Dental Gingival Retraction Cord: What It Is and Why We Use It

Dental Gingival Retraction Cord: What It Is and Why We Use It

Dental Retraction Cord In Gums
©Lighthunter/Shutterstock.com

An Oral Answers reader, Austin emailed me last week with the following question:

“I had 3 temp crowns that were put in on my right side lower and 2 on my left side lower. Today when I was using my water pic I was cleaning my lower right and something started to feel like it was stuck between my teeth so I kept going and pulled out a black and white string, my gums have been bleeding and hurting.  What should I do?”

Before we talk about what happened with Austin, let’s take a look at what exactly this “black and white string” was and why it’s used in dentistry.

Dental Retraction Cord

Ultradent Ultrapak Brand Dental Retraction Cord
Dental Retraction Cord – © Ultradent Products, Inc.

Usually when dentists cut teeth for crowns, they will pack a piece of string, known as dental retraction cord, gingival retraction cord, or just dental cord between your tooth and your gums.  I’ve also used retraction cord when doing fillings on teeth that have a cavity that goes below the gum-line.

This cord helps move the gums away from the teeth and can also be treated with a solution that prevents the gums from bleeding.  That way, the dentist can focus on preparing the tooth without the gums getting in the way.  The dental cord also helps the dentist make sure that the whole tooth gets recorded when an impression is taken.

If you want to see what impression cord looks like in the mouth, scroll down to Figure 3 on this page for a picture (the dentist has prepared a tooth for a type of filling that will be made in a dental lab.)   This article has another picture of dental retraction cord.

Is Dental Cord Harmful to Your Gums?

This study looked at a few different ways to retract patients’ gum tissue and found that while dental retraction cord does cause an inflammation of the gums, they do completely heal and there is no long-term harm.  Here’s some direct quotes from the study:

  • “This study showed that all retraction techniques caused an acute injury after 1 day of retraction, which took 1 week to heal in the Ultrapak and the Magic Foam groups.”
  • “This study showed that none of the techniques tested seems to harm the tissues in the long term.”
  • “The data indicated that all retraction techniques caused a temporary inflammation, measured through the gingival index.”

In Austin’s case, it would appear that the dentist and dental assistant simply forgot to remove the retraction cord after the impression was taken and just cemented the temporary crowns on the teeth with the retraction cord in place.  If the retraction cord was in between the gums and the tooth for an extended period of time, the gum tissues may have started growing around it and it probably caused more pain and bled more when Austin removed the cord during his oral hygiene routine.

Conclusion

Although having the cord around his gums probably wasn’t very comfortable, the studies seem to show that there aren’t any long-term harmful effects.

Thanks for your question, Austin.  Hopefully you’ve helped more people know what to do if they end up finding some cord between their teeth and gums after getting their temporary crowns put on!

If you have any questions about dental retraction cord, I’d love to hear them in the comments section below.  Thanks for reading!

32 COMMENTS

  1. This is really interesting – I had never even heard of a dental retraction cord before. I have a few questions:

    1. Is it just a simple cord coated with (something), or is it made out of something special?
    2. Is it typically left in place only for the time it takes to make an impression or fill a tooth and then removed immediately after?
    3. Is this technique something that nearly all dentists use as a routine, or is it just personal preference whether a dentist wants to use it or not?

    Thanks for such an informative article!

    • Hi Hannah – You’ve got a very informative dental site – good job!

      As for your questions:

      1 – it is simply a cloth piece of cord. The brand that is pictured above is made out of 100% cotton. Many times dentists will coat it with a substance that causes bleeding to stop so that everything stays nice and clean around the tooth.
      2 – It is normally left in place only during tooth preparation/impression taking and then immediately removed. As Austin’s email showed, it can be slightly painful if left in for more time than that!
      3 – For taking impressions of crown preps I think most, if not all dentists use it. When it comes to cutting a tooth for a crown and deep fillings, sometimes it just depends on the dentist’s preference. If I’m doing a filling that goes below the gum-line, I will definitely use cord so that the patient’s gums don’t get cut and so that I can see what I’m doing better.

      I hope that helps. Thanks for your comment, Hannah!

