HOW TO PLACE A SUTURE

When you remove two or more teeth in a row, it is a good idea to join the gums with a suture (needle and thread). If you need more than one suture, place the first one nearest the front of the mouth and work toward the back.

The needle and thread you use must be sterile. Boil both for twenty minutes.

You will need an instrument to hold the needle firmly (hemostat) and scissors to cut the thread.

A. Pass the needle through the loose gum-the one you can move most easily. Then pass it through the more firmly attached gum.

If the looser gum is on the outside, you will bring the needle toward the tongue. Protect the tongue with a tongue blade or your dental mirror.

You must suture both the upper and the lower gums in this way.

After this you must tie two knots and cut the thread. See the below.

B. Pull the thread until about 4 cm. of thread is left loose on the starting side.

Wrap the longer end of thread 2 times around the beaks of the needle holder.

Then grab the shorter free end of the thread with the tip of the needle holder. With the needle in your fingers, pull the needle holder in the opposite direction. The thread will slide off the beaks and form the first knot.

Tighten the knot onto the side of the wound, not on top of it.

C. Tie a second knot, to keep the first one tight.

Wrap the thread once around the beaks of the needle holder.

Grab the free end with the tip of the needle holder as you did before. Pull the two ends in opposite directions. The second knot will form over the first knot.

D. Cut the threads so that about 1/2 cm. is left free, if the ends are too long, they will bother the person's tongue. If they are too short, the knot may come open.

Then cover the area with cotton gauze. Tell the person to:

• bite against the cotton for 1 hour to stop the bleeding
• return in 1 week for you to remove the thread

There is a special kind of suture material that disappears by itself, which is good to use because the person does not have to return for you to remove sutures. Unfortunately, it is expensive. If you cannot afford it, use sewing thread and remove it 1 week later.

7. Explain to the person what you have done, and what to do at home to look after the wound. Remember that her mouth is numb, so she cannot feel what is happening.

Taking out a tooth is like a small operation. There will be bleeding and later some pain and swelling. This is normal and should be expected. Tell the person this. Then give the following advice:

• Bite firmly on cotton gauze for an hour, and again later if blood comes from the socket.

Always give the person some extra cotton gauze to carry home, in case bleeding starts again later.

Show them how to use the cotton gauze.

• Take an aspirin for pain as soon as you need it, and then one every 3 or 4 hours.
• Keep your head up when you rest. This reduces bleeding because it is harder for blood to flow uphill. It also hurts less.
• Do not rinse your mouth, in some places people believe they should immediately rinse with salt water and spit a lot after a tooth comes out, but this is harmful! It is important for the blood clot to stay inside the socket and not wash away.
• Do not drink hot liquids like tea or coffee, because they encourage bleeding. However, cool liquids are good for you. Drink a lot of water.
• Continue to eat, but be sure the food is soft and easy to chew. Try to chew food on the side opposite the wound.
• Keep your mouth clean. Start on the second day and continue until the socket is well. To do this, rinse your mouth with warm salt water and keep your teeth clean, especially the teeth near the socket.