How painful is having a tooth pulled? -

Details about what a patient may feel (pain, pressure) during their tooth extraction procedure, and why.  |  How likely is it that your extraction will hurt and how much?  |  What dentists can do to minimize and manage procedure discomfort.

Will you feel pain when your tooth is extracted?

No, you don't have to expect that having your tooth pulled will hurt. But we'd be lying if we said that getting one out never did. And that's basically what this page is all about. It explains:

  • What usually takes place when teeth are taken out.
  • The disappointing, hopefully minor, sensations that may occur during a patient's procedure (and why).
  • And what you and your dentist can do along the way to help to insure that your experience is as pain-free as possible.

What will you feel when your tooth is pulled? (Will it hurt?)

Here are the standard things you can expect to experience during your extraction process:

  • You may feel the pinch of the needle as your dentist numbs up your teeth and gums.
  • You will feel the back-and-forth pressure used to loosen up your tooth until it's free enough to come out (but this shouldn't be confused with feeling pain).
  • Other than that, you don't have to expect that you'll feel any discomfort during your procedure but a minor percentage of people do (read: a majority of people don't).
  • But if you do feel pain (and not just pressure) and your dentist is aware of it (like when they test), there are steps they can take to control it.

A list of painful events that may occur during your extraction procedure.

1) Numbing up your tooth.

Just like with so many other dental procedures, every extraction begins with numbing up your tooth.

And the way that's done is the same way you're already familiar with when other types of dental work are performed. Your dentist will give you some dental injections ("shots").

Your tooth and surrounding bone and gum tissue must all be numbed up.

What may be different when having an extraction that you haven't experienced before is that all of the tissues that surround your tooth (bone and gum) must be anesthetized too.

And while there's nothing really different about the process used to do that for an extraction as opposed to other types of work, it may mean that you'll end up getting more total shots, and therefore have more potential for feeling needle pricks.

Use this link for details about getting dental injections (types of injections, which hurt the most, etc...).

2) Testing to see if you feel pain.

After your initial round of injections has been completed, there's no reason why you should expect to feel any pain for the remainder of your procedure.

Having said that, there can be times when a patient's tooth or surrounding tissues simply haven't been numbed up adequately. It's never the dentist's intention, it's just something that statistically happens.

a) How does a dentist test for numbness?

Since a dentist knows that some percentage of people will need further numbing, they'll follow a protocol that's designed to test and evaluate their patient's status before the work of actually removing their tooth is begun. That way whatever level of pain is felt is kept to a brief, bare minimum.

Here are some of the ways they'll evaluate and test:

i) Does your lip feel tingly?

Your dentist knows the specific areas each injection they give should numb up. And they'll quiz you about and test these areas just to make sure they have.

For example, before extracting lower back teeth a dentist will usually ask their patient if their lower lip feels tingly. That's typically a sign that the anesthetic that's been given has been effective.

But this type of questioning is only valid in some situations. For example, the injections used to anesthetize upper back teeth may have been fully effective without causing much change in the way the adjacent lip or cheek tissues feel.

ii) Pressing and wiggling on your tooth.

Another way of evaluating a tooth's numbness is for your dentist to press on it firmly, or rock it side-to-side with their fingers.

iii) Testing your gum tissue.

A dentist knows which areas of your mouth should have numbed up with the anesthetic they've administered. (In some cases this might be quite distant from the location where the shot was actually given.)

So as a test for effectiveness, it's common for them to use a pointed dental tool and deliberately poke your gum tissue in those areas, just to make sure you don't feel anything.

iv) Testing as your extraction process begins.
  • The first step in removing a tooth involves using a tool to strip away its gum tissue.

    Your dentist will be gentle at first so they can test out how you're doing. Then once they've confirmed that you're feeling no pain, they'll continue on with this task in earnest.

  • Likewise, when a dentist begins the process of loosing up the tooth in it socket they'll ease into applying full pressure, looking for confirmation from their patient's reaction that all is going well.

b) Setting up an "it hurts" signal.

Even with all of the checks above, it's still possible that your tooth isn't as numb as it needs to be to remove it painlessly.

And due to this inherent uncertainty, it's basic protocol for a dentist to set up a signal with their patient. A sign that can be used to unambiguously communicate to them that something is amiss, even when you are unable to speak.

  • One common signal is simply having the patient raise their hand immediately upon noticing that something isn't right.
  • Even when it's not in the dentist's direct line of vision, their peripheral vision will notice this type of sign.

