In the field of oral health, wisdom tooth extraction is a common surgical procedure. Many patients who have undergone wisdom tooth extraction may have such a feeling: after the lower wisdom tooth is extracted, the pain seems to be more intense than that after the upper wisdom tooth is extracted. In fact, there are multiple reasons behind this, involving factors such as the position of wisdom teeth, anatomical structure, and the surgical process. This article will explore in detail why it is more painful after extracting the wisdom teeth below.
Location factors: Deeper wounds and greater trauma
The lower wisdom teeth, usually located at the very end of the mandible, are close to the throat and facial nerves. Compared with the wisdom teeth in the upper jaw, it is located deeper into the interior of the oral cavity. When performing tooth extraction surgery, in order to smoothly expose and extract the wisdom teeth in the lower jaw, doctors often need to cut open a larger area of oral mucosa. A larger area of mucosal incision means a larger postoperative wound area and a more significant trauma. This larger trauma will stimulate more nerve endings, thereby triggering a more intense pain sensation.
For instance, due to the relatively shallow position of the upper wisdom teeth, the area of the mucous membrane cut during surgery may be smaller, the wound is relatively easier to heal, and the degree of pain is also relatively lower. The deep position of the lower wisdom teeth makes the surgical operation have to involve a larger area of tissue incision, which undoubtedly increases the degree of postoperative pain.
Operating space: Complex structures restrict operation and exacerbate trauma
The skeletal structure around the lower wisdom teeth is rather complex, which brings great challenges to the surgical operation. The limited operating space makes it necessary for doctors to operate more precisely and carefully when extracting wisdom teeth. During the operation, doctors not only have to separate the soft tissues around the wisdom teeth, but also often need to deal with the bones closely connected to the wisdom teeth. To expose wisdom teeth and extract them smoothly, doctors may need to use special instruments to remove part of the bone around the wisdom teeth. This process is called bone-removal. The bone removal operation itself causes significant trauma to the surrounding tissues because it involves destroying the bone structure, which is rich in the distribution of nerves and blood vessels. This additional trauma can lead to more obvious postoperative pain.
In addition, the cramped operating space makes it difficult for doctors to completely avoid pulling and squeezing the surrounding soft tissues during the operation, which further aggravates the damage to the tissues and the degree of pain. In contrast, the skeletal structure around the upper wisdom teeth is relatively simple, the operating space is more spacious, and the trauma to the surrounding tissues during the surgery is relatively small, so the postoperative pain is also relatively mild.
Nerve distribution: Dense nerves are prone to damage, causing pain
There are many important nerves distributed around the lower wisdom teeth, including the inferior alveolar nerve, lingual nerve and buccal nerve, etc. The inferior alveolar nerve is responsible for the sensation of the lower teeth, gums, lower lip and chin, while the lingual nerve is responsible for the sensation of the front two-thirds of the tongue. During the surgical process of extracting wisdom teeth in the lower jaw, if these nerves are accidentally damaged, it may lead to numbness and pain in the jaw, tongue and oral mucosa. Moreover, the pain caused by nerve damage is often rather special. It may not only be a simple stabbing pain but also be accompanied by numbness, abnormal sensations and other symptoms. This complex sensation makes the pain even more unbearable for the patient.
Even if the nerve is not directly damaged during the operation, the squeezing and pulling of the tissues around the nerve during the operation may still stimulate the nerve and trigger a pain response. The distribution of nerves around the upper wisdom teeth is relatively small, and the risk of nerve damage during the operation is low. Therefore, postoperative pain caused by nerve factors is also relatively rare.
Root morphology: The variable and complex tooth roots increase the difficulty of the surgery
The root morphology of lower wisdom teeth is usually rather complex and variable. They may have multiple tooth roots, and the lengths, curvatures and bifurcations of the tooth roots vary. Some lower wisdom teeth may have very long roots, even extending deep into the mandible. Some tooth roots may be curved, which makes it very difficult to remove the entire root completely when extracting wisdom teeth. To successfully extract wisdom teeth, doctors may need to divide the tooth roots and remove them one by one. This process undoubtedly increases the complexity of the surgery and the trauma to the surrounding tissues. The instruments used in root segmentation may cause additional damage to the surrounding alveolar bone, periodontal ligament and other tissues, thereby intensifying postoperative pain.
