Pain during and after tooth extraction
Before tooth extraction, the affected area is well anaesthetized and a few minutes are waited for the local anaesthetic to take effect. During the extraction, the patient does not feel any pain, but he/she does feel a feeling of pressure, which is caused by the dentist’s use of a lever. This feeling can be very unpleasant, but is of a quality, if at all, only a slight pain.
Should an extraction last longer, so that the effect of a local anaesthetic wears off, it can be easily re-aesthetized. A combination of several anaesthesia techniques can also accelerate the response of the syringe. However, there are cases in which the anesthesia is not good or hardly effective, so that the patient feels pain during the procedure.
This is the case, for example, with severe inflammation. If the tissue around the affected tooth is highly inflamed, the pH value is shifted to the acidic range, which is why local anesthesia does not work there. Furthermore, the patient can be a so-called non-responder, which means that the anesthesia generally does not work.
Pain during extraction by a non-effective syringe is also likely in drug users. In addition to drugs, alcohol consumption on the day before the extraction has the effect that local anesthesia does not work. Even a glass of wine in the evening may mean that the syringe will not work the next day.
Pain after an extraction is not the rule. The extraction of a tooth is a routine procedure, which is usually painless and associated with complication-free wound healing. Pain after extractions occurs primarily during longer procedures that turn out to be more complicated and require more effort.
Due to the effort of the dentist when pulling with pliers or using the lever, the surrounding tissue is irritated and due to the support of the adjacent teeth, these can cause discomfort in the first days after the procedure. This results in a slight pressure pain and chewing on the affected side appears unpleasant. However, these complaints disappear completely after one week at the latest.
Furthermore, there may be pain in the wound, as the alveolus must close up again. Pain occurs when bacteria infect the wound and an inflammation develops. The patient feels the typical signs of inflammation with pain, possible swelling, redness and a noticeable warming.
The wound closure is prolonged by the inflammation. If, after the tooth extraction, the blood, which turns into connective tissue cells in the tooth socket, is rinsed out, the phenomenon of empty alveolus is created. The germs now have direct access to the bare bone via the tooth socket and can infect it.
The physician speaks of alveolitis sicca. The alveolitis causes severe pain due to the infection, and the patient must consult the dentist in charge of the treatment. If alveolitis sicca is not treated, pus may form and collect to form an abscess.This results in a severe swelling of the cheek, pain, up to swallowing and breathing difficulties.
The patient should keep as calm as possible after a tooth extraction and not perform any strenuous work. In addition to resting, targeted cooling helps against wound pain and prevents the spread of swelling and inflammation. If the pain is still unbearable, painkillers are indicated.
Ibuprofen is considered the painkiller of choice because of its anti-inflammatory and analgesic effect. In case of allergy, paracetamol or Novalgin® should be used. Any medication containing the active ingredient acetylsalicylic acid is contraindicated due to its increased tendency to bleed, as it can cause secondary bleeding. If the pain medication does not help, however, the dentist should be consulted for aftercare, who can prescribe stronger medication such as opiates.