The agreement between the dentist and patient should be one where work is stopped immediately upon the signal. That way if something does hurt its kept to a minimum and just minor levels.

3) Managing pain discovered during testing or your procedure.

Once your dentist knows that you've not yet been numbed up enough, they'll then determine how to best resolve the issue.

A dentist giving a dental injection.

Numbing up a tooth for extraction.

  • In some cases they may repeat your initial injections.

    The goal here is not simply placing more anesthetic solution but instead an additional quantity in a slightly different (more on-target) location in hopes of it creating a more profound effect. (Nusstein 2010) [page references]

  • Or some type of adjunct technique might be used. This could include giving you a shot in an entirely different location, or using a different injection method.
You may not feel these additional injections.

While you might find the idea of requiring additional shots taxing, relax. Receiving them may be quite uneventful due to the fact that the gum tissue in the area receiving them has already been numbed by your previous injections.

How likely is it that your first shots won't be totally effective in numbing your tooth?

A couple of papers have investigated this topic. And while the numbers they've reported may not be entirely reassuring, with just a little explaining you'll find they aren't as bad as they initially seem.

Wong (2001)

This paper reviewed published literature that had evaluated the subject of:

  • Numbing up lower molars (probably the most challenging teeth to numb [Nusstein 2010]) ...
  • ... by way of using conventional dental shots (an inferior alveolar nerve block [IANB], a type of dental injection).

This review concluded that the use of conventional methods (IANB injections) to numb up asymptomatic molars (teeth that weren't hurting at the time of their extraction) was only successful 69% of the time.

Kanaa (2012)

This paper contained a section that provided background information about this subject. It cited two studies that placed the effectiveness of initial rounds of anesthesia for lower teeth at 63% and 76%.

Your dentist is quite aware of the possibility of numbing failure.

A person could look at the figures above and have some concerns. After all, they suggest that about one fourth to one third of patients being prepared for a tooth extraction won't be adequately numbed up after getting their initial injections.

But don't think for a second that your dentist doesn't anticipate this problem. That's why they use a protocol laden with evaluation and testing, aimed at identifying ahead of time those patients whose situation requires further anesthesia.

Actually, this is the way you want it to be.

What you don't want is for your dentist to initially administer more anesthetic than is reasonably expected to be required. That's because doing so can lead to complications:

  • Administering more than that quantity that has already been effective serves no purpose.
  • Administering more will require additional shots, some of which might be felt.
  • There are limits on the total amount of anesthetic solution that can be safely used with a patient. (Maximum dosages are typically based on the patient's weight.)

    Having expended most of this quantity needlessly can jeopardize the procedure if later on pain control becomes a problem, or the procedure runs long.

Numbing up "hot" teeth for extraction can be even more difficult.

The numbers reported above are for numbing up asymptomatic teeth (teeth that weren't hurting at the time of their extraction).

The more difficult challenge is when dentists numb up "hot" teeth (teeth that are painful because they are experiencing irreversible pulpitis).

  • The review of published literature mentioned above (Wong 2001) determined that only 30% of initial attempts at numbing up extremely sensitive ("hot") lower molars using conventional methods (IANB injections) were successful.
  • Not all studies put this number for "hot" teeth (numbed via initial IANB injections) so low. Zain (2016) reported a 63% success rate for lower molars. Kanaa (2012) found a success rate of 67% for lower teeth in general, not just molars.
Why these numbers really aren't so negative.

The variation reported above withstanding, it's doubtful that any dentist would dispute that numbing up "hot" teeth can be a challenge. And that point is where good news lies.

Every dentist knows that the use of adjunct (supplemental) injections can improve anesthesia numbers substantially. So any dentist treating a "hot" tooth would know that these techniques are probably needed and therefore would go ahead and take those additional steps right off the bat. After all, your dentist doesn't want your extraction to hurt any more than you do.

How much can adjunct numbing techniques help?

The Wong (2001) paper mentioned above also reviewed studies that evaluated the use of supplemental techniques with lower molars after an initial round of conventional (IANB) injections had failed.

  • For asymptomatic teeth, success rates could be raised from 69% to 97% with the addition of adjunct methods.
  • For "hot" teeth, the 30% number reported above could be raised to 83% effective.

That means with just routine discovery (all of the steps we mention above that a dentist takes to make sure that their patient really is numb), the vast majority of people can expect to enter the actual work of their extraction process having profound tooth anesthesia.

