Painful tooth after extraction: how to relieve pain

February 24, 2022 Čas branja ~ 8 min Number of reads : 104020

Ekstrakcija zoba je kirurški poseg, ki ga spremlja poškodba obzobnih tkiv (dlesni, kostne votline, sluznice). Bolečina po ekstrakciji zoba je normalen odziv telesa na kirurški poseg. Odvisno od zapletenosti klinične situacije, obsega posega, po posegu, ko preneha učinek anestetika (po 3-4 urah), začne bolnik čutiti bolečino na poškodovanem območju.

Zakaj in koliko boli?

Bolečina nastane zaradi travmatskega otekanja tkiv in stiskanja živčnih končičev. Bolj kot je bil poseg zapleten in obsežen, močnejša je bolečina v dlesni po ekstrakciji zoba. Običajno so simptomi po ekstrakciji sekalca ali molarja naslednji:

Aching pain, persists for 1-3 dni, but subsides day by day;
slight swelling, hematoma, redness around the extracted unit (may increase on the 2-3 day, and then subside);
formation of a blood clot in the wound;
the appearance of a whitish plaque (fibrin, accelerating tissue healing).

This is a normal reaction to surgical intervention. How much the tooth hurts after extraction depends on the complexity of the operation, the peculiarities of the body, the pain threshold of the patient, the location of the dental unit in the row (after extraction of molars, the injury is more extensive, it bothers longer). Normally, discomfort persists for 3-5 days, gradually subsides and disappears on its own.

Tissues recover about 10-14 days. By this time, the mucosa is completely healed, new bone begins to form inside the hole, which will completely fill the defect in about six months.

The most difficult to treat and remove is the 3 molars (eights, wisdom tooth). They have very crooked, intertwined roots. The wisdom tooth is often completely unerupted (retined), covered with mucosa or bone, or improperly erupted (dystopiated). The surgery is made more difficult by the difficult access to the eight. Therefore, healing after complex removal of the 3rd molar may require more time (about a month). But if pain and swelling have not begun to subside a week after the intervention, it is necessary to consult a dentist.

Mechanism of pain

Trauma to the soft, hard peri-dental tissues;
damage (rupture) of the connective tissue holding the tooth;
destruction of blood vessels, nerve endings;
swelling of the traumatized gum, pressure on nearby areas, impaired blood circulation;
irradiation of pain along the nerve trunks to other parts of the maxillofacial regions.

Pain after extraction of any dental unit is the body’s natural reaction to the intervention. No matter how carefully the surgeon does not act, the integrity of vessels, nerves, fibers is inevitably broken. It is normal, when the place of the removed tooth hurts no more than 2-3 days, after the removal of the eighth tooth, the gum can bother about a week. If after 7-10 days discomfort does not disappear, but continues or increases, you need the help of a doctor.

Localization of pain

As a rule, painful sensations are localized in the zone of innervation of nerve endings, traumatized during intervention. According to where the hole is located, pain can irradiate to the throat, temple, ear. Often after the removal of a tooth, the neighboring tooth hurts. The most common cause is damage to soft tissues with tools, because of which the gum around the wound swells, begins to ache, painful sensations spread further to the neighboring units.

Incisors and canines usually have 1 root, which makes their removal the least traumatic. Chewing units have 2-3 and more roots, which complicates the operation, making it more extensive. The posterior teeth of the upper jaw border the bottom of the maxillary sinuses, after extraction, pain may recoil into the nasopharynx, cheek, eye socket, ear.

If the jaw hurts after the removal of the lower tooth, especially when it comes to multi-rooted chewing units (7, 8 tooth) – this is normal. Usually such sensations pass in a few days. You should go to the dentist if the pain does not subside for 5-7 days, accompanied by other alarming symptoms.

Stages of healing of the hole

2-3 hours after the intervention – a blood clot (thrombus) is formed in the hole. It serves as a barrier for pathogenic microorganisms, preventing them from entering the wound.
The next 2-3 days – the blood clot thickens, decreases, the wound is covered with a whitish plaque (fibrin film), inside the hole begins to form granulation tissue, the basis for the restoration of mucous membranes.
After 3-7 days – the clot lightens, becomes whitish, connective tissue has almost filled the well, swelling and pain are minimal or completely absent.
After 7-10 days – the hole has significantly reduced, under the healed gingiva begins the formation of new bone, which will completely fill the defect after 4-6 months.
After 2 weeks – the gum is completely healed.

