Wisdom teeth removal is a common procedure, and the primary concern for most patients is experiencing pain during the extraction. With local anesthesia, the sensation of pain is effectively eliminated, though you remain fully awake. Local anesthesia is the standard method used to manage discomfort, ensuring the entire area around the third molars is completely numb. This allows the oral surgeon or dentist to perform the necessary work while you remain comfortable.
How Local Anesthesia Works to Block Pain
The effectiveness of local anesthesia is based on a precise scientific mechanism that targets the nervous system. Medications such as Lidocaine or Articaine are commonly used in dentistry. These drugs function by temporarily blocking the electrical signals in nerve cells and are injected near the nerves that transmit sensations from the surgical site to the brain.
The Role of Sodium Channels
The key to this process involves the voltage-gated sodium channel, a tiny opening located in the membrane of the nerve cell. When a nerve impulse, such as a pain signal, travels along the nerve, these sodium channels open. This allows sodium ions to rush into the cell, propagating the signal toward the brain. Local anesthetic molecules enter the nerve cell and bind to these sodium channels, acting as a temporary plug.
Blocking the Signal
By blocking the sodium channels, the local anesthetic prevents the necessary influx of sodium ions. This action stops the nerve cell from generating and propagating the electrical signal entirely. This interruption means the pain message never reaches the brain, so the area is temporarily desensitized. This action is highly targeted, meaning the patient remains conscious, but the specific surgical area is fully numb.
Sensations Experienced During the Extraction
While local anesthesia successfully prevents the feeling of sharp pain, it does not eliminate all sensation. This distinction can sometimes be a source of confusion for patients. The primary sensations experienced are pressure, pushing, and vibration. These feelings are transmitted by different types of nerve fibers than those that carry pain signals, and they are harder for the local anesthetic to completely block.
Pressure and Pushing
The oral surgeon must apply significant force to move and loosen the wisdom tooth from its socket. This necessary force is often felt as intense pressure deep within the jaw. You may feel a strong pushing or pulling sensation as the tooth is manipulated, and this is a normal part of the procedure. It is important to remember that this heavy pressure is not pain, and this distinction is a direct result of the local anesthetic’s action.
Auditory Sensations
You will also hear various sounds, which can be the most unsettling aspect for many patients. The removal process often involves instruments like drills or burrs to section the tooth or remove surrounding bone. This creates loud grinding or whirring noises. There may also be cracking sounds as the tooth is separated or removed, but these are merely the sounds of the work being performed on a fully numb area.
Addressing Insufficient Anesthesia During the Procedure
The concern that the anesthesia might wear off or be insufficient is common, but oral surgeons have clear protocols to address this immediately. The goal of the procedure is for the patient to feel no sharp pain at any point. The dental team monitors for signs of discomfort throughout the extraction. Incomplete numbness can occur if the anesthetic does not fully block the targeted nerve signals, sometimes due to anatomical variation or infection.
If you feel any sharp sensation that registers as pain, it is important to communicate this to the surgical team immediately. Many offices recommend agreeing on a simple, non-verbal hand signal beforehand, such as raising a hand, to alert the surgeon without needing to speak. The dentist will immediately stop the procedure and administer a supplemental dose, often called a “top-up,” of the local anesthetic.
This additional injection is highly effective and works very quickly, often within a minute or two, to completely numb the area that was not fully blocked initially. This rapid response ensures that any breakthrough pain is short-lived. The procedure can then continue safely and comfortably.