For those who aren't adequately numbed up, as soon as their discomfort is evident their dentist will simply continue down their list of solutions to find a way to control it.


How much pain can you expect to feel during your tooth extraction?

We found a couple of studies that evaluated intraoperative pain (discomfort experienced during the extraction process alone).

  • Intraoperative pain was generally defined as those events that took place after giving the needed shots to numb up the patient's tooth (discomfort following "injection pain").
  • We're of the opinion that this definition would include the following scenario: 1) after the tooth had been numbed, 2) the extraction process was begun, 3) pain was felt, 4) additional injections were given, 5) the extraction process was then resumed and completed.

Research findings.

[Similar to those above, the studies mentioned here evaluated the extraction of mandibular (lower) teeth using conventional methods (IANB injection), which is probably the most challenging numbing situation.]

Kammerer (2012)

This study asked its 88 subjects who had lower molars removed to rate the level of pain they experienced during their procedure from 0 to 10, with 10 being the worst. The average of the scores reported was between 0 and 1.

Bataineh (2016)

This study evaluated intraoperative pain levels (rated 0 to 100) experienced by 52 patients having lower molars removed.

  • On average, the level of injection pain (IANB injection) was rated as 41 (the high end of the mild pain range).
  • As for the level of pain experienced during their extraction, 81% of patients reported mild pain, 17% moderate pain and 2% severe pain.
  • 89% of subjects reported that the level of discomfort they felt during their procedure was less severe than expected, 11% the same as expected and 0% felt it was greater.

In regard to the 2% (one person) who felt severe pain, the authors stated that their experience might be attributed to:

  • "... the intense pressure felt by some patients during the extraction, which may be difficult to differentiate from pain ..."

Pain vs. pressure is a critically important distinction that the patient must be able to make. We discuss why in our next section below.

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Rousseau (2002)

This study evaluated 50 patients who rated their intraoperative pain from 0 to 100. Some of the extractions involved "hot" teeth. (These are teeth that were painful because they were experiencing irreversible pulpitis. As mentioned above, "hot" teeth are generally more difficult to anesthetize.)

  • Preoperatively, the patients rated their level of pain as being 61 (defined as moderate pain).
  • Postoperatively the patients were asked to rate their procedure pain. They rated it as 24 (defined as mild pain). (With this study, intraoperative pain was defined as including injection discomfort.)

So even though this study is somewhat off-target because it includes injection discomfort with intraoperative pain, on average even though some minor level of pain was noticed, what was experienced during the procedure was substantially lower than what the patient had been experiencing before their procedure.


Why it's normal to feel pressure during your extraction.

What occurs.

The local anesthetics used in dentistry to numb up teeth and gum tissue are quite effective in inhibiting (conking out) the type of nerve fibers that transmit pain. But they're not as effective on those that transmit the sensation of pressure.

And because of this, it's normal and expected that you will feel the pressure your dentist applies to your tooth with their instruments as they loosen it up during your extraction process.

Explanation why.

The way our bodies are wired is that different types of nerve fibers, having different physical characteristics, transmit different types of sensations.

And due to these physical differences (for example the thickness of the sheathing surrounding the nerve), local anesthetics are able to have a more profound effect on some kinds of fibers (pain, temperature, touch) as opposed to others (pressure).

Tooth socket, immediately after extraction.

It takes applying pressure to loosen teeth from their sockets.

How much pressure will you feel?

We actually found a study (Ahel 2015) that evaluated how much force it takes for a dentist to extract teeth (upper front ones). The number came out to around 18 psi (pounds per square inch).

As it turns out, that's a difficult number to find a direct comparison for. We did however discover that regulation basketballs and soccer balls are typically inflated to around 8 psi.

So if you think in terms of putting one of those balls on the floor and pressing hard enough on it to just slightly indent it, when having an upper front tooth extracted you could expect to feel about twice that much pressure. That's really a fairly substantial amount of force.

How to distinguish between pain and pressure during your extraction.

One common problem that occurs during tooth extractions is that patients sometimes confuse the sensation of pressure with pain.

  • Some patients may not realize that it's normal and expected for them to feel pressure, or they may not have anticipated the amount of it involved, and therefore mistake feeling it for experiencing pain.
  • Patients may fail to realize that pain characteristically has a sharpness to it whereas pressure does not.
  • The patient may incorrectly assume that because they feel increasing levels of pressure that they will soon feel pain too.
Why making a distinction between the two is so important.

Being accurate in your interpretation of what's going on (feeling sharp or shooting pain vs. pressure) is vital.

