Medical expert of the article
New publications
Anesthesia for tooth extraction: the main methods and preparations
Last reviewed: 04.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Throughout the history of medicine, dentists have used all sorts of anesthetics for tooth extraction: the Aztecs used mandrake root extract, the Egyptians applied the fat of the sacred crocodile that lived in the waters of the Nile to the skin. In the 19th century, they began to spray ether, then nitrous oxide and chloroform... Today, dentists around the world use modern anesthetics that allow tooth extraction and other manipulations to be performed absolutely painlessly.
Anesthesia for tooth extraction: methods
Local anesthesia for tooth extraction has two main methods: non-injection (external) and injection (using an injection).
The non-injection method provides superficial tissue anesthesia using drugs that are applied to or irrigated on the required area. This is an application method. There are other non-injection methods (exposure to low temperatures, electromagnetic waves, administration of anesthetic using electrophoresis), but they are practically not used in domestic dentistry.
The application method is usually used when removing baby teeth in children or as a means of numbing the needle insertion site during injection anesthesia - in order to completely relieve the patient from discomfort during a visit to the dentist.
Injection methods of anesthesia during tooth extraction, in turn, are divided into conduction, infiltration, intraligamentary and intraosseous anesthesia.
Conduction anesthesia can numb several teeth at once, since the injection is made in the area of the last tooth (where the nerve branch passes), and thus the entire nerve is blocked.
Infiltration anesthesia is performed by injecting an anesthetic into the area of the projection of the apex of the tooth root. For anesthesia when removing teeth in the upper jaw, an injection is made into the area of the root tip in the gum (from the side of the lips and from the side of the palate). For anesthesia when removing teeth located in the center of the lower jaw, an injection is made into the area of the root tip in the gum only from the side of the lip.
Intraligamentary (intraligament) anesthesia numbs the tooth and adjacent gum due to the fact that the injection is made through the gum into the periodontal circular ligament of the tooth (these are the fibers and tissues that support the tooth in the alveolus). For this method, there is a special syringe with a dispenser, which allows you to use a minimal amount of anesthetic.
Intraosseous anesthesia is recognized as the best anesthesia for tooth extraction, since the injection is made directly into the spongy bone that surrounds the dental alveoli.
Anesthesia for tooth extraction: basic painkillers
Not all painkillers are suitable for anesthesia during tooth extraction. Therefore, dentistry has its own list of the most commonly used drugs, which starts with the well-known novocaine.
However, novocaine is not used as often now as it used to be. Some people cannot stand it at all, many are allergic to it, and its side effects include dizziness, weakness, and decreased blood pressure. In addition, it is far from being the strongest anesthetic, and for this reason it is often administered together with small doses of adrenaline - for a better pain-relieving effect. A mixture of novocaine and adrenaline is contraindicated for people with high blood pressure.
For infiltration anesthesia during tooth extraction in adults, a 0.5% solution of Lidocaine is widely used, for conduction anesthesia, a 1-2% solution is used. Its maximum total dose is 300-400 mg. Side effects of Lidocaine are rare, but headaches, fatigue, temporary loss of sensitivity of the lips and tongue, abnormal heart rhythm, decreased blood pressure, and urticaria are possible.
Today, the most modern anesthetics are drugs based on the active substance articaine: Articaine and its analogues - Ultracaine D-S, Ubistezin, Septanest. These anesthetics act long enough and reliably, so most dental surgeons believe that this is the best anesthesia for tooth extraction. The anesthetic effect of Articaine manifests itself in a maximum of 10 minutes and lasts 1-3.5 hours from the moment of administration. Side effects of the drug can be expressed in the form of headache, tremor and muscle twitching, nausea, vomiting and diarrhea. In rare cases, a decrease in blood pressure, cardiac arrhythmia, skin rash, angioedema are possible. The list of contraindications for Articaine includes: meningitis, tumors, poliomyelitis, osteochondrosis, spondylitis, tuberculosis or metastatic lesions of the spine, heart failure, tumors in the abdominal cavity, severe arterial hypotension, hemostasis disorder. Use during pregnancy may result in decreased fetal heart rate.
