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Pain is the number one reason why people avoid dentists. Thankfully, pain during planned procedures is no longer a problem thanks to improved techniques and medicaments. In this article, we deal with pain after wisdom tooth removal.

We are well aware of the fear that a visit to the dentist brings about in the vast majority of the patients. Tell them that they need a wisdom tooth extraction and there is a good chance that the fear will be increased manifold instantly. So what is the reason behind the existence of this fear? Pain.

Pain has been associated with a visit to the dentist since dental work has been performed. It was also largely true until about a few decades back, however, improvement in local anesthesia and understanding of less invasive techniques have made painless dentistry a reality [1].

Pain after wisdom tooth removal can vary in severity depending upon a large number of factors [2]. Here are a few things that a patient can expect:

Ease of extraction

Typically, the easier and quicker an extraction can be carried out, the less painful it is. In the case of fully erupted wisdom teeth or partially erupted upper wisdom teeth, the extraction is usually quite straightforward and does not require too much of surgical manipulation by the dentist [3].

Patients are most likely going to be put on oral pain killers for a couple of days along with a dose of antibiotics.  Most patients do not complain of too much post-operative discomfort after such extractions [4].

In the case of teeth that are buried inside the bone or lower wisdom teeth that have very little space to erupt, the extraction procedure can be a lot longer and tougher. The dentist may need to remove some amount of bone surrounding the tooth to get access to it and then extract it. The post-operative pain will be a lot more than other ‘regular’ extractions [5].

Patients will also have to deal with some amount of swelling around the area of extraction which may cause pain and discomfort in talking, opening the mouth, and swallowing.

Dry Socket

Normal, non-surgical extraction or surgical ones can have some complications during healing. One of the most common and painful ones is called a dry socket. The reason behind this occurrence could be an infection after wisdom tooth removal, poor blood circulation to the socket, or due to a very traumatic extraction [6].

The name dry socket comes from the fact this condition is characterized by an empty socket with no blood clot. The exposed bone starts to necrotize and becomes very painful. Patients will need to take painkillers for a prolonged period of time and visit their dentist repeatedly for some dressings as well [7].

A dry socket can take around two weeks to heal completely during which the pain can be excruciating at times. The difficult nature of wisdom teeth removal makes them much more likely to develop a dry socket than in other cases. People who smoke or are in poor systemic health are exponentially more likely to develop a dry socket [8].

Systemic conditions of the patient

Patients that are in poor systemic health also tend to have a little more pain during the healing of their extraction socket. Uncontrolled diabetes is the first condition that dentists will be wary of. Diabetes affects the formation and function of small-sized blood vessels and also affects the healing response everywhere in the body.

This double blow can come together quite painfully in patients that have undergone extraction [9]. Patients should make their dentists aware of any pre-existing conditions that they have during the medical history so that such things can be avoided.   

Sometimes, though, a dental extraction has to be carried out as an emergency procedure even in medically compromised conditions.

Osteoradionecrosis

Patients suffering from cancer will most often undergo treatment with chemotherapeutic drugs, radiation therapy, or a combination of the two approaches. A lack of knowledge or awareness even in some of the best cancer setups results in direct exposure of the jaw bone to harmful radiation.

This can affect the teeth in a great number of ways that affect the quality of life in cancer patients. If, as a result of this radiation-induced damage, patients need to undergo a tooth extraction, then osteoradionecrosis becomes a very real danger [10].

Osteoradionecrosis is a condition where the healing does not occur after the extraction and severe pain continues to occur to the patient. The treatment for such a condition is quite complex and involves the use of hyperbaric oxygen chambers among other things.

In fact, the best option would be to avoid an extraction as much as possible for patients that are believed to be at a risk of osteoradionecrosis.

Conclusion

Pain after wisdom tooth removal is something that may sound scary but the truth of the matter is that most planned extractions should not result in any complications that cause excessive pain. That being said, surgical extractions are more invasive and can take a longer period to heal. For the patients, this means taking painkillers for a few more days until things begin to subside.  

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