That's because leading your dentist to believe that you are feeling pain instead of just pressure may lead them to needlessly administer more anesthetic.

  • As explained above, administering more anesthetic will do absolutely nothing to alleviate the sense of pressure you are feeling.
  • Using additional quantities of anesthetic place you at greater risk for complications during your procedure.
  • Since only so much anesthetic solution can be given safely (based on the patient's weight), administering some of this quantity needlessly could mean that little or none is available for use later on during the procedure (if needed).
  • Responding to unwarranted patient complaints that have no solution simply draws your dentist's attention away from the important task at hand (extracting your tooth).

Extraction pain correlates with anxiety levels.

It's important for us to mention that research has shown that the level of a patient's anxiety about their procedure is a predictor of how much pain they will experience during it. This is true for any type of dental work but especially tooth extractions.

Here's what studies have found:

Fagade (2005)

This paper evaluated 122 patients who had had extractions and found a positive correlation between patient anxiety scores and the level of procedure pain they experience.

Tickel (2012)

This study evaluated a group of 451 patients who had varying types of dental work performed (including extractions). Patients rated as "very anxious" were 5 times more likely to report experiencing pain during their procedure.

If you have anxiety about your extraction, make sure to let your dentist know.

A patient's level of anxiety can be controlled via the use of various sedation techniques administered either before or at the time of their procedure. The decision to employ such methods is both the responsibility of the dentist and the patient.

  • The issue should be brought up by the dentist during their pre-extraction examination and the patient's options explained to them. (We discuss conscious sedation techniques here.)
  • The patient must then be willing to admit that they do have apprehensions and be receptive to the dentist's suggestions and recommendations.

Our next page discusses how long extractions take. ▶

 

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Comments

Dentist should have put me out.

I had infection. Dentist scraped and drilled bone. Felt every bit of it. He didnt care. He kept saying one more second. At end I had fluid coming through skin. Assistant said i was pale. Couldn't get up for some time. In checking after I read lower bone not as porous as top and may not take shot as well. Dentist should have put me out.

F

Sorry to hear about your unpleasant experience.

You're right, the density of the bone surrounding a tooth does dictate what type of injections can be expected to be effective. We have content that discusses this issue in regard to infiltration and block injections.

You also mention the presence of infection around your tooth. The acid nature of infected tissue typically hinders an anesthetic's effectiveness.

Unfortunately based strictly on percentages, it's not all that common that the first round of a patient's injections aren't 100% effective (especially with "hot" teeth) but with the use of supplemental techniques the effectiveness level can be raised substantially. But even then failures do occur.

There's no simple solution. The use of general anesthetic would be unacceptable for all extractions from the standpoint of patient safety. Sedating patients could be considered but with it conventional tooth numbing is still required.

Probably the best rule of thumb is to select a practitioner (dentist, oral surgeon) who has as much experience as possible, so both performing the procedure and anticipation of real and potential problems are handled as expertly as possible.

Would pulling out a permanent tooth hurt as well?

I'm having a surgery in which the dentist will open up my gum to extract a permanent tooth. Obviously, anesthesia will be used. Will I feel much pain?

Rick

Your procedure would probably be best described as either a surgical extraction or else the removal of an impacted tooth (akin to removing an impacted wisdom tooth).

Either way, short of any complicating factors [like an active infection (swelling/pain would be an indication) or acutely inflammed pulp (spontaneous pain could be an indication) (see "hot" teeth section above)] there's no reason to expect that the local anesthetic your dentist uses to numb up your tooth won't be effective, as it would be for any other tooth (the tooth's position doesn't affect which/what surrounding nerves connect with it).

Your procedure might be expected to be more involved than a routine extraction (longer duration, greater surgical difficulty). If so, you and your dentist might consider the use of some method of conscious sedation to help you tolerate your surgery better. But its use has to do with patient management only and not pain control.

Good luck, expect the best.

Does it hurt getting teeth extracted?

For me it didn’t hurt as much as I thought it would! All they do is they first take a blue type of gel so your mouth will feel numb and tingly after a while. After, they asked me to close my eyes so they can give you the shot and the assistant held out her hand so I could squeeze it if I felt any pain. After that you will feel pressure when they take out the tooth(or teeth) but it doesn’t hurt at all! Finally, they give you a cotton that you bite down on and then your done!!

