Category Archives: Oral Surgery & Tooth Extractions

Factors Determining Wisdom Tooth Extraction Pain

Does it hurt to have my wisdom teeth removed?

wisdom tooth extraction pain
Factors determining wisdom tooth extraction pain

Wondering about how painful wisdom teeth extractions are is a very common concern. They want to know how much pain they will have to deal with during wisdom tooth removal surgery. The answer to this question really depends. If your dentist or oral surgeon fails to properly numb you then you may feel pain during the surgery. However, if he or she properly numbs your teeth then you won’t feel any pain but will still feel pressure. If you’re being put under then you shouldn’t feel neither pain or pressure. We will now discuss wisdom tooth extraction pain scenarios when you are awake or asleep.

Wisdom tooth extraction pain levels while you are awake

wisdom teeth numbing
Factors affecting how easily you will get numb for your tooth extraction surgery

Not everyone can afford to be put under anesthesia and not every dentist offers this option. Putting patients under deep sedation requires your dentist to take additional courses as well as to hold a special sedation license. Most general dentists don’t offer full sedation to their patients. Oral surgeons, on the other hand, almost always offer deep sedation as an option.

Of course there are other ways to get you to become more relaxed during surgery. There are milder forms of sedation which most dentists do actually offer. Administering nitrous oxide gas or taking anti-anxiety medications before your surgery are two very effective options which help reduce your stress levels. These milder forms of sedation work quite well for easier extraction cases. 

If you are awake during your surgery then it’s very important to make sure that you’re fully numb in advance of your surgery. You and your dentist must work together to properly reach this point. Once you’re fully numbed up then the rest of the procedure is quite easy. Here are some factors which determine how easily you will get numb:

  1. How much pain you already have
  2. Difficulty of your wisdom tooth removal
  3. Location of your wisdom tooth
  4. Speed of your metabolism
  5. Your age
  6. Other miscellaneous factors
Existing pain levels prior to surgery
Wisdom teeth pain levels
The more pain you have coming in, the more difficult
it will be yo numb you

When you are in lots of pain you it’s more difficult to numb your teeth. There is a big difference between removing wisdom teeth, or for that matter any tooth, which are actively hurting versus doing it to prevent pain.

If you’re experiencing a severe toothache it will be much harder to numb your tooth. This is because chronic infections are more resistant to numbing agents. Your nerves become more sensitive when experiencing pain which consequently makes it much harder to numb your tooth.

Numbing teeth becomes much more difficult when you are in severe pain or have been in pain for a long time. For instance, it usually takes 2 to 3 shots to numb up an average wisdom tooth. However, a very painful toothache could easily require 4, 5 or even more shots to get fully numb.

My advice to you is that if your wisdom teeth need to be removed then do so before they start to hurt. Prevention is always the better route to go in these cases. Otherwise you might get plenty of shots and still not get fully numbed up!

Difficulty of tooth removal
Impacted wisdom teeth
The more impacted your wisdom tooth, the more difficult it will be to numb you

Teeth which are covered with bone are more challenging to remove. This is referred to as tooth impaction. These are several scenarios which we face in regards to tooth impaction:

No impaction whatsoever

Teeth which are all the way out have no bone covering them so they aren’t impacted at all. These teeth are the easiest ones to remove.

Partial bony impaction

Some wisdom teeth are partially trapped underneath your bones. These teeth are more difficult to remove than fully erupted ones.

Full (complete) bony impaction

Then there are those wisdom teeth that are fully trapped underneath your jawbone. These are by far the most difficult teeth to extract from your mouth.

Regardless of how impacted your wisdom teeth are, you shouldn’t feel any pain if your tooth has been fully numbed in advance. Yet you will definitely feel lots of pressure when impacted wisdom teeth are being removed.

I usually tell my patients in advance which teeth are expected to be the hardest ones to remove. This mentally prepares them for what to expect during treatment. Also you will know which teeth are going to take the longest to heal. Typically more complicated extractions are followed by more painful recovery periods.

Location of your wisdom tooth
Upper Lower Wisdom teeth
Upper wisdom teeth are usually easier to remove than lower ones

As a general rule, lower wisdom teeth are more difficult to remove than upper ones. Which also means lower wisdom teeth are also harder to numb up. Here is why:

  • There are more nerves going to your lower wisdom teeth than the upper ones due to human anatomy.
  • Your jawbone is denser in the lower jaw (mandible) as compared to the upper jaw (maxilla). Having dense bone makes it harder for your dentist or oral surgeon to remove your teeth.

As a result, your lower wisdom teeth are generally more difficult to remove than upper ones. To put this in perspective, a seasoned oral surgeon typically takes about 5 to 10 minutes to remove an upper impacted wisdom tooth wheres lower wisdoms usually take 20 to 30 minutes.

