“I have some tooth pain following a tooth extraction a couple of days ago. What is a normal amount of pain after an extraction and what is the expected healing time?

What should I be aware of in relation to complications such as dry sockets and blood clots?””

– Question from Robert from Zillmere, Brisbane

Dr Darryl Marsh replies:

There will always be some degree of pain after a tooth extraction; it’s just a question of how much.

Three things will determine the amount of pain:

1. The amount of damage to the tissues that was required to get the tooth out. Our practice’s approach has been to try and do our treatments slowly, gently and as least traumatically as possible. Research backs up the fact that if you do a procedure this way then patients will have less pain afterwards.
2. The amount of infection that was present to begin with. If you leave an infection to progress to point where all the tissues are swollen, there’s pus everywhere and the bone is brittle and eaten away, then you’re going to have more pain and more difficulty with healing than you would if the tissues were healthier. This is regardless of antibiotics or the care taken by your surgeon.
3. The patient: Some people’s tissues are just more sensitive than the next person, some people have a higher pain threshold than others that’s why some women can give birth without drugs and other people there’s just no chance on earth.

There are ways to help minimise the pain after extraction

Those 3 things are the main techniques to minimise pain after a tooth extraction. One of the things that we have also found to be most helpful is a mixture that one of our oral surgeon colleagues has developed. It’s a combination of an antiseptic, chlorhexidine, and vitamins and minerals and, applied to the tissues after extraction, we have found it to be effective in aiding tissues to heal and minimising pain afterwards.

We believe it also reduce post-extraction problems with dry sockets and allows wounds to heal quickly with the minimum of pain and swelling.

Minimising the pain during a tooth extraction

There is no reason these days that any dental procedure, tooth extractions included, should be painful. The local anaesthetics that we have now, especially the new ones like Articaine, which has been released in the last few years, are more powerful than before. The anaesthetic goes deeper and lasts longer, so there is absolutely no need to anyone to suffer in pain at the dentist.

In addition to the modern pain relief we also add in all the TLC (tender loving care), take our time to do things gently, and help patients relax with mod-cons like DVD’s, noise cancelling headphones and nice warm blankets.

Pain management options after tooth extraction

Most people can get by with paracetamol, but I prefer ibuprofen-paracetamol combination, which is more effective than when they are taken are separately. This pain management will usually only be required by patients for 24 hours, for others it might be for 72 hours. It really depends on the nature of the extraction and the patient themselves.

We always give our patients a good idea at that time of the extraction how long to expect pain and how to best manage that pain.

When is the dental pain not normal?

Pain after 3 days could indicate other problems. A dry socket is when the clot that is forming at the root of the tooth is dislodged. If you’re going to have a dry socket, you’re will notice the pain around day 3 – 4.

The cause of a dry socket might be from a number of things:

• An increase in blood pressure: if you exercise such as going for a run, then the increased blood pressure can push the clot out and it can start bleeding again.
• Smoking: this is the most common cause as smoking will cause the clot to disintegrate.
• Rinsing and cleaning the clot: I have heard of people vigorously rinsing a wound like there’s no tomorrow or using a syringe to flush out the area. They may think that they are cleaning the wound and getting all the food out but they’re just flushing all the blood clot out.

Tooth extraction patients need their blood to clot as that is what holds everything in place and helps it heal.

What to do if you think your tooth pain isn’t normal

If the pain continues, grows, changes or you just fear that something is not right then we encourage our patients to call us, come in and we have a look. It is best for everyone and we would much rather check than have someone sit worried and in pain at home. If you are in this position call your dentist that performed the extraction and explain what is happening.

Do many people fear tooth extractions?

We see a lot of people who freaking-out at the idea of an extraction or root canal. The two reasons that people are most fearful are:

1. They’ve had a bad experience in the past
2. The extraction has been managed in the wrong way, eg where someone has been trying to take the tooth out when the tooth should have been sent to a specialist.

Hindsight is always 20-20 vision! If a patient comes to see me and says: “Last time I had a tooth out the dentist said it ought to be easy but the tooth broke up and I was there for 4 painful hours”, I would respond that even though this extraction doesn’t look that hard either everyone will be better off if this went to a specialist. In those cases where it is unpredictable, I just don’t want anyone to have a bad experience if there is a simple solution.

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