These days tooth extraction is usually relatively straightforward, and the vast majority can be usually performed quickly while the individual is awake by using local anesthetic injections to eliminate pain. Still, pulling a tooth involves more than just numbing the patient, grabbing the tooth and yanking it out.
First the dentist will anesthetize both the tooth, bone and gum tissue that surround it. There's no way to do this except by injection which will hurt a bit and usually there's a momentary sensation of tsting something metallic, but it can't b helped.
You're feel pressure during your extraction procedure, usually a whole lot of it. The sensation of pain is transmitted by different nerve fibers than those that transmit pressure and only the nerves that transmit pain are the one that have been numbed. No amount of anesthetic will eliminate the sensation of pressure.
Also, it's not surprising to hear snap or breaking noises when teeth re being pulled. A study done in 2015 determined that the level of force that resulted in tooth fracture was sometimes only slightly greater than that required for routine tooth removal, so it doesn't take much to break a tooth during extraction. The consequences of having a root break can vary and range from a piece proving to be difficult to “fish” out with the result that the time in the chair is increased, or if you're lucky, the dentist can just tease it out.
When a tooth is pulled, the root portion is firmly encased in bone (aka the socket), and tightly held in place by its ligament which is a fibrous tissue between the tooth and bone that binds the two together. To get the tooth out the dentist must both widen and enlarge the socket and separate the tooth from its ligament before it can actually be removed.
If you've ever tried to remove a tent stake that's been driven deeply into the ground, you know that you can't just pull the stake straight out. You have to rock it back and forth to widen the hole. The dentist does the same thing. Fortunately the bone that encases a tooth's root is relatively spongy. This rocking process also loosens the tooth's ligaments.
They'll use tools like extraction forceps and an elevators which looks like a screwdriver. The tip of an elevator is wedged into the ligament space between a tooth and its surrounding bone and twisted around and the tooth is rocked around to both expand the shape of the socket and separate the tooth from its ligament. In some cases, the dentist may be able to completely remove the tooth just using their elevator, but if not they'll use the forceps.
A dentist will usually have a number of different ones, each having a design that's tailored to the specific shape of the tooth he's removing and the location of the tooth in the mouth. They grab the tooth with the forceps and then firmly rock it back and forth as much as it will move. While he's rocking it, he's also rotating the tooth back and forth. This helps to rip and tear the tooth away from the ligament. Sometimes all this twisting and rocking won't be real gentle. An assistant may be required to hold you head in place.
It's during this process that you can be thankful for lidocaine, the most commonly used local anesthetic. They used to use procaine, also known as novocaine. Lidocaine is a faster-acting and longer-lasting local anesthetic than procaine. Its half-life in the body is about 1.5–2 hours.
The numbing drug is only one part of what's injected. Included can be can include a type of drug called a vasoconstrictor which narrows your blood vessels and makes the numbness last longer. It can also include a chemical that keeps the vasoconstrictor from breaking down, Sodium hydroxide, which helps the numbing drug work. Another ingredient is Sodium chloride which helps the drugs get into your blood.
There are two kinds of numbing injections. A block injection numbs an entire region of your mouth, such as one side of your lower jaw. An infiltration injection numbs a smaller area. This is the area near where the injection was given.
The dentist begins by drying part of your mouth with air or cotton then swab the area with a gel to numb the skin. Then they will slowly inject the local anesthetic. Here's a surprise. Most people don't feel the needle; they only feel a sting caused by the anesthetic moving into the tissue.
If the patient is nervous, some dentists may also use Nitrous oxide, a sedative agent that is mixed with oxygen and inhaled through a small mask that fits over your nose to help you relax. Nitrous oxide, sometimes called “laughing gas,” is one option your dentist may offer to help make you more comfortable during certain procedures. You may feel light-headed or a tingling in your arms and legs and some people say their arms and legs feel heavy. It also feels cold. Ultimately, you should feel calm and comfortable. The effects wear off soon after the mask is removed.
Contrary to popular belief, laughing gas is not a pain reliever and is never used to fully sedate a patient because the concentration needed to completely anesthetize a patient is close to the amount that would lower blood oxygen level to a point where a state of hypoxia results.