The drug Ubistesin for anesthesia during tooth extraction, in addition to articaine, contains adrenaline (epinephrine hydrochloride), which causes vasoconstriction at the injection site, complicates its absorption and prolongs the analgesic effect. The onset of the effect does not exceed three minutes, the duration of action is about 45 minutes. In addition to all the above-mentioned side effects of Articaine, there is the possibility of ischemic zones appearing at the injection site in case of accidental entry into a blood vessel or nerve damage if the injection technique is not followed.
Local anesthetics Ultracaine D-S and Septanest also contain adrenaline, so they are contraindicated in paroxysmal tachycardia, arrhythmia with a high heart rate and some forms of glaucoma.
[ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]
Anesthesia for wisdom tooth extraction
For anesthesia during wisdom tooth extraction, the same painkillers are used as for other teeth extraction. And the method of their administration (infiltration, intraligamentary or intraosseous) will be chosen by the doctor taking into account the specific pathology and the patient's condition.
Removal of wisdom teeth is most often caused not by their damage, but by their abnormal position in the dental row. The most complex pathologies are dystopia and retention.
Dystopia of a wisdom tooth is expressed in the fact that during the eruption process the tooth has shifted towards the cheek, towards the tongue, or has even turned around its own axis.
And when a wisdom tooth is retained in the jaw bone, there are its rudiments, and the tooth itself does not develop further and does not erupt. With such a pathology, the dentist has to cut the gum, remove the unerupted tooth, and then put stitches on the gum. Such operations to remove a wisdom tooth are performed under local anesthesia.
[ 11 ]
Anesthesia for extraction of baby teeth
Milk teeth that are not subject to treatment or have caused various acute inflammations (bone or periosteum) require removal. The choice of method and method of anesthesia for the removal of milk teeth is dictated by the specific situation.
For example, a baby tooth is so mobile that the doctor concludes that the root of the tooth has almost completely dissolved. In this case, application anesthesia - gel or aerosol - will be sufficient for its removal. For example, Lidocaine aerosol (the maximum recommended dose for children is 3 mg per 1 kg of body weight) is recommended to be applied to children using a cotton swab.
Most often, dentists use infiltration anesthesia for anesthesia when removing baby teeth in children: an anesthetic drug (Lidocaine, Ubistezin Forte and their analogues) is administered using two injections - from the gum side and from the tongue side. If Ubistezin is used, its dosage is determined by the child's body weight. For children weighing 20-30 kg, 0.25-1 ml is enough, with a body weight of 30-45 kg - 0.5-2 ml.
In most cases, these anesthetics are well tolerated by children. However, the dentist must be aware of any allergies to medications or cardiovascular problems.
P.S. For your information, in Europe the first anesthesia for tooth extraction in the form of ether anesthesia was officially registered on December 19, 1846, but even in the first quarter of the 20th century, in most cases, “tooth extraction” was performed without any anesthesia, although the well-known novocaine was synthesized in 1904.
[ 12 ]
Anesthesia after tooth extraction
After the anesthesia for tooth extraction begins, as they often say, to "wear off", the wound - the site of the dental operation to extract the tooth - begins to hurt. Sometimes the pain is so strong that anesthesia is required after tooth extraction. In such cases, you need to take painkillers, and most often doctors recommend Ketanov.
The painkiller Ketanov quickly relieves severe pain, including postoperative pain. It is taken one tablet every 6 hours. But this drug can be taken for no more than 7 days. There may be side effects, which are manifested by drowsiness, dyspeptic phenomena, increased dry mouth and increased heart rate. If the patient has diseases such as bronchial asthma, gastric ulcer or duodenal ulcer, as well as kidney problems, the use of this analgesic is contraindicated, as well as pregnant and lactating women.
By the way, in the first 24 hours after tooth extraction, you can't rinse your mouth with anything, drink alcohol or anything hot. And if swelling and pain suddenly appear again three days after tooth extraction, you should go to your dentist quickly.