      • Thanks for this article; I recently have been undergoing oral restoration. I have gone through two different bone grafts, a sinus lift, 5 root canals, 7 crowns and 5 implants. I am not at the final stage of impressions and when someone says this will take a while and I need to numb your whole mouth make me think it’s not going to be easy. When I went in for my 3 hour appointment several things happened

        1: They attempted to take out all the caps and get ready for the impressions well 2 caps next to each other did not want to come out so they had to file them out….
        2: They started to numb my whole entire upper mouth as that is where the 7 caps were and this time of year brings wonderful sinus pressure and with 6 shots of Novocain and pressure come PAIN…. wait did I say that the first step caused PAIN when they used a tool called “THE TAPPER”

        3: They started to prepare the retraction chord and used two different sizes I of course opted to not get the shot in the roof of my mouth because i don’t’ like PAIN well as it turns out the Prosthodontist should have INSISTED that I get it because the pain from that point on was unbearable….

        4: So now it’s time all of the “Retraction Chord” is in place and packed in and now they begin to fill around the top of my teeth with a material that was auto loaded into a dispensing gun….. WAIT the shocker is it DID NOT WORK!!!!! So they RAN to get another one however by the time they got it the other material settled more than it should have and even though they attempted the impression was unsuccessful.

        5: LET’S try again so they now attempt it again all materials in place and well the tray was put into my mouth however did not feel right the Pallet of the tray was more in alignment with my lower teeth so can you guess what happened next? Come ON? Yes it did not work…
        So my appointment was a huge flop and the staff is upfront and says well that did not work… NO KIDDING!!!!! As soon as they get the last cap back in but not yet cleaned up THE FIRE ALARM goes off….

        Is this my crazy life or is having dental surgery this difficult?
        Should they have not attempted to 7 at once or is it needed to ensure that all of the teeth are perfectly aligned in the universe?

        Don’t get me wrong i want the best possible outcome and having to go through another 4 hours of torture (that is exactly what it was) is not my idea of GOOD HEALTH!!!!

        I want to say that the group of Dentists, Specialists and Oral Surgeons has been absolutely wonderful and for that I am grateful. I just thought that this information would have been good to have before I had this done and could have better prepared myself to say JUST SAY YES to NOVOCAIN!!!!

        Respectfully Rae Lettau

  2. Hi Tom,
    I just what to know what might be the cause of the numbness of my patient on left side of his face and lips wherein I just put Gingi- Pak on Distal of 36 and done restoration of Cl II DO cavity?

    Thank you
    Dr. Glad

    • Hi Glad –

      The only thing that comes to mind right now is prolonged paresthesia that can occur with an inferior alveolar nerve block.

      I hope that helps, Glad. Let me know if you have any other questions. Thanks for your comment!

  3. Thank goodness I found this page! I had temporary caps put on my front teeth a few days ago and my gums are so swollen and irritated now. Instead of the pain lessening every day, it’s actually getting a little more painful every day. Tonight, while brushing my teeth I noticed something that looks like dark string at the gum line and coming down between the teeth. I guess they forgot to remove the cord. By the time the dentist’s office is open again I will have had the cord on for 5 days! Am I at risk for infection? Should I call the dentist’s emergency number or will I be ok waiting until Monday morning?

    • Hi Crystal – Hopefully they got them removed. If you can see the string, you could probably pull it out yourself without a problem unless it feels like it’s really stuck in there. I don’t think there should be a problem with infection – the inflammation seems to occur because of the irritation from the cord, not bacteria.

      Let us know how it went – Thanks for your comment!

  4. Hi Tom:

    I got my question answered by your posting ! Today I sat in a dentist’s chair for two hours start-to-finish for a molar crown prep.

    The only thing that brought tears to my eyes was during the cord packing, which the dentist said that some people want more numbing during the packing. I managed to get through it with the primary numbing dose and no more.

    I have had packing cord used in my mouth before, and today after my visit, I concluded that it was probably for getting a better impression of the tooth, without the gumline getting in the way of the impressed image. I was pretty correct, but now I know better why and when it is used…

    After feeling “rattled around” for two hours, high speed burr, low speed burr, numbing needles, synthetic buildup compounds, impressiion mold compound, distasteful packing solution going into my throat a little, etc. I had a good dinner chewing on the other side of my mouth, and a nice walk, boy, do I feel better now that my nerves are back in order !

    ALSO, YOUR OPINION, if a porclein over gold molar crown is only $200 more than a porclein over non-precious metal molar crown, in today’s precious metals market, is the porclein over gold molar crown a better value, even though it is $200 more ?? How much gold is in a porclein over gold molar crown ?? I always get porclein over non-precious metal, because the porclein surface usually gets more worn out before anything ever happens to the base metal. If the gold content is high, maybe the porclein over gold molar crown can be better looked upon more as an investment, and sold in the future (asset liquidation) if need be ??

