Despite the procedure leaving a hole your gums afterwards, you don't always need stitches after having your wisdom teeth removed. It all depends on how complicated your extraction was and that depends on your specific situation.
Therefore it is quite normal and probable for you to leave the dentist without any stitches in your wisdom tooth socket. If you really wanted to know the answer, you could always ask your dentist ahead of time about if you needed stitches or not prior to the procedure.
Nonetheless, here are four common situations where you may not need sutures after getting your wisdom teeth removed:
Routine extractions with fully erupted wisdom teeth
If your wisdom teeth were fully erupted and not impacted, they would be considered a routine extraction and those rarely if ever require stitches afterwards. Non-complicated extractions usually do not need sutures because there is often nothing to stitch up.
What we mean by having nothing to stitch up after taking the wisdom tooth out is that there is not enough gums for you to close up the extraction socket. As you can imagine, the gums are already tightly surrounding the tooth before the removal.
If you imagine taking out the tooth, the gums aren't going to suddenly extend farther for you to be able to close the hole. The gums are taut and there is insufficient gum for your dentist to pull it closer together with stitches.
However, you can still request your dentist to put in stitches but it won't make a difference in how quickly the gums regrow in the wisdom tooth hole. The reason is because since you can't pull the gums together, the wound will heal with secondary intention with and without stitches. This makes the healing process identical and the stitches having little to no benefit for you.
Wound healing by secondary intention vs primary intention
Healing by secondary intention is when you leave the wound unstitched to heal all on its own naturally. The rate of healing is typically slower than primary intention but we are often left with no choice but to let it heal on its own. One such case is when you routinely extract non-impacted wisdom teeth.
Healing by primary intention is when your doctor approximates the edges of the wound together with stitches. This process allows for faster healing because your body does NOT have to fill in the giant hole in your wound. It is less work for your body to repair. This method of healing is only available in certain situations but most notable in lacerations where you sustain a cut.
Wisdom teeth that are only mildly impacted
If your wisdom teeth are only mildly impacted, there is a good chance that you won't need stitches after the extraction. The reason is that the extraction process is very similar to a fully erupted wisdom tooth. There isn't any additional steps that your dentist needs to perform.
Most of the molar is erupted out of the gums with only a small part of the left side which is still covered by the gums slightly. This wisdom tooth is about 90% erupted.
In order to have this tooth removed, you mostly treat it as if it was fully erupted. After the extraction, if you try to visualize it, there still isn't enough gums to pull it together with stitches. This situation is usually better left to heal on its own without sutures.
The wisdom teeth extraction did not require a gum flap
The vast majority of times where you would need stitches after wisdom teeth removal would be if the teeth were fully impacted. This means that they were mostly underneath the gums and probably still stuck in the bone.
Here are what fully impacted wisdom teeth look like on dental x-rays:
As you can see on the x-rays, the impacted third molars are usually not straight and have an abnormal orientation. They're either partially sideways or fully sideways.
Deeply impacted wisdom teeth only have a small part of the tooth erupting out of the gums. From the pictures above you can tell that most of the tooth is not erupted. The process for removing these teeth is first to lay a flap, which is to cut open the gums to expose the tooth.
As you can imagine, the gums already look pretty close together before the extraction. Then after laying the flap and removing the wisdom tooth, you can visualize how you CAN stitch the gums back together. This is especially true since you had to use a scalpel to cut into it. If you had to peel the gums back to expose the wisdom tooth, it is only right if your dentist stitches it back together.
In other words what we're trying to say is that if you didn't get stitches after your wisdom tooth removal then it probably meant that they simply weren't that impacted. That is good news because it meant that your treatment should've been less complicated.
You didn't need a bone graft after the extraction
There is one particular situation where you would absolutely need stitches after a tooth extraction and that is if you needed a bone graft with a membrane. It is pretty rare for wisdom teeth to require a bone graft but if yours did, then you can expect to leave the office with stitches. If you didn't get a bone graft then you most likely didn't need sutures.
Bone grafts will always need stitches because the entire procedure involves filling in the extraction socket with the bone graft material. Then your dentist will place a membrane over the entire socket so that the grafting material doesn't spill out. Finally, you will NEED stitches to pull the gums as tight as possible together and to hold the membrane down so that you don't lose any bone grafting material.
Basically if you had an extraction and got a bone graft afterwards you will leave with stitches. These are basic principles:
The membrane is placed over the socket and bone graft to prevent it from spilling out.
The stitches are placed over the membrane to hold the membrane in place so that the bone graft doesn't spill out!
Takeaway
Most of us picture a very scary process when we hear the words wisdom teeth removal. We imagine a lot of blood and probably stitches afterwards. However, that isn't true because the treatment isn't as scary as you think it is and you may not need stitches after having the third molars removed.
In fact, there are four situations where you don't even need stitches afterwards! Isn't that four more than what you would've initially thought?
Therefore, if you finished your extraction and you left the dentist office without any stitches, it doesn't mean that your dentist did something wrong. It simply mean that your wisdom teeth were most likely fully erupted and that meant the treatment was less complicated.
If you wanted some good news, what it means if you didn't get stitches is that it wasn't as complicated and that means you'll most likely have a more pleasant healing process. The hole will close faster and you'll experience less post-operative pain as well!