When i first went to the

When i first went to the dentist, i was scared. They put a numbing gel on my gums and told me to close my eyes for the shots. I had 4 shots and they did hurt, it felt really sharp, I have anxiety so as son as i felt the injection pain i was uncontrollably shaking and tears coming out my eyes. After they told me im doing well etc and they pulled out my teeth. I had 2 taken out and the whole procedure took around 10 minutes which was really good.

Tooth Extraction

I had ALL my tops and bottoms pulled at once. All he gave me was the freezing. Please get your pain meds into you before you go for procedure and if you don't agree with your dentist how many teeth need to come out, you would be better off getting that second opinion. The bad teeth that needed to come out went easy and I dont feel a thing .. the good ones that he took out he had to PRY AND DRILL with a lot of effort because they were healthy and functioning teeth. I got my dentures in right after, very very painful. Lots of bleeding, discuss stitches before and get lots of advice about food because I cant wait to eat my next meal I should have ate just before.

Tooth extraction pain

got my tooth extracted a few hours ago. They told me I also had gingivitis.
They numbed my mouth which was good. The extraction was still painful though, I could hear and feel the tooth breaking as they were getting it out of my gum. I shut my eyes tight at those bits, and she kept asking if I were okay,, but I never told her to stop because I wanted to get through with the extraction asap. It hurt more than I thought it would. I have no idea why it hurt though even though they numbed my mouth.

Englan

We're glad for you that your extraction is over and you're fine.

For people reading this comment we must point out the sentence "she kept asking if I were okay,, but I never told her to stop because I wanted to get through with the extraction asap."

As we describe at length on this page above, insuring that a person's extraction process is as pain-free as possible involves communication between the dentist and the patient.

In this situation the dentist was never offered the opportunity to provide additional anesthesia because the need for it was never communicated to them.

Tooth Extraction

I just got a tooth pulled a few hours ago. They rubbed a gel around the tooth and gums . The Dentist walked in to give me injections to numb the area. He gave me two injections never felt them go in. They left the room for a few minutes while the meds took affect. When they came back he tested the area to make sure it was indeed numb. I felt when he poked the gum so they injected me one more time. After a few minutes he came back extracted the tooth .
Through out the procedure, I was asked several times if I was ok and to raise my left hand if I felt any pain. I asked what was injected forgot the name but it was the best stuff acts quickly and lasts for hours. I have severe anxiety and not once did I feel any pain from start to finish. I was however told to breathe after it was over. Best experience I ever had with a dentist

alpj

Thank you for posting. We really apologize for not getting your comment posted quicker.

Not every extraction process will be totally painless. But as alpj explains, if you give your dentist prompt and accurate feedback you tip the scales far in your favor of having a pain-free experience.

tooth extraction

i am 12 and about to have 3 teeth removed tomorrow. I am very nervous about the pain it will inflict, any tips?

Jason

We're sure you'll do fine and after it's all over hopefully pleasantly surprised about how easy it was.
As this page discusses at length, your dentist will do those normal and usual things that should make your extraction painless. They'll then test and quiz you (before your extraction is started) to confirm that what they've done has been successful.
Only you can provide the needed feedback. If all is well, then let them know. If anything is amiss, let them know so they can remedy it.
The same goes for during your procedure. Have a way you can signal if anything isn't right so it can be remedied immediately.
Your dentist has a number of different things they can do to manage a patient's concerns and discomfort. But each step builds on what's been learned about the effects of the previous ones. In part, they need to know what hasn't worked so they can make the needed adjustments or change tactics so they can be successful in their next step.
Once again, good luck.

I'm Getting My teeth pulled!

I'm 10 and my teeth are pushed out front. My dentist said that I have to remove 2 top teeth and 2 bottom teeth, so they can put braces on. Can you guys tell me what happens and if it'll hurt?? On a scale of 1-10 (1:hurts so bad-10: No pain at all) Thanks

AS

We like to think that people find that the whole experience is more pleasant than they might have expected.

While our pages aren't exactly geared toward your age group (and instead more toward adults), you might choose to read through the following pages:

What's the extraction process like.
Do dental injections hurt?

And if you haven't already, you should read this entire page. It answers questions like the ones you've asked.

Extraction

I just got my tooth pulled 2 hours ago...I’m feeling a bit of pain, is that bad?

Ashley

In all cases a patient should feel free to contact their dentist about any concerns that they have. Responding to your needs is a part of their obligation to you as a treatment provider.

It seems possible that what you are experiencing falls within the realm of usual. Here's what our pages state about post-op pain during the same day of an extraction.

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