    Thanks for your website. Is is very informative, and I am going to bookmark it for future reference.

  5. hi tom,
    it’s me mr.rakesh.i want to know that ,Is the gingival retraction cord used before or after tooth cutting.
    thankes

  6. Good evening. I have a temp crown on #11, waiting three weeks for the permenant and I distinctly remember the technician packing a cord when she put the temporary on for the last time. I thought maybe to keep a space for the permenant. This cord is white and is starting to come out.

  7. Its friday morning and all 8 of my front teeth are out. They DID have TEMPS for CROWNS on, but
    they all fell off the first day, which was Wednesday of this week.

    Im afraid I went to a new, young, experimental dentist and I’ve learned my lesson. Plus I don’t think you were around at the time of my initial serarch for a dentist.

    Are you open after lunch this afternon? Thought I could run in and have you reglue them in, butI may just have the problem til the permanents come in>

    Please call as soon as you can get my information.

    escape key, and another pain cemterc

    • Hi Danna – I would get in touch with your current dentist, they should be available for emergencies. The temporaries help hold the teeth in place so that the permanent crowns will fit well. Hopefully they can fit you in ASAP. Good luck!

  8. hey there, iam a dental assistant and I am glad to find this page. I want to know if you can show a video or give some tips of how to remove the cords when it’s time to do the last impression. I’ve been having a hard time getting a good grip on those cords because they have to be taken out fast. so if you have anything that can help that would be great !!

  9. Hi, this post was very helpful! I think the dentist has left a portion of dental retraction cord in my gums and he will be getting a call from me in the morning. This was my second crown build up, and unlike the first time, the gum pain has not gone away. Definitely feels like something is shoved down in there were it should not be.

  10. Hi Tom.

    In all the years and all of the crowns I have had put in, I never came across this retraction cord. Today however, I have a couple of questions for you about this Dental Gingival Retraction Cord. How long has it been around? Anyway, I recently had a root canal done on a molar through an existing crown. There was also decay remaining that necessitated ultimately removing and replacing the crown as well.

    In the process, I had an upper crown replaced opposite the aforementioned one and to get a better mold for a new crown a couple layers of cord was inserted under the gum line. It went smooth.

    Back on the lower tooth the decay was drilled and it apparently extended below the gum line at which point the dentist indicated that the gum needed to be trimmed back in order to be able to complete the work.

    My question is, if the cord worked well enough to get around the gum line on the upper tooth for a mold, then why wouldn’t it be suitable to provide space to drill out the decay below the gum line? That is one of the stated purposes for using the cord isn’t it? This trimming is on a gum line that is already receding, and besides that it is fairly costly to boot. I believe this is for something called crown lengthening to conceal the exposed root due to a receded gum line.

    I’ll leave it to you from here Tom. Thanks kindly for your input.

    • Hi George – I’m not an expert on the history, but I would think that it’s been around for several decades. Some dentists don’t use it, and if the crown is going to be above the gums, it probably isn’t necessary.

      Sometimes the crown will go far enough below the gums that it is necessary to remove gum tissue and even some of the bone underneath to ensure that the crown fits properly and doesn’t cause any inflammation in the gums after it is cemented onto the remaining tooth structure.

      For example, let’s say you have a cavity that goes down below the gum-line on a tooth. In order to get a crown onto the tooth, the dentist will have to remove the cavity, and exend the edge of the crown below that point in order for the crown to be able to grip onto solid tooth structure. If there’s not enough room to do that, the dentist will do a “crown lengthening procedure” which lengthens the crown of the tooth (the part of the tooth above bone) by removing some of the bone that supports the tooth.

      I hope that helps. Thanks for your comment, George!

  11. Lately I have had far too much experience with the retraction cord! It’s a long story, but I had a root canal in January and after having two ill-fitting crowns arrive from the lab and we are hoping that the third impression will be perfect. We just might get this stubborn tooth capped in May! During the lengthy process of having many molds taken of this one tooth, my dentist has been very hesitant to give any kind of numbing agent to dull the pain.

    I am curious. Do most dentists numb patients during the packing of the retraction cord? My dentist has even used a lazar at one point and the pain was INTENSE. Not to mention the smell. I understand that the tooth root is dead because of the root canal, but my gums are killing me. Should she at least be numbing the area during the procedure? Or am I a wimp?

