Pain in First Molar After Second Premolar Extraction: What to Expect?

Pain in the first molar after extraction of the second premolar?

I had my second molar extracted five days ago.
This tooth had previously undergone root canal treatment, but due to the presence of a dark shadow, it needed to be removed.
The surgery lasted for an hour, and the tooth was extracted in small pieces.
Afterward, I took antibiotics and painkillers for five days.
However, once the anesthesia wore off, the first molar behind the extraction site became extremely painful, making it difficult to eat.
The pain has persisted until today, the fifth day; while the intensity has slightly decreased, I still experience tooth pain.
I tried tapping on the tooth and found it to be painful (the dentist did not elicit pain when tapping before the procedure).
I called the nurse, and she informed me that the extraction site is large and that since there was surgery, as long as the pain in the neighboring tooth is not worsening day by day and is instead improving, it is considered a positive sign and there is no need to worry.
But why does tapping on the neighboring tooth hurt now? I recall that if tapping on a tooth causes pain, it usually indicates the need for root canal treatment or extraction.
How long should I expect the neighboring tooth to hurt after the extraction? I am unable to eat anything and am uncertain when this will end...
I am very worried.

Ms. Yu, 40~49 year old female. Ask Date: 2022/03/17

Dr. Lin Jiayong reply Dentistry

Hello, after tooth extraction, it is common for the neighboring tooth roots to become exposed due to the reduction in alveolar bone height, leading to sensitivity and discomfort.
It usually takes about 7 to 14 days for the keratinized gingiva to initially cover the extraction site, after which the sensitivity symptoms may lessen.
If there is still persistent swelling, pain, or foul odor with pus, it is advisable to return to the clinic for a professional evaluation.

Reply Date: 2022/03/17

More Info

After the extraction of your second premolar, experiencing pain in the adjacent first molar can be concerning, especially when the pain persists for several days. It’s important to understand the potential reasons for this discomfort and what you might expect moving forward.

Firstly, it’s not uncommon for neighboring teeth to experience some discomfort after a tooth extraction. This can be due to several factors:
1. Trauma to Adjacent Teeth: During the extraction process, the surrounding teeth can be subjected to pressure or minor trauma, which may lead to temporary sensitivity or pain. This is particularly true if the extraction was complicated or if the tooth was broken into pieces during removal.

2. Inflammation: The extraction site can cause localized inflammation, which may affect the surrounding teeth. Inflammation can lead to increased sensitivity in adjacent teeth, making them painful to bite down on or tap.

3. Changes in Bite: After the extraction, your bite may change slightly, which can lead to discomfort in the neighboring teeth. If the first molar is now bearing more load than it did before, it may become sensitive or painful.

4. Infection: Although you mentioned that you are taking antibiotics, it’s still possible for an infection to develop in the extraction site or in the adjacent tooth. If the pain worsens or if you notice swelling, fever, or pus, you should contact your dentist immediately.

5. Dry Socket: This condition occurs when the blood clot at the extraction site dislodges or dissolves before the wound has healed. It can cause severe pain and may radiate to nearby teeth. Symptoms typically appear a few days after the extraction.

Regarding your specific situation, it’s reassuring that the dental assistant mentioned that as long as the pain is not worsening and is gradually improving, it’s a positive sign. However, the fact that you are experiencing pain when tapping on the first molar is something to monitor closely. If the pain persists or worsens, it would be wise to follow up with your dentist for a thorough examination.

As for how long you can expect the discomfort to last, it varies from person to person. Generally, post-extraction pain should start to diminish within a few days to a week. If you are still experiencing significant pain after five days, it’s advisable to consult your dentist. They may want to take an X-ray to rule out any complications, such as an infection or issues with the adjacent tooth.

In the meantime, here are some tips to manage your discomfort:
- Pain Management: Continue taking the prescribed pain medication as directed. Over-the-counter NSAIDs (if not contraindicated) can also help reduce inflammation and pain.

- Soft Diet: Stick to soft foods that require minimal chewing to avoid aggravating the pain in your molar.

- Oral Hygiene: Maintain good oral hygiene, but be gentle around the extraction site to avoid dislodging any blood clots.

- Follow-Up: If you notice any worsening symptoms or if the pain does not improve, do not hesitate to reach out to your dentist for further evaluation.

In summary, while some discomfort in the first molar after the extraction of the second premolar can be expected, persistent or worsening pain should be addressed by your dental professional. They can provide a proper diagnosis and treatment plan to ensure your recovery is on track.

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