Speed of your metabolism

Another factor affecting tooth extraction pain levels is your body’s metabolism. Your body’s metabolism not only affects how quickly your numbness kicks in, but also affects how rapidly numbness wears off. If you have a very high metabolism rate, then chances are by the time your dentist reaches your last tooth it’s no longer numb.

Immediately inform your dentist or oral surgeon if you start to feel your numbness wearing off during surgery. Don’t try to be a hero. Ask your dentist or oral surgeon for more Novocaine right away. Keep in mind that being numb is not only important throughout your surgery, but also matters for after the procedure has been completed. Should your numbness wear off before you’ve had a chance to take your medications, then you might experience some serious pain. Thus don’t be shy about asking for more shots if you actually need them. In the end being numb is only to your own benefit.

Your age
Age wisdom teeth
Removing and numbing wisdom teeth becomes more difficult as you age

Just like many other things, aging complicates wisdom teeth removal surgery. Younger patients have softer bones, undeveloped wisdom teeth as well as lower resistance to drugs and medications. Which means younger patients usually numb up easier and stay numb for longer periods.

Numbing adult patients on the other hand can be challenging. Not only do older adults have high blood pressure and a slew of other medical complications, but adults are generally tougher to numb up. Yet another reason you should remove your wisdom teeth while you’re still in your teens or twenties

In fact age is such an important factor that for older adults most dentists usually recommended either removing your wisdom teeth individually or at most two at a time. You’re likely to reach the maximum allowable amount of anesthesia without being able to numb up more than one or two teeth at a time. On the other hand, this is rarely an issue with younger patients.

Miscellaneous factors

Your sensitivity level is yet another factor which affects your tooth extraction pain levels. Some people tend to be more sensitive during dental treatment, the same way they would be sensitive to sunlight for instance. Occasionally a patient just won’t get numb no matter how many shots we give them.

If you know yourself to be extremely sensitive to pain, it might be best to either go under sedation. Otherwise remove your wisdom teeth one or two at a time. This way your dentist can give you enough shots to numb up each individual tooth without having to worry about reaching the maximum allowable dose of anesthetic.

As you can see, there are many factors which affect how easily one gets numb. But don’t worry too much, an experienced dentist or oral surgeon who pays attention to details should be able to get you numb one way or another. However, if you still have your doubts, then you can always consider the option of sedation for your surgery instead.

Pain versus pressure

Pressure tooth extraction
Distinguishing between pressure and pain is very important during tooth extraction

No matter how numb your dentist makes you, you’ll still feel pressure when wisdom teeth come out. There are different nerve receptors for pain as opposed to pressure. Conventional local anesthetics, such as Novocaine, only numb pain receptors and not pressure sensors. Therefore no matter how many shots you receive, pressure sensation will not go away.

If this is your first extraction, distinguishing the difference between pressure and pain is very important. Let us demonstrate the difference between pressure and pain:

What pressure feels like:

Grab your front tooth and tug at it hard. This is what pressure feels like. Pressure feels like pulling and pushing. There is no actual painful sensation associated with pressure alone.

What pain feels like:

Poke at your gums with you nails or some other sharp object. This is what pain feels like. Pain is a sharp, pricking sensation that actually hurts.

Once you’re numbed up correctly, you should expect lots of pressure but no actual pain. If you feel pain then communicate with your dentist or oral surgeon right away to receive more numbing agent. Just make sure it is really pain, not pressure, that you are feeling.

If you get scared and keep insisting that you’re feeling pain while it’s actually pressure, then the procedure may not go as well. There are only so many shots you can safely receive during surgery. Insisting on more and more shots could raise your blood pressure to dangerously high levels. Getting too many shots can be dangerous and compromises your overall health. Consider being put under sedation if you don’t want to feel any pain or pressure.

Sedation options for wisdom teeth removal

Sleeping sedation tooth extraction pain
If you don’t want to be bothered with any pain or pressure then have them put you to sleep

Wisdom teeth are large teeth which are usually stuck underneath your gum and bones. Your dentist first needs to remove the gum and bone tissue trapping your wisdom teeth. Afterwards, they need to remove the tooth itself. Since most of the times your tooth is stuck in your jaws your dentist needs to cut the tooth in fragments and remove it piece by piece.

Cutting gums, bone and teeth is no picnic. If you don’t want to deal with any tooth extraction pain or pressure, then consider being deep sedation options. Being placed under anesthesia for difficult wisdom tooth removals is probably a wise idea. Particularly when you are removing all four of your wisdom teeth at once or when dealing with very difficult extractions.

You have two options when it comes to going to sleep for wisdom tooth removal. IV sedation is usually the preferred method. You dentist injects sleeping medication into your veins to put you to sleep. With IV sedation almost no one remembers anything from the procedure itself. This type of sedation can be conveniently administered in your dentist or oral surgeon’s office. IV sedation is an outpatient procedure which involves minimal preparation.

General anesthesia is the other option to for being sleep during surgery. However, general anesthesia is not as popular as IV sedation for wisdom removals. Costs and extensive preparation associated with general anesthesia make it a less desirable option as compared to IV sedation.

