Pain Following Tooth Extraction

It is important to remember that the extraction of any tooth is a surgical procedure and as such is likely to result in pain. Fortunately significant pain after an extraction is not common and when present may occur despite the best efforts of your dentist. The degree of difficulty of the extraction probably has some relevance in regard to subsequent pain, but interestingly it is often found that patients undergoing a difficult surgical extraction of a tooth may not experience pain whereas those having a relatively easy surgical extraction may have a high level of pain. This would seem to imply that some have a tendency to develop pain with less provocation.

Smoking carries a high risk of development of pain following extractions as does poor oral hygiene and failure to follow simple instructions that your dentist may give after an extraction. Mild to moderate pain for one or two days following a simple extraction and should be largely controlled with simple over the counter pain-killers such as paracetamol or ibuprofen.

Pain following an extraction lasting more than 2 days or developing two or more days following an extraction likely indicates the development of a condition commonly known as dry socket. This is a poorly understood condition and is likely not preventable. As it involves inflammation in the bony socket where the tooth was anchored in place it does not respond to treatment with antibiotics and is not prevented by taking antibiotics prior to the extraction. The inflammation which develops leads to destruction of the blood clot (mouth equivalent of a scab on the skin) which is required to promote normal healing. The result is a particularly severe pain which is difficult to eliminate and may take ten to fourteen days to clear. Strong painkillers may be required to manage the pain. Your dentist may also provide a medical dressing in the gum to help keep the area clean and stimulate normal healing.

People with a dry socket will often complain that the pain is not localised in the gum where the tooth was removed but rather the entire side of the face and head and often extending to the neck and shoulder is painful. This widespread pain is due to pain and tenderness developing in the jaw and neck muscles. Pain with obvious swelling in the gum area or face may indicate that the problem is an infection as opposed to a dry socket and in this instance antibiotics and urgent care from your dentist or emergency dental clinic may be required.

Pain lasting more than a few weeks and perhaps for months or years is very uncommon but does occur. In this event it is important, assuming your dentist has not found another dental problem in the area, to see an orofacial pain specialist firstly to rule out other possibilities such as chronic jaw pain.

In this instance which is very rare pain may be caused by a disruption of normal pain nerve activity or neuropathic pain.

(see neuropathic pain in section: “MOUTH and TONGUE PAIN”)