    Thanks!

    • Hi Rachael – I believe most dentists do numb when packing retraction cord as it can cause pain in the gums. Normally the patient is numb when I’m doing retraction cord, but if they aren’t, I will ask them if they would like to be numb. We’ll usually do whatever makes you more comfortable. If you are uncomfortable, speak up and let your dentist know. Good luck with your crown – that is a good sign that your dentist wants to take the time to make sure that it fits correctly.

      • I agree about her attention to detail and am quite thankful that she wants to do it right, but if crown number three doesn’t fit I feel a little better about begging for numbness on round four. Thanks for your response!

  12. I wonder if the cord is not still in my gums because ever since i had caps put on my front teeth my gums are red and get bumps around my teeth like when you have an abcess. I have bought a water pick and it made my gums bleed bad at first but it is getting better. If the cord is in there will my gums ever heal? Is there a way that an xray would be able to see it?

  13. Hi. This was very interesting for me as I just had a crown prep 2 days ago. I have 8 crowns done over the last 15 years…all the dentists have used the gingival retraction cord except the dentist 2 days ago. The temp crown he put in was quite uncomfortable. I could feel the sharp edge all around the tooth with my tongue. There was a large gap between the temp crown and my gum. Food got caught in it 3 times over 2 days. Last night a tiny sharp piece of tooth or plastic came out from between the temp crown and the next tooth but nothing felt different so I let that go. When ever I bite down to chew or just experimenting, the temp crown and the opposing tooth are the first to come together. Then tonight, the temp crown just fell off. I’ve never had this happen although always was warned that it could happen. I will go back to the dentist to morrow morning.

    Thanks for any answers you can give me.

    So my questions are:
    1) is the temp crown the exact same as the real crown.
    2) should the temp crown go below the gum too? I think they did on all my earlier crowns.
    3) is it really possible to get below the gum line without using the cord

    • Hi Kathy –

      1 – The temp crown should mimic how the permanent crown will be, but it won’t be perfect.
      2 – Ideally, the temp crown should adapt well to where the tooth was trimmed away. If it was trimmed below the gums, then the temp crown should go there as well.
      3 – Without using the cord, it is possible to get below the gum line. There are a couple of other techniques dentists can use to get below the gum line. Some dentists will use a clay putty in a syringe that they keep under the gums for a minute or two, then wash it away and immediately take the impression. Another way is to take a “rough draft” impression, then add more material into that impression and put it back on the tooth, forcing the new material below the gums. This technique is slightly more controversial as it can cause the impression to be distorted, causing a poor-fitting crown.

      I hope that helps! Let me know if you have any other questions.

  14. Tom –

    I left a comment the other day regarding everything I have been going through with my oral restoration and it seems I can’t get a break. I have the best care in the world but in your experience have you every worked with someone who just has very brittle teeth and bone? Thinking I was through everything and now just awaiting my new appointment to get my impressions, this weekend I ended up with a verticle fracture on one of the 7 crowns. There was a temp in place and now unfortunately a crown can not be used. It was the Right Incisor and both to the either side are also crowns which long term could be questionable if we are to attach a bridge. What would you recommend? I also wanted to know your thoughts on this tool called “The Tapper”.

    I know nothing comes easy however at what point do I just give up.

    Rae

  15. Hello. If the Dr accidentally leaves the thin retraction cord in the patient tooth, what may the patient experience the first day?

  16. I had a bridge that fell out some months ago and where one tooth used to be there are these short little strings sticking up. Is that the same as the chords? I fell like I can pull them out, but just playing with them with my tongue sometimes hurt if I rub them the wrong way. There is little pieces of tooth at the bottom of the gum where the tooth used to be and it’s started to rot. But I really want to know what are all those little strings sticking up from my gum,? They are driving me Crazy!

  17. When I did my bridge over, the dentist did not use the retraction cord. Is the cord neccessary in order to get an accurate impression?

  18. Two weeks ago I had front teeth fillings done. The dentist used a retraction string to hold the gum back but did not warn me ahead of time she was using this method. I had never had this done before. Now two weeks later one of my front teeth the gum on it is still raised and I noticed it after the procedure and it is still raise now. The gum is higher up than the one next to it and when I scrape my fingernail across it I can fit my nail to where the beginning of the root would be. When I eat I feel air and food and drink going into that area of the tooth. What should I do?

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