Tooth Extraction

Tooth Extraction Pain

A tooth extraction involves removing damaged or severely decayed teeth from a socket inside the jawbone.  Commonly, people require this type of service when they need a wisdom tooth extraction or in preparation for dental implants.  The very nature of the procedure opens the door for pain before, during, and after an extraction.  A skillful dentist and the proper use of anesthetics will usually minimize the pain.

To complete an extraction, your dentist will need to apply enough force to break the ligaments that hold your teeth in place.  He will also need to widen the socket enough to dislodge the tooth for removal.  He will numb the extraction area with anesthetic in order to minimize the pain; however, you can still expect some level of discomfort by the very nature of the force that is being applied by the dentist.  The degree of discomfort will depend on the complexity of the extraction.  The complexity will be affected by a number of factors such as the ligament strength, the position of the tooth, the amount of damage to the tooth, and the strength of the tooth.

During a simple extraction, many of these factors are of minimal seriousness.  The tooth is in good enough shape that basic extraction tools can be used without fracturing the tooth.  These extractions are usually performed by a general dentist and the expectation of pain will be low.

Since extraction by oral surgery requires an incision and minor surgery, the possibility of pain during and after the procedure is elevated.  Often the tooth is in such poor condition that it is difficult to get a good grip on it.  In other cases, the tooth will be partially impacted and make be difficult to remove.  These situations will often require the oral surgeon to break the tooth into smaller sections in order to facilitate removal of the tooth.

In the most difficult extractions, dental sedation can be used in order to minimize pain and anxiety.  There are three levels of sedation that can be used.  Which level is necessary will be determined by the complexity and length of the procedure along with the individual needs of the patient.  The most basic and common is what is known as “laughing gas.”  This is mild enough to allow you to drive yourself home after the procedure is completed.  For more serious situations, there are two higher levels of sedation.  Either of these scenarios will mean that you need someone to drive you home once the treatment is completed.

 The following process is followed during extractions in order to minimize the pain as much as possible:

  • Local anesthetic will be applied in the area of the affected tooth.
  • The dentist will check to make sure you have lost feeling in that area before he begins the extraction.
  • The socket of the affected tooth will gradually be widened to allow the removal of the tooth.  During this time, you will feel strong pressure.  Don’t be alarmed.
  • While the pressure is to be expected, you should NOT be feeling any pain.
  • Let your dentist know if you DO feel pain at any moment during the extraction.  Your dentist and his assistant will focus on eliminating the pain before continuing the procedure.

Tooth Extraction Care

 As soon as the tooth as been successfully extracted, the blood should begin to clot in order to stop the bleeding and to allow the healing process to begin.  To this end, a dental assistant will give you a gauze pad to bite on for a minimum of 30 minutes after the extraction.  The healing process will be helped by maintaining a firm pressure over the extraction area for up to two hours after the surgery.  Use the gauze packing that is provided to maintain the pressure.  You may experience minor levels of bleeding for up to 24 hours after the extraction. 

 Once the blood begins to clot, you will want to avoid disturbing the clot for 72 hours.  Do not rinse your mouth vigorously, do not use a straw, do not smoke, and do not brush your teeth near the extraction point for this period of time.  It will also be helpful to avoid strenuous exercise for 24 hours.

 It is normal to experience some pain and swelling after a tooth is extracted.  Use an ice pack or an unopened bag of frozen peas or corn against the outside of the extraction area in order to minimize swelling.  Make sure to take any pain medications that your dentist has prescribed.  Call your dentist if the pain medication is not effective.  Most of the swelling should be gone within 48-72 hours.  During this time, you should eat drink lots of fluid.  You should be able to eat soft food as you find it to be comfortable.

 After a period of 24 hours, you should be able to continue your normal oral hygiene routine.  Proper brushing and flossing will speed up the healing process and make your mouth clean and fresh.  If any bleeding occurs during this time, place a clean gauze pad over the affected area and bite gently for 30 minutes.  Avoid hot liquids and exercise for the remainder of the day.  Try to keep your head elevated.

 Apply cold packs to the outside of the extraction area for 20 minutes on and 20 minutes off during the first 12-24 hours after the surgery.  This will keep swelling to a minimum.  It is recommended to take pain medication before the anesthetic wears off.  Over the counter ibuprofen (200 mg tablets) can be taken 2-4 at a time every six hours if your pain is moderate.  For more severe pain, you can take prescribed pain medication as directed.  Avoid the pain medications if you are allergic or your doctor has told you to avoid them.

 Aim to drink at least six glasses of liquid on the first day after surgery.  During this first day, avoid rinsing your mouth.  On the following days, use a warm, salt-water rinse if you so desire.  Gently brushing the extraction area will help keep the area clean of food particles and bacteria.  Limit your diet to liquids and any soft foods that are comfortable to eat.  Over the following days, your diet can be expanded as you feel comfortable.

Tooth Extraction Infection

By following the post-extraction directions given above you should be able to minimize the possibility of infections in the extraction area.  However, any dental procedure carries with it the possibility of some complications.  These complications can lead to pain and infection. 

Here are some examples of post-extraction complications that can cause pain and possibly infection.

  • Damage to adjacent teeth – During an extraction, especially a difficult one, a dentist may accidentally damage nearby teeth or nearby restoration work.  In time, the damaged tooth may become painful and require treatment.  If the gum is opened up or a tooth is cracked during this damage, it may make it easier for bacteria to get into a hidden place and bring about infection.
  • Dry socket – This condition develops when a blood clot does not form in the extraction area.  It can also occur if a developed blood clot breaks loose or is washed away.  This exposes the operation area to the bacteria that is present in the mouth.  Intense pain and possible infection can result from this situation.
  • Poor oral hygiene – Since bacteria is always present in the mouth, any time that an area is opened up there is the possibility of infection.  If good brushing and flossing are not practiced, there may be an abundance of bacteria in the mouth when the extraction is done.  This can lead to the introduction of bacteria into the extraction area.
  • Poor post-extraction care – Every step in post-extraction care is given with the goal of speeding and strengthening the healing process.  When those directions are ignored, they can open up the possibility for the area of operation to become infected.

If you continue to have bleeding, swelling, or pain several days after an extraction, these may be signs of an infection.  Call your dentist and he will help you determine whether you need to come in to check for infection.  Post-extraction infections can be extremely painful and dangerous to your overall health.