so much with healing the empty socket but augmenting the gingival integrity of the neighbouring tooth (for instance, where you have periodontitis originating interproximally 408/409 and your strategy is to extract the 8 and preserve the 9. The same maybe if you are extracting 108 but preserving the less-affected 109).

Rules like "always suture" or "never suture" are wrong. The approach for anyone calling themselves a veterinary dentist is to be competent at periodontal surgery and then to judge each site according to all the factors involved.

Re: Suturing sockets - humans?

Martin Atkinson — Wed, 25 Feb 2015 14:02:35 GMT

I fear you have opened Pandora's box, the dust has only just settled on the last thread on this topic. The dinovets will say they never suture, the dentists will say you always should. As ever the truth is somewhere in between. I rarely suture, or raise a flap for that matter, and everything always seems to come up smelling like roses eventually whether I do or not.