Pain after tooth extraction

Pain after tooth extraction is an inevitable consequence that usually passes quickly, provided that the extraction is successful and the patient follows the rules for caring for the cavity.

Modern dentistry, its surgical component, strives for maximum preservation of the patient's teeth, thanks to unique technologies, materials and equipment, this has become a fairly common occurrence. However, there are either emergency cases or conditions of so-called "neglected" teeth, when dentists have to resort to extraction, that is, tooth removal.

Despite all the efforts of the pharmaceutical market, offering new and effective anesthetics, it must be acknowledged that removal is a minor surgical operation, which in one way or another injures bone tissue and gum tissue, and often the oral mucosa.

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Cause of pain after tooth extraction

Dolor post extractionem - this is the Latin name for pain after tooth extraction. This unpleasant and inevitable phenomenon has its causes, caused by various factors:

• The condition of a tooth or teeth in general.
• The number of teeth removed at the same time.
• The presence of a purulent inflammatory process in the oral cavity.
• Associated dental diseases – periodontosis, stomatitis, abscess, caries and others.
• Localization of the diseased tooth.
• The degree of destruction of the tooth or teeth.
• The presence of chronic diseases of internal organs and systems in the patient's medical history.
• Age of the patient.

As a rule, the main causes of pain after tooth extraction are associated with trauma to the gums and bone tissue during surgery. This is an inevitable consequence, which ideally should disappear after a maximum of 24 hours. In order to respond correctly to pain symptoms, it is necessary to find out how extraction trauma occurs:

1. When removing a tooth, the integrity of the ligaments holding the tooth is inevitably damaged, because it needs to be pulled out. In this case, nerve fibers and blood vessels are torn, otherwise the diseased tooth will continue to "sit" in place and provoke inflammation and pain.
2. During extraction, mechanical pressure is applied to the walls of the tooth socket, which inevitably results in crushing of the nerve effector endings.
3. As a result of mechanical pressure during the operation, some expansion of the infection zone occurs until the localized infection is removed. The inflammatory process is temporarily activated and spreads to nearby tissues.

These causes of pain after tooth extraction are considered normal and fall under the category of extraction injuries.

Specific factors that provoke dolor post extractionem (pain) may be associated with the following consequences of extraction:

• 85% of the causes of pain symptoms are alveolar neuritis, damage or inflammation of the alveolaris inferior (nerve) of toxic, infectious or mechanical nature. This complication is also called post-traumatic alveolitis. Alveolitis can develop as a result of an infectious agent entering the socket, this happens especially often with a "dry" socket, when the necessary blood clot does not form in it. The inflammatory process in the periosteum lining the socket causes severe, pulsating pain spreading along the location of the nerve trunks. Purulent contents may appear in the swollen socket. Alveolitis manifests its symptoms 3-4 days after tooth extraction if oral hygiene rules are not followed. In addition, alveolar neuritis can develop into phlegmon and cause severe general intoxication of the body. Such complications are extremely rare and are associated with the patient's late visit to the dentist or attempts to independently solve the problem of pain with the help of warming, compresses and folk remedies. Professional treatment of alveolitis consists of aseptic rinsing, antibiotic therapy. It is also worth reminding that the blood clot after removal is very important, so rinsing is not performed in the first 2-3 days to avoid opening the socket for infectious inflammation.
• The causes of pain after tooth extraction may be associated with a fracture of a separate section of the alveolar process. This damage is visible during the procedure and is immediately treated. A fracture may occur due to the individual anatomical properties of the patient's jaw, as a result of the fusion of the tooth with the bone tissue of the jaw (ankylosis). Fractures are treated in a hospital setting by applying plates or splinting. Signs of a fracture of the process are facial swelling, bleeding, severe pain. Such a complication occurs extremely rarely, and if it does occur, then only during the extraction of lower teeth. In addition, the risk of a fracture is minimized before surgery, when a panoramic image (OPTG) is taken.
• Acceptable extraction injuries are a wound at the extraction site, hyperemia of the oral mucosa, swelling on the side of the extracted tooth. The swelling goes away in 2-3 days, a cold compress helps speed up this process.
• The cause of pain may be associated with increased bleeding, which always alerts the doctor. This may indicate a blood clotting disorder, high blood pressure, diabetes, but most often it is caused by basic non-compliance with the oral care regimen after extraction. Bleeding is also associated with possible damage to the vascular bundle, which passes close to the lower eighth teeth. Bleeding is eliminated by tamponade, antihemorrhagic drugs.
• Traumatic damage to the bottom of the maxillary sinus is possible during extraction of the upper teeth. Perforation causes a characteristic whistling sound on exhalation, aching pain that intensifies at night. This complication is almost never encountered, since its occurrence is prevented in advance, before the operation, using a panoramic X-ray.
• Psychosomatic cause or so-called phantom pains, which appear a month or more after tooth extraction. This is due to individual hypersensitivity and the process of regeneration, restoration of bone tissue, nerve endings, and blood vessels.

