Why Am I in Pain After a Tooth Extraction?

extraction graphic 2Despite all of our efforts and abilities to save damaged teeth, tooth extractions remain one of the most commonly performed dental procedures.  An extraction is a surgical procedure because it removes an important part of the human body.  As with any surgery, some pain afterward is to be expected.  However, there are also complications that can occur after tooth extractions that require additional treatment.  This week’s blog will describe each scenario and help you learn how to distinguish the difference between them.

The Process of Extraction and Healing

Teeth attach to the upper and lower jawbone via a small ligament, called the periodontal ligament (periodontal literally means “around the tooth”).  In order to extract a tooth, the dentist must sever that attachment.  That’s not all, though.  In many cases, the shape of the tooth’s roots require some fancy hand-work to remove it from the bone.  For example, a curved root or roots that flare outward from the central axis of a tooth require more than just simple “pulling”.

Once the dentist removes the tooth, bleeding at the surgery site is very important.  The empty socket must fill with a blood clot for appropriate healing.  Sometimes the dentist must place stitches in the gums over the socket.  With a blood clot sealing the extraction site, the gum tissues will slowly heal over the socket over the following two to three weeks.  The jawbone will fill in underneath the gum tissues over the next 6-9 months.

Normal Post-Surgical Pain

The human body responds to any type of surgical removal with inflammation.  Inflammation causes pain, swelling, redness, and sometimes heat.  Since we know the cause of the inflammation (the extraction itself), it is safe to treat the pain with anti-inflammatory medication like Motrin and Aleve.

Normal post-extraction pain will include mild to moderate pain that may be achy or throbbing, which slowly decreases in intensity over the days following the procedure.  Following your doctor’s post-operative instructions as strictly as possible helps to reduce normal post-op pain.

Post-Surgical Complications

In contrast to normal or expected post-surgical pain are certain complications that cause abnormal types of pain.  While we expect some pain following a surgical procedure, when complications occur, the pain can be more intense and last for longer periods of time.  There are two common complications that lead to post-extraction pain.


In general, infections following an extraction are rare.  This is because the source of the infection (the tooth) has been eliminated.  Typically, this allows your body to remove any residual infection on its own.  This is why many dentists do not prescribe antibiotics following the extraction of a tooth.

However, in patients with compromised immune systems or severe PRE-operative infections, a post-extraction infection is possible.  If an infection does occur, it causes swelling, and increase in pain and sometimes the production of pus.

Dry Socket

Dry socket is a problem that occurs when the protective blood clot is either dislodged or dissolved from the socket, exposing the underlying jawbone.  It typically occurs three to five days after the extraction.  It causes severe pain, a bad smell, and a bad taste.  It also slows down the healing process.

Dry socket is more likely following a very difficult extraction, and you can reduce the likelihood of this complication by strictly following the doctor’s post-extraction instructions.Extraction post op instructions no straws

  • No straws and no smoking – The sucking motion can dislodge the blood clot.
  • No carbonated or alcoholic beverages – They can chemically dissolve the clot.

The remedy for dry socket is filling in the empty extraction site with a medicated dressing.  The sooner the dentist places a dressing, the sooner you get relief from your pain.  It is important to change out the dressing every day, so you need to let your dentist know ASAP if you think you have this complication.

How to Know Whether your Post-Op Pain is Normal or a Complication

Normal pain will decrease over the first few days after the extraction and should be completely gone within 7-10 days.

A complication will cause a sharp increase in pain.

Since everyone experiences pain differently, it can be difficult to know if what you feel is “normal”.  In general, the average adult is able to sufficiently manage pain following a tooth extraction with a combination of over-the-counter medication, like Motrin and Tylenol.

Patients with chronic pain syndromes or nerve-related disorders may experience above average pain following an extraction.

If you’re not sure whether your pain is “normal”, call the office and speak to your dentist.  She will let you know if you need to return for evaluation.

More Questions about Extractions?

Call the office at 972-347-1145.  We can answer any question you have about tooth extractions and post-operative pain.

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