NEXT >> When do I get to keep my wisdom teeth?

What are the steps involved in wisdom teeth removal surgery?

What are the instructions I need to follow after removing my wisdom teeth?

What are potential wisdom teeth problems which occur after surgery?

What are wisdom teeth (third molars)?

When do I need to remove my wisdom teeth?

What to do if You’re Experiencing Pain After a Tooth Extraction: Waiting a Little Bit

1. Having pain is a normal part of the recovery process. Keep in mind that pain is part of the healing process and your body’s normal reaction to the surgery. Once a tooth has been fully removed it takes anywhere from 2 to 3 days to over a week for the initial pain to subside. Make sure to take your medications as prescribed and follow the instructions to heal as quickly as possible. The level of pain after the surgery typically correlates with the complexity of the procedure. The simpler extractions heal within 2 to 3 days whereas the more complicated ones as well as wisdom teeth usually require a week or so before you start seeing improvements.

2. Once the tooth is removed properly there is not much more that your dentist or oral surgeon can do for it. An ideal extraction is when your dentist removes the tooth within a few minutes. The surgeries that end up taking longer than fifteen minutes will typically require bone removal and lots of cutting so it will hurt more afterwards. If you lose a lot of bone the dentist or oral surgeon may choose to place some bone graft to assist with the healing process and to preserve the extraction socket better. The dentist may also use sutures to bring your gum tissue together to allow for a better healing process.

Oftentimes patients who have their four wisdom teeth removed all at once return within just a day or two to re-evaluate the area but can’t even open their mouths wide enough for the dentist to see back there since their jaws are still sore. Not much your dentist can do for you if he or she can’t see the surgery site. It is best to give it some time for the initial swelling to subside before going back to the dentist or oral surgeon so he or she can thoroughly evaluate you.

3. Wisdom removals and dry sockets can lead to pain which will last for several weeks. It is very important to avoid spitting for the first day after the tooth has been removed. Applying pressure by biting on gauze is a good way to get the bleeding under control. Keep in mind that the most crucial part of the healing occurs within the first 24 to 48 hours so you must be very careful to follow the instructions and allow for proper healing to occur in this critical period.

  • Smokers and those with a long list of medical problems generally heal slower than healthier patients
  • You will also heal slower as you age so expect the recovery to take a bit longer

If you spit and don’t follow the instructions then you’re not allowing the blood clot to form and you could end up with what’s known as a dry socket. It basically means poor healing and you will suffer for a few weeks. There is not much to be done for dry sockets, there is a solution that your dentist can apply which helps a little bit, but otherwise it needs to be managed with painkillers and takes a few weeks to resolve. No additional antibiotic is indicated as a dry socket is not an infection but is simply poor healing. And of course when it comes to removing wisdom teeth, especially when the teeth are embedded under your gums or jaw bone, then assume it will hurt for one week and anything less than that is a bonus!

NEXT >> How to Decide

What to do if You’re Experiencing Pain After a Tooth Extraction: Going to the Dentist

What to do if You’re Experiencing Pain After a Tooth Extraction: How to Decide

How to Decide?

Answer the following questions:

  1. Has it been more than 3 days and you are still in severe pain?
  2. If it was a complex wisdom tooth removal, has it been more than one week and you are still in severe pain?
  3. Have you been taking your antibiotics and pain killers but it’s not helping?
  4. Do you feel that there is still a piece of tooth or bone left behind?
  5. Are you having a hard time breathing?
  6. Are you still gushing blood and you can’t get the bleeding under control?

If you answered “yes” to most of the above questions then you should go back to your dentist or oral surgeon to have the area evaluated further. If you feel the pain levels are too excessive, contact your dentist to see if they can up your medications to a stronger one. If you feel you’re not reacting well to the medications, you should contact the dentist for a substitute. You may be able to handle this over the phone and not necessarily go back to the dentist office.

If you answered “no” to most of the above questions then you should probably try to wait it out for a bit longer to see if the pain is subsiding.

Final Thought

Most pains after extractions go away with tim. How much pain you will be in has lots to do with how difficult your tooth extraction is. Easier extractions come with 2 to 3 days of pain but the more difficult ones take longer and closer to one week. Healing times of a few days to a week are normal as this is your body’s reaction to having a tooth removed. Get some rest, take your medications, follow the instructions and give your body some time to recover.

At the end of the day if you feel that you are more comfortable having your dentist or your oral surgeon re-evaluate the area then you should go ahead and contact them on phone of visit them to have your questions answered. Try to ask any questions prior to leaving the office. Most questions can be answered on the phone as well, but in certain occasions your dentist or oral surgeon will ask you to come back to the office for further evaluation.

NEXT >> What to do if You’re Experiencing Pain After a Tooth Extraction: Going to the Dentist

What to do if You’re Experiencing Pain After a Tooth Extraction: Waiting a Little Bit