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Pain after wisdom tooth removal

The pain after the removal of a wisdom tooth is more intense than after the extraction of other teeth. As a rule, the eighth tooth is removed, which may not have enough space in the arch and it begins to displace neighboring teeth. The development of the eighth tooth itself is often accompanied by pain symptoms, especially when it erupts for a long time and at an incorrect angle. If the wisdom tooth is removed at the stage of eruption, then the extraction is faster, and complications are minimal.

During the operation, there is an inevitable, rather strong injury to the gum, caused by the anatomical location of the wisdom teeth. But even the most severe pain after the removal of a wisdom tooth passes within 2 days. If the pain intensifies on the second day and is accompanied by hyperthermia, you should not postpone a visit to the dentist, as these are typical signs of the onset of alveolitis. The infectious process is easier to neutralize at the very beginning with the help of antibacterial therapy, possibly - suturing the gum, antiseptic irrigation and tamponade of the socket. If the process is left to its own devices, it can give a serious complication in the form of osteomyelitis of the jaw bone tissue. The pain after the removal of such teeth is aching, spread throughout the gum, with inflammation of the socket and gum, the pain symptom can be very strong, and accompanied by an elevated temperature.

Symptoms of pain after tooth extraction

Typical signs and symptoms of pain after tooth extraction include:

• Primary pain within 2-3 hours after the anesthetic wears off. The pain is aching, transient, and subsides after 1-2 days. A nonsteroidal anti-inflammatory drug or analgesic may be prescribed as symptomatic treatment.
• Swelling of the gums and cheek tissues in the area of tooth extraction. This is a temporary post-traumatic inflammatory process, especially common when removing a wisdom tooth in the lower jaw. Swelling may increase on the second day after extraction, this is considered an acceptable phenomenon. In no case should a swollen cheek be heated, on the contrary, cold compresses can significantly speed up the reduction of swelling.
• Pain when opening the mouth. This is also an acceptable temporary phenomenon caused by inflammation of the mucous membrane, gums and chewing muscles. As a rule, the pain subsides on the third day and disappears completely 5-7 days after removal.
• Hematoma on the cheek on the side where the tooth was extracted. This is due to possible mechanical pressure during wisdom tooth extraction, and is also possible in patients suffering from arterial hypertension. The bruise goes away within 3-5 days.
• Elevated body temperature, up to 38-39 degrees, especially in the evening or at night. This is caused by the immune system's resistance, aimed at neutralizing post-traumatic inflammation. Thus, hyperthermia for 1-2 days is considered a protective reaction of the body, and not a pathology.

As a rule, the symptoms of pain after tooth extraction disappear after 5-6 days, rarely they persist for more than a week, which indicates the possible development of complications. Usually, the dentist performing the extraction schedules follow-up visits and supervises the wound healing process. If the symptoms develop atypically and cause acute, severe pain, persistent temperature, general deterioration of the condition, you should not hesitate, but visit a doctor immediately. The following symptoms are dangerous signs:

• Severe swelling of the face, affecting both cheeks.
• Bleeding that does not stop within 24 hours.
• Feverish condition, chills.
• Nausea and vomiting.
• Purulent discharge from the socket of an extracted tooth.
• Cough, difficulty breathing.
• Severe pain after tooth extraction.

