tooth extractions / oral surgery / dental surgery

Your dentist will "numb" your tooth.

Before the tooth extraction process is begun your dentist will of course need to anesthetize ("numb up") both the tooth that will be extracted and the jawbone and gums that surround it. Unfortunately, at this point in time there is still no way for a dentist to predictably administer a local anesthetic ("novocaine" or, more accurately, usually lidocaine) except as an injection (a "shot").

Why do dental injections hurt?

The amount of discomfort associated with a dental injection can vary significantly, primarily due to the location where the shot is given. And even though so many dental patients seem to be so focused on the fact that injections do involve needles, most of the discomfort associated with a dental injection is not from the needle itself.

Typically the bulk of the discomfort that is noticed by a patient during a dental injection has to do with the act of placing a quantity of liquid (the anesthetic) into soft tissues. And this explains why injections in different locations have varying potential to hurt. In some locations the soft tissue will be comparatively loose and therefore it will be easy for the injected anesthetic solution to find a space to occupy. In other areas the soft tissue will be dense and tight and as the anesthetic solution is injected into this type of tissue it must forcibly make its own space, and this can pinch.

Think about it. Sure the needle initially pricks as it first enters through the skin. (But surely you've pricked your finger with a pin and that wasn't the end of the world.) Once the needle is in position the dentist typically isn't moving it around a great deal. (So what's to cause a further pricking sensation?) The solution coming out of the tip of the needle, the sharp part, is the very solution (the anesthetic) that makes nerves that carry pain sensations stop functioning. (So how is this needle causing so much pain?)

So, if the needle isn't the main culprit what is? Well as we were saying, it has to do with the fact that a quantity of liquid (the anesthetic) must be placed into the soft tissues that surround the tooth. Where the tissues are relatively loose, the anesthetic solution will flow into tissue spaces easily and you won't feel the injection process much at all. In those locations where the soft tissue is relatively tighter and more dense, the liquid must force its way into the tissue and that's when you will feel the injection more so.

So how likely is it that you will feel much discomfort with your dental injection? Like we have been saying, it's location, location, location. Ask your dentist what to expect with any specific injection. You may be pleasantly surprised to learn what they have to say.

Give your dentist some cooperation with the injection process.

Without question, the more cooperative you are when the dentist is performing your injection the more pleasant the experience will be for you. One factor associated with the ease with which the anesthetic solution can enter into soft tissue has to do with the rate at which the anesthetic solution is injected. The slower the rate, the less potential there is for discomfort. So if you are being an uncooperative patient the dentist's natural instinct (they're human too) will be to speed up the injection process so to finish it more quickly.

Additionally, when a dentist performs a dental injection they must place the anesthetic in the proper location, and this takes a little concentration. If the dentist is focused on your behavior, as opposed to just performing the injection, it will increase the likelihood that the injection will be off-target and additional "shots" will be required.

Some people place themselves in a position of creating a self-fulfilling prophecy. They expect the injection to hurt and don't give the process a chance, thus making a guaranteed unpleasant experience for both themselves and the dentist. If you have apprehensions about injections you need to clue your dentist in, in advance, so they can address your concerns and help to make things as pleasant for you as possible.

What to expect during the tooth extraction process.

When your dentist performs the extraction you should expect that you will feel a lot of pressure, here's why.

The root portion of a tooth is firmly encased in bone (its socket) and it is tightly bound into place in this socket by a ligament. During the extraction process the dentist needs to expand the socket (widen and enlarge it) and separate the tooth from its ligament to a point where the tooth is loose and free to come out.

The bone of the jaw is compressible to some degree. That means if a dentist can apply firm pressure to a tooth, forcing it against one of the sides of its socket, the bone in that area will become compressed. The net result is that the socket becomes slightly enlarged. After repeated application of pressure to a tooth, from many different directions, the entire socket becomes larger. The ligament that holds the tooth in place will become detached from the tooth too. Finally at some point, enough space will have been created and the ligament separated from the tooth enough that the tooth will come out.

Dentists have a variety of tools they use to manipulate and apply pressure to teeth. Some of them are specialized pliers termed "extraction forceps." Dentists also use levers that are called "elevators" (they look somewhat similar to small screwdrivers). Usually a dentist will use an elevator first. These tools are intended to wedge between the tooth and the bone surrounding it. The force the dentist applies to the elevator in turn places pressure on the tooth. This action on the tooth helps to expand its socket and separate its ligament. It's somewhat common that a tooth can be extracted with just the use of an elevator.

Understanding the dentist's use of extraction forceps is more straightforward. The dentist will grasp the tooth with the forceps and then firmly and deliberately rock the tooth back and forth. They will also rotate the tooth as much as it will. The combination of these tooth movements expands the tooth's socket and separates its ligament.

Why you will feel pressure, yet no pain, during a tooth extraction.

The reason you will feel pressure during the tooth extraction process is because our bodies have different types of nerve fibers, each of which carry different types of sensations. Each of these different types of nerve fibers have different physical characteristics. The local anesthetic ("novocaine," more actually usually lidocaine) that a dentist uses to "numb up" a tooth is very effective at inhibiting the function of nerve fibers that transmit pain sensations, but it doesn't have as great an effect on the nerves that transmit pressure sensations.

So, expect to feel pressure during the tooth extraction process, even a whole lot of pressure, but don't assume that this indicates that you will soon be feeling pain because it doesn't. If you do find you feel pain (discomfort that has a sharpness to it) during the extraction process, you should let your dentist know so they can "numb you up" some more. But more anesthetic will not reduce the pressure sensation you are experiencing.

Sectioning a tooth during an extraction.

Sometimes a tooth is so firmly anchored in its socket, or else the tooth's roots are so curved, that the dentist can't get the tooth's socket expanded enough that it will come out. In this type of situation one of a dentist's tricks is to cut the tooth into pieces and then remove each portion individually.

Don't be alarmed if your dentist tells you that this technique is required. Sectioning teeth is very commonplace and can significantly reduce the amount of time and effort needed to remove a tooth.