"Does it hurt?" is the question almost everyone asks, and the honest answer is that there is no single answer, because the answer depends on which tooth, which procedure, and how long it takes.
A baby tooth that is nearly loose takes seconds and is barely noticed. An impacted wisdom tooth cut out of bone can take a long time and be genuinely uncomfortable afterwards. Those are not the same procedure, and treating them as the same thing is why the subject confuses people.
During the procedure: it should be painless
The area is numbed before anything happens, and for most people the extraction itself should be painless. You may still feel pressure, pulling or vibration, but not sharp pain.
How the anaesthetic is given depends on the tooth. A loose baby tooth may need only a numbing gel on the gum. Most adult teeth are handled with an injection into the gum around the tooth. For wisdom teeth and other teeth with several roots, an injection is often placed near the nerve itself, which numbs a whole region: the teeth, the cheek, and sometimes the tongue.
That last technique is deeper, and the injection itself can be more uncomfortable. In exchange, the numbing is more complete and lasts longer.
Sedation or general anaesthesia is used in some cases, typically for children who are unable to cooperate, highly anxious patients, or patients with cognitive or physical disabilities, or when several difficult teeth are being removed in one visit. It is not routine.
Afterwards: what is normal and what is not
The discomfort after an extraction follows a fairly predictable pattern.
For the first few hours, numbness is still wearing off, and the area may feel strange rather than painful. Once the anaesthetic clears, the sore feeling arrives.
For a simple extraction, soreness usually peaks within the first day and settles within a few days. For a surgical extraction involving gum incisions and bone, soreness can last several days and the surrounding area is often firm and swollen for a week or more.
A raised temperature in the first day or two after a difficult extraction can occur and is not always alarming. What matters is whether it is settling or climbing. A high fever, a fever that persists, or one that is getting worse should be assessed promptly.
Four things that genuinely help
Take the painkillers on the schedule, not on the pain. This is a common mistake and one that is avoidable. Painkillers are far more effective taken at regular intervals before pain peaks than taken once it has already established itself. Waiting until it hurts means you are chasing it. Follow the dose and interval advised by your dentist, doctor or the product label.
Use a cold compress properly. An ice pack wrapped in a cloth, applied for about ten minutes and off for ten, alternated. Applying ice directly to the skin causes a cold burn, which is a small and entirely avoidable injury.
Do not disturb the socket. No rinsing, no spitting, no probing with a tongue or a finger, for the first 24 hours after a surgical extraction. The clot forming in the socket is what protects the bone underneath, and removing it is the direct route to a dry socket.
Keep it clean once the first day is over. After 24 hours, gentle brushing and rinsing should resume. Food that collects in the socket is a genuine infection risk, and clean tissue heals faster.
When to go back
Persistent pain that painkillers do not touch, especially if the socket begins to smell, points to a dry socket. This is a condition where the clot is lost and the bone underneath becomes exposed, which is far more painful than the extraction itself.
It typically shows up two to three days after the procedure, and lower wisdom teeth are the usual culprits. It is common enough to be worth knowing about in advance, and it cannot be treated at home. It needs the socket cleaned out under local anaesthetic, which is unpleasant but resolves quickly once done.
Go back promptly if you also develop any of these: bleeding that has not eased after applying pressure, fever, a bad taste that does not shift, difficulty opening your mouth, or swelling that is getting worse after the third day rather than better.
If you are travelling
Two practical points, both learned the hard way by people who did not think of them in advance.
Do not book the extraction immediately before a flight. It is standard practice to wait at least a day or two, and ideally longer for a surgical extraction. Swelling in the face can make the pressure change on the ear painful, and in rare cases flying soon after surgery can worsen swelling or bruising.
And know in advance how you would reach a dentist where you are staying. If a dry socket develops two days after you fly home — or while you are still travelling — the answer is not to wait. Knowing the name of a local dental clinic costs nothing and is worth having written down.