What are the possible complications

The intensity of pain should be carefully monitored. Unpleasant sensations should subside, otherwise this indicates the development of pathology. Especially excruciatingly painful gum pain after a complex removal, if complications of an inflammatory nature develop:

Alveolitis – inflammation of the bone well, surrounding tissues. accompanied by acute, throbbing pain, redness, swelling, the formation of yellow, greenish, dark gray plaque, cloudy pus with a putrid odor. The cause of the complication – poor hygiene in the postoperative period, ignoring the doctor’s prescribed drug therapy.
Dry hole – there is no blood clot in the hole, it is dry, empty, there is a yellowish-gray plaque, putrid odor. The reason – the clot was not formed due to a blood clotting disorder, the clot was removed from the well by the patient during hygiene, intensive rinsing, etc.
Bulb bleeding – may be due to a violation of blood coagulation, excessive damage to tissues, blood vessels, break part of the alveolus.
Facial nerve neuralgia – a rare complication resulting from damage to the facial nerve during tooth extraction. It is accompanied by numbness in the cheek, tongue, lips.
Periostitis – purulent inflammation of the periosteum, develops for the same reasons as alveolitis. It is accompanied by acute, diffuse pain that cannot be relieved by analgesics. Swelling is severe, may spread to the neck, temperature is above 38℃, general intoxication (headache, weakness, etc.).
Osteomyelitis is a purulent and necrotic lesion of the jawbone, accompanied by throbbing pain radiating to the ear, temple, fever, swelling of the gum and oral mucosa, spasms of the masticatory muscles, deterioration of general health, enlargement of submandibular lymph nodes.

Cheek pain after tooth extraction is a quite common symptom, the duration of which depends on the complexity of the intervention. Normally, aching pain subsides completely after 2-3 days. Quite a different picture in the development of complications. With inflammatory complications in the tissues are formed purulent foci, many times the risk of spreading purulent contents in the general bloodstream. There is a high probability of phlegmon, abscess, destruction of bone tissue. Inevitably serious surgical intervention, prolonged rehabilitation.

When do I need to see a dentist immediately?

Severe, sharp, pulsating pain that is not controlled by analgesics, spreads across the face, irradiates to the ear, neck;
bleeding from the hole, which does not stop, but on the contrary, increases;
absence of a blood clot in the hole;
bad breath;
discharge of pus from the wound;
formation of yellow, dirty gray, green plaque on the wound;
temperature rise above 38℃;
numbness of part of the face (gums, cheeks) for more than a day;
pronounced swelling of the gum, cheek, which does not decrease 2-3 days after extraction.

What can and should be done after tooth extraction

20-30 minutes after the intervention, gently extract the cotton swab;
to minimize swelling, use cold compresses for 2-3 hours after the intervention (every 10-15 minutes take a break to avoid hypothermia of tissues);
for 3-5 days to make mouth baths with antiseptic solutions (take the solution, hold it in the mouth for a minute, spit it out);
when performing daily hygiene, avoid the traumatized area, toothbrush can be used on 2-3 days, it should be new, with soft bristles;
chewing on the opposite side;
eating is allowed after the end of anesthesia (not earlier than 3-4 hours later).

What is forbidden to do?

To exclude the accidental washing out of the clot from the hole, it is forbidden to rinse the mouth. For the treatment of the cavity is quite enough mouth baths;
hot compresses are forbidden, this stimulates severe swelling, the development of inflammation, bleeding;
it is forbidden to puff up the cheeks, blow your nose hard, sneeze;
it is forbidden to touch the wound with fingers, tongue, objects;
do not hot, cold, irritating food, preference – soft, warm, neutral food;
do not smoke, use alcoholic beverages for at least a week – tobacco, alcohol slows tissue regeneration;
it is necessary to avoid hypothermia, overheating – forbidden to go to the sauna, swimming pool, solarium for 5-7 days;
do not take aspirin and other blood thinners;
do not engage in active sports, do not subject the body to excessive physical or sports loads.

How to reduce pain?

Analgesics will help relieve pain after the extraction of a molar tooth (or any other tooth) – it is better if it is one of the non-steroidal anti-inflammatory drugs (NSAIDs). Antihistamines will help to remove swelling, and antibiotics will help to prevent inflammation. The doctor will prescribe effective drugs according to the clinical picture. Medications should be taken strictly as prescribed. Treatment of pain after tooth extraction depends on the cause of its occurrence. The most important thing after the intervention is to scrupulously adhere to the instructions and recommendations of the dentist. This will help to reduce the recovery time, avoid complications.