Severe, acute pain after tooth extraction may develop after 2-3 hours, when the anesthesia wears off. The pain subsides with each hour and disappears on the second day, if this does not happen, you need to see a dentist and find out the cause of the complication.

The nature and intensity of pain depends on the type of extraction. When removing a wisdom tooth, severe pain is almost inevitable, this is explained by the necessary trauma during the operation. Most often, the pain symptom is relieved by analgesics, in cases where they do not work, antibacterial therapy is used, since an inflammatory process in the socket is possible - alveolitis or infectious infection of the gum tissue.

In addition, severe pain after tooth extraction is provoked by the remains of bone fragments, roots. It should be noted that such cases are practically not observed recently, since any experienced doctor after extraction conducts a revision examination of the cavity, aseptic irrigation, and, if necessary, prescribes a repeat panoramic image.

One of the possible causes of severe pain may be a purulent process in an empty socket. This is due to the absence of a blood clot, which either does not form due to severe bleeding or is washed out by inadmissible rinsing on the part of the patient. The clot performs the task of a kind of protection of the exposed wound, if it does not form, a condition called "dry socket" develops. Infected saliva and food can get into the empty socket, causing inflammation up to an abscess.

Aching pain after tooth extraction

Aching pain after tooth extraction is a completely acceptable symptom, the nature and duration of which depend on the complexity of the extraction process. If the operation is successful, the patient needs to be patient for 2-3 days, after which the aching pain subsides.

The aching pain "starts" immediately after the anesthetic wears off. The pain can be transient, periodic, and rarely develops into a severe one. If the pain is exhausting and does not allow you to sleep, causes discomfort, it can be relieved with an analgesic and a cold compress on the side of the face where the tooth was removed. Please note that the compress should cool, not warm, so it should be changed every 10-15 minutes, in addition, breaks are necessary in cold procedures. If the aching sensation does not go away within two days and spreads along the gum, you should contact the dentist again and get recommendations for more intensive treatment. It is quite possible that prolonged pain is associated with complications - alveolitis, a purulent process in a "dry" socket, where a blood clot has not formed.

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Headache after tooth extraction

The head can hurt both when there is a tooth and after its removal, which is quite natural and can be explained by the location of the teeth.

Headache after tooth extraction is most often caused by gum swelling, less often by alveolitis or abscess. As a rule, painful sensations are localized in the innervation zone of nerve endings damaged during extraction and pass together with the main post-traumatic symptoms, i.e. after 2-3 days.

The most dangerous complication of extraction is inflammation of the trigeminal nerve, which provokes severe, intolerable headache. Neuropathy of the trigeminal nerve can be caused by traumatic damage to the nerve branches during extraction, less often by incomplete obturation of the root canal during partial extraction (preparation for prosthetics). Also, a purulent inflammatory process in the socket, fragments of the tooth root remaining in the gum can cause headache.

A severe headache after tooth extraction, accompanied by high fever, confusion, enlarged lymph nodes, nausea and vomiting, requires emergency medical care, as it is a sign of acute intoxication of the body.

If there is a throbbing pain after tooth extraction

The pulsating nature of pain is a typical symptom of pulp inflammation, or more precisely, in its nerve. Underextirpation, when the pulp is not completely removed, and an inflamed nerve are factors that cause pulsating pain after tooth extraction.

The pulp is actually the pulp, the tissue of the tooth, rich in blood vessels and nerve endings, receptors. Thus, it is a very sensitive tissue, which is innervated by the branches of the trigeminal nerve. Any inflammation of it is accompanied by severe, pulsating pain. It should be noted that extirpation (removal) of the pulp is indicated in cases of acute or chronic infectious process - pulpitis. If the removal was not completed, the process not only continues, but is also activated by the surgical mechanical impact. Consequently, after tooth extraction, pulsating pain with incomplete extirpation is associated with exacerbation of inflammation and irritation of nerve bundles.

In addition, pulsation may indicate a developing purulent process in the gum or socket of the extracted tooth. The gum becomes inflamed as a result of root fragments getting into it, and the socket in the absence of a dense blood clot covering the wound opening.

Treatment of pain after tooth extraction

All measures aimed at reducing pain after extraction should be planned and recommended by the attending dentist, as they depend on many factors – the patient’s age, indications for extraction and other reasons. However, there are standard tips that help reduce pain.

