Dental Care

Tooth Extraction Pain

Some tooth extraction pain is difficult to avoid. After all, the procedure involves the forcible removal of an entire tooth from its socket in the bone.

There are two main types of tooth extraction procedures.  A "simple tooth extraction" can be performed using only local anesthesia if the tooth to be removed is visible above the gums and appears to be easily removable.  This type of tooth extraction is often performed by general dentists.

A "surgical tooth extraction," on the other hand, is performed in cases that are likely to be more difficult or complicated.  Typically performed by an oral surgeon rather than a general dentist, a surgical tooth extraction involves cutting through gum tissue to expose the tooth. 

In some cases, portions of bone must be removed in order to free the tooth from its socket.  And, one or more stitches might be needed to close the incision. 

Obviously, the patient will experience more pain during a surgical tooth extraction, so in addition to or instead of a local anesthetic, the oral surgeon typically administers nitrous oxide (often called "laughing gas"), an intravenous sedative or even a general anesthetic to alleviate the pain.

In this article, we'll discuss the pain a dental patient typically experiences during a simple tooth extraction.  Although patients sometimes feel pain and discomfort after a tooth extraction is completed, we'll discuss post-procedure pain and aftercare in a separate article.

The Anesthetic Injection

Even for a simple tooth extraction, your dentist will need to anesthetize not only the tooth to be extracted, but the surrounding gums and jawbone. 

Typically, this is done by injecting a Xylocaine® (lidocaine) or Novocain® (procaine) solution directly into the area to be numbed, although several other injectable local anesthetics are also available for this purpose.

We all know that receiving an injection of a local anesthetics for tooth extraction pain is accompanied by some sharp but short-term pain and discomfort - in fact, in some cases the injection itself causes more pain than the actual dental procedure. 

Contrary to popular belief, most of this pain and discomfort is not caused by the needle being inserted into the area to be anesthetized.  Instead, the pain is more closely associated with the act of injecting the liquid anesthetic into soft tissues. 

In some areas this soft tissue is relatively "loose," and once it is injected, the anesthetic solution will easily "find" space within the tissue to physically occupy. 

In other areas, however, the soft tissue is denser and the injected anesthetic solution must forcibly create a space to occupy in the tissue.  This more forcible process is responsible for the infamous "pinch" your dentist will probably warn you about as he's preparing to inject the anesthetic.

Some dental patients can be a bit squeamish while waiting for the injection, but the calmer and more cooperative you are while the dentist is injecting the solution, the better and less painful the process will be. 

The rate at which the anesthetic is injected is one of the factors associated with how easy or difficult it is for the anesthetic solution to enter the soft tissue. 

Patients who squirm or struggle during the process do themselves no favors, because the dentist's instinct will be to speed up the rate of injection to complete it more quickly.  In some cases this can make the injection more painful.

Your dentist's ability to concentrate on the act of injecting the anesthetic can also affect how much pain you experience.  If the dentist is distracted by your behavior or focuses more on it than on injecting the anesthetic, he or she will be more likely to miss the target.  If that occurs, you'll need an additional injection to properly anesthetize the site.

Other Types of Tooth Extraction Pain

Despite receiving an injection of local anesthetic, you will still feel some tooth extraction pain in the form of pressure during the actual extraction procedure. 

The human body includes several different types of nerve fibers, and each one transmits different types of sensations.  They also have different physical characteristics and are affected differently by the local anesthesia. 

Lidocaine® and Novocain®, dentistry's most frequently-used local anesthetics, are quite effective at inhibiting the firing of the neurons that transmit pain, but neither one works as well on the nerves that give rise to feeling the sensation of pressure.


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