Tooth Extraction Pain

Tooth extraction pain used to be a dreadful experience until some years ago, before dental anesthetics become available. In modern dentistry the pain during the extraction procedure is almost diminished, but post-operative tooth extraction pain still remains a concern. Possible complications such as dry socket may also be a cause of severe pain.

A tooth extraction is the removal of a tooth from its socket inside the jaw bone. It is necessary for removing severely decayed teeth, abscessed teeth, fractured, broken or impacted teeth, to stop a tooth infection, or as a preparation for an orthodontic treatment or a complete denture. Despite the use of anesthetics, tooth extractions still remain as some of the relatively more painful dental procedures.

The extraction of a tooth requires the application of force in order to break the periodontal ligaments that keep it in place, and extending the width of the socket in order to dislocate the tooth and remove it. In difficult cases the a procedure may take several hours to complete.

The dentist will numb the extraction area with several shots of anesthetic so that you do not feel any pain during the procedure. But even if you actually do not feel the tooth extraction pain, you must be prepared to feel some degree of discomfort due to the forces applied to the mouth tissues by the extraction tools.

The discomfort you experience during the procedure and the level of post-operative tooth extraction pain that should be expected afterwards, depend on the difficulty of the extraction. Several factors can affect the difficulty of a tooth extraction, such as the strength of the supporting periodontal tissues, the position of tooth, the extend of damage, the amount of crown hard tissue and the brittleness of the tooth.

The procedure may be either a simple extraction or a surgical tooth extraction.

A simple extraction is generally not expected to cause significant tooth extraction pain. It is performed on teeth that have enough part of the tooth’s crown in good condition, so that it can be removed with the extraction tools without fracturing. Simple extractions are commonly performed by general dentists under local anesthesia.

A surgical tooth extraction involves making an incision to the gums or/and cutting the bone to allow access for the removal of a tooth. It is a much more invasive procedure than a simple extraction and it has much more chances to cause tooth extraction pain especially after the procedure. Surgical tooth extractions are needed for teeth that do not have enough tooth structure left in good condition above the gums to provide a good grip for the extraction tools, teeth that break during the extraction, teeth with curved root morphology and impacted teeth that remain inside the jaw bone under the gums. In some cases, a tooth has to be cut or broken into smaller sections to facilitate tooth extraction (tooth sectioning).

Dental sedation can be used for difficult surgical extractions for patients with dental anxiety and for everyone who wants to feel more comfortable during lengthy procedures.

As with any dental procedure there is some possibility of complications, which can be another source of tooth extraction pain. Some of these complications can cause severe post-operative pain.

• Dry socket. The most common complication of a tooth extraction is the development of a dry socket. The condition occurs after about 5% of teeth extractions, when a blood clot is either not formed in the extracted tooth socket or it is washed out or dissolved. In this case the jaw bone and nerves remain exposed to the mouth environment causing intense post tooth extraction pain. Medicated dressings can be placed from the dentist into the socket to cover the bone, relieve the pain and help healing.
• Damage to adjacent teeth or jaw. During the procedure the dentist may accidentally cause damage to a nearby tooth or to a restoration. Sooner or later the fractured or chipped tooth will start to cause sensitivity or pain and require treatment. Jaw fractures have also happened during tooth extractions especially in elderly patients or patients with osteoporosis.
• Nerve damage. A complication that may occur during the extraction of a tooth of the lower jaw is the accidental damage of the alveolar nerve. This can cause severe pain after the procedure that may be felt to other teeth, jaw or all over the mouth. The nerve usually heals in a few weeks up to some months depending on the extend of the damage, but sometimes the damage is permanent causing chronic pain.
• Infection. If proper disinfection measures are not taken during the procedure or the patient neglects oral hygiene after the procedure, the extraction area may get infected and cause severe pain and health complications.

Even after a simple and successful tooth extraction, it is normal to experience some post tooth extraction pain for some days after the procedure. Use of over-the-counter analgesics is usually enough to ease the pain after a common tooth extraction. Acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) based pain relievers are commonly recommended. Aspirin based drugs should be avoided because aspirin can increase the risk of bleeding.

The level of pain after tooth extraction is directly related with the degree of damage to the dental tissues. A surgical extraction that involved incisions to the gums and cutting through the jaw bone can cause severe post tooth extraction pain for many days. The dentist will normally prescribe stronger prescription tooth pain medication to help relieve the pain. Any type of medication should always be taken according to your dentist’s instructions.

How long does pain last after tooth extraction

The duration of pain after a tooth extraction depends on the difficulty of the procedure and the possible damage and force that the related dental tissues had to suffer. Pain for 3-7 days is normal after a simple procedure until the wound is healed. For surgical extractions the tooth extraction pain may last for some weeks especially if there is extensive damage to the jawbone. The pain after extracting an impacted tooth will definitely last much more then extracting a tooth that has already become loose due to periodontal disease.

Jaw pain after tooth extraction

A sore jaw joint is another common cause of tooth extraction pain. Holding the mouth open for a long time during the procedure and the pressure that the dentist puts on the jaw can cause irritation to the jaw joint and the jaw muscles. Gentle massaging of the muscles, the application of hot compresses and over-the-counter pain medication can help ease the soreness of the jaw. Do not eat hard foods and avoid over extending the mouth to allow the jaw joint and muscles to relax.

Phantom pain

In some rare cases, patients who had a tooth extracted may feel pain at the site of the extraction for a long period afterwards. This pain is similar to the phantom pain some patients feel after a limb amputation and will stop on its own after some time. The problem is not only that there is not much that can be done to relieve this kind of pain, but also that it may be misinterpreted as a sign of post treatment complications and lead to unnecessary and useless further treatments.