Treatment for pain after tooth extraction is as follows:

• Immediately after the extraction, it is necessary to provide cold in the area of the face, on the side of the extraction site. This can be a cold compress, ice. The procedure should cool, not warm the gum tissue, and breaks are also necessary so as not to provoke hypothermia, not to chill the gum.
• You cannot rinse or brush your teeth for a day or more. A blood clot should form in the hole, closing the wound.
• Rinsing is allowed on the second or third day. Solution: a teaspoon of soda or half a spoon of salt per glass of boiled water at room temperature. The procedure should be done 2-3 times a day.
• In case of severe pain, it is permissible to take analgin, ketanov, and antipyretic drugs.
• The dentist may prescribe treatment after tooth extraction in the form of antibiotics if complications of an inflammatory nature develop. Drugs that effectively neutralize infection are Sumamed, Biseptol, Amoxiclav, etc. Please note that antibiotics should be taken according to the doctor's recommendations, in a course, even if the pain has already passed.
• The doctor may apply stitches, especially if a wisdom tooth is removed. Modern dentistry has all the means to relieve pain and the patient's condition, so stitches are applied with threads that dissolve on their own.
• In cases of complications, a course of antiseptic irrigation and tamponade can be performed on an outpatient basis.

How to relieve pain after tooth extraction?

In order to relieve pain after tooth extraction, cold procedures are used at the initial stage. If the extraction was successful, applying a cold compress to the cheek is quite sufficient. If the pain increases and becomes unbearable, taking an analgesic or anti-inflammatory drug is indicated. As a rule, Ketanov, Diclofenac, and less often Analgin are prescribed. Antispasmodics are not effective, since they perform a completely different task. In addition, self-administration of anesthetic drugs is unacceptable; they must be recommended by a doctor, taking into account all the features of the operation and the patient's health.

The following tips also help relieve pain after tooth extraction:

• The tampon placed on the hole should not be removed immediately; it should provide protection to the wound for 20-30 minutes until a blood clot forms.
• You must not remove blood from the socket or rinse your mouth for 24 hours after tooth extraction.
• You should not eat for 2-3 hours after extraction to avoid wound infection.
• You cannot warm your cheek or gums or take baths in hot water.
• Contact of the wound with any household items is not allowed. Access to the hole is allowed only to a doctor under sterile conditions.
• You cannot eat spicy or very hot foods, or chew on the side where the tooth was removed.
• Just like warming up, overcooling of the gums and cheeks is unacceptable.
• It is advisable to quit smoking, and drinking alcohol is strictly contraindicated.
• All prescribed medications must be taken as a course.
• You should follow the doctor's visit schedule and not miss examinations.
• You should not use so-called folk remedies for pain treatment, they can provoke complications up to and including abscess or phlegmon.

How to prevent pain after tooth extraction?

Prevention of pain after extraction is strict adherence to all medical prescriptions and recommendations for oral care. The main goal of pain prevention after tooth extraction is to minimize possible complications, such as alveolitis, purulent infectious process. The rules for preventing pain symptoms are simple:

• Do not disturb the wound unnecessarily for 2-3 days. Do not touch it with your tongue or objects, do not rinse your mouth or chew on the injured side.
• Oral cavity cleaning can be started 2 days after extraction; it consists of irrigation with antiseptic solutions, which can be purchased at a pharmacy on the recommendation of a doctor.
• You cannot tolerate the growing pain, if it becomes acute, you need to take a painkiller once, maximum - 2 times a day. If the pain does not subside, you should visit a dentist, but do not suppress the pain symptom, as the clinical picture will be blurred.
• Cold helps prevent pain during the first day, but on the second day it is not effective and can provoke gum inflammation.

Prevention of pain after tooth extraction consists of systematic oral care and regular visits to the dentist until the moment when you have to part with the tooth. Like treatment of other diseases, prevention of pain symptoms is the prevention of the cause, that is, the disease. Then toothache will be just an unpleasant memory, not a reality, and getting rid of it will be considered a real gift of fate. As Bernard Shaw once wrote: "A person suffering from toothache considers everyone who does not have toothache happy."