In contrast, the root shape of the upper wisdom teeth is relatively simple. In most cases, the number of roots is small, and the curvature and length of the roots are relatively moderate. They are relatively easy to extract during surgery, cause relatively less damage to the surrounding tissues, and naturally have a lower degree of postoperative pain.
Postoperative inflammatory response: Greater trauma leads to more obvious inflammation
Because the surgical trauma during the extraction of lower wisdom teeth is relatively large, the inflammatory response at the wound site after the operation is often more obvious. After the body is injured, the immune system is immediately activated, causing inflammatory cells to gather at the wound site. These inflammatory cells release various inflammatory mediators, such as prostaglandins and bradykinin, which stimulate nerve endings and lead to the generation of pain sensations. At the same time, the inflammatory response can also cause local tissue swelling, which will further compress the surrounding nerves and blood vessels, intensifying the degree of pain.
In addition, the duration of the inflammatory response may also be relatively long. Generally speaking, the inflammatory response after the extraction of lower wisdom teeth may last for several days or even about a week. During this period, patients will continuously experience relatively obvious pain. After the upper wisdom teeth are extracted, due to the smaller trauma, the inflammatory response is relatively mild, the degree of pain and swelling will also be relatively low, and the duration will be shorter.
Individual differences: Different pain thresholds and psychological factors affect feelings
Of course, different individuals have differences in their perception and tolerance of pain. Some people are born with a higher pain threshold and a lower sensitivity to pain. Even after having their lower wisdom teeth extracted, the pain they feel may be relatively mild. For people with a lower pain threshold, the same surgical trauma may make them feel unbearable pain. Psychological factors also play an important role in it. If patients are filled with fear and anxiety about the surgery before tooth extraction, they may pay more attention to the feeling of pain after the operation, thereby magnifying the degree of pain.
For instance, some patients are overly nervous before tooth extraction, worrying about the pain during the operation and their recovery after the surgery. This psychological state makes them more sensitive to pain after the operation. Even if the pain is not actually that severe, they still find it unbearable. Those patients who have a more relaxed mindset and a correct understanding of the surgery may be better able to cope with postoperative pain.
Risk of dry socket syndrome: Higher incidence after mandibular wisdom tooth surgery
Dry socket syndrome is a complication after tooth extraction, which is more common after the extraction of impacted wisdom teeth in the lower jaw. The mechanism of its occurrence is generally believed to be that the blood clot in the tooth extraction socket falls off, causing the alveolar bone to be directly exposed to the oral cavity. Bacteria in the oral cavity invade the tooth extraction socket, triggering infection and inflammatory responses, and subsequently causing severe pain. Dry socket syndrome usually occurs 2 to 3 days after tooth extraction. Patients will experience severe pain at the extraction site, which may radiate to other parts of the face. The extraction socket may be empty or have putrid and degenerated blood clots, accompanied by a foul smell.
Due to factors such as the position of the mandibular wisdom teeth, surgical trauma, and the distribution of bacteria in the oral cavity, the risk of dry socket syndrome after the extraction of mandibular wisdom teeth is relatively high. Once dry slot syndrome occurs, the degree of pain in patients will significantly intensify, and the pain lasts for a long time, seriously affecting the quality of life of patients. The probability of dry socket syndrome after the extraction of upper wisdom teeth is relatively low, which is one of the reasons why many patients feel more severe pain after the extraction of lower wisdom teeth.
Conclusion
To sum up, the increased pain after extracting the wisdom tooth below is the result of the combined effect of multiple factors. These factors include the deep location of the lower wisdom teeth, the limited operating space, the dense distribution of nerves, the complex shape of the tooth root, the obvious postoperative inflammatory response, and the relatively high risk of dry socket syndrome. Coupled with the influence of individual differences on pain perception, patients often have to endure more severe pain after the extraction of lower wisdom teeth. Understanding these reasons can help patients mentally prepare before tooth extraction and actively cooperate with doctors for postoperative care and treatment to alleviate pain and promote smooth wound healing. If the pain is too severe or does not subside after the extraction of the lower wisdom teeth, one should seek medical attention promptly so that the doctor can assess and handle it.
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