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Pain Experience After Simple Tooth Extraction

Article  in  Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons · June 2008
DOI: 10.1016/j.joms.2007.12.008 · Source: PubMed

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 J Oral Maxillofac Surg
66:911-917, 2008

Pain Experience After Simple

Tooth Extraction
Taiseer Hussain Al-Khateeb, BDS, MScD, FDSRCSE, FFDRCSI,*
and Amir Alnahar, BDS, MDSc†

Purpose: To assess pain experience after simple uncomplicated tooth extraction and to see if there is
a need to prescribe analgesic drugs after such a procedure.
Patients and Methods: A random sample of patients presenting for tooth extraction at the Maxillo-
facial Unit, Jordan University of Science and Technology was included. A baseline assessment of
previously experienced general and dental pains using numeric scales was done. Subsequently, tooth
extractions were done and telephone interviews were made during evenings for a week. Pain intensity
was assessed on a numeric scale, and use of analgesic drugs and pain quality were recorded.
Results: At the evening of extraction 81.8% of patients had pain. Female gender predominance in pain
reporting was statistically significant on postextraction days 3 and 5. Chronically inflamed teeth caused
the highest mean pain intensity scores and nonsmokers showed significantly higher mean pain intensity
scores compared with smokers. Mild pain was experienced by most patients (38.6%) on the evening of
extraction. It was found that 55.3% of participants (largely females) used analgesic drugs on the evening
of extraction, and 6.8% of participants still used analgesic drugs on day 7 postextraction. There was a
significant correlation between mean pain intensity score and previous dental injection pain.
Conclusion: Patients, notably females, experienced pain of varying intensity after simple uncompli-
cated tooth extraction maximally at the evening of extraction; and greater than 50% of the patients used
analgesic drugs. We recommend offering regular analgesic drugs during the first week after tooth
extraction.
© 2008 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 66:911-917, 2008

Pain is an unpleasant sensory and emotional experi-
ence associated with actual or potential tissue dam-
age.1 The Institute of Medicine Committee on Pain,
Disability, and Chronic Illness Behavior highlighted
the complex nature of pain by noting that experience
of pain is more than a simple sensory process; it is a
complex perception involving higher levels of the
central nervous system, emotional states, and higher
mental processes.2
Extraction of teeth is a common dental procedure.
After tooth extraction the patient may experience
pain, and there is a varying degree of severity be-
*Associate Professor, Division of Oral and Maxillofacial Surgery,
Faculty of Dentistry, Jordan University of Science and Technology,
Irbid, Jordan.
†Private Practice, Jerash, Jordan.
Address correspondence and reprint requests to Dr Al-Khateeb:
Jordan University of Science and Technology, Faculty of Dentistry,
Oral and Maxillofacial Surgery, JUST, PO Box 3030, Irbid 22110,
Jordan; e-mail: khateeb@just.edu.jo
© 2008 American Association of Oral and Maxillofacial Surgeons
0278-2391/08/6605-0013$34.00/0
doi:10.1016/j.joms.2007.12.008
tween patients.3 Postoperative pain is related signifi-
cantly to the amount of surgical trauma.4 Surgical
removal of bony impactions and osseous periodontal
surgery are more traumatic and produce more intense
pain when compared with simple uncomplicated
tooth extraction. Little information is available in the
literature about pain experience after simple uncom-
plicated tooth extraction. Most of the literature fo-
cuses on postoperative pain after surgical removal of
impacted third molars or on the effectiveness of dif-
ferent pharmaceutical options in combating postsur-
gical pain. The aim of this study was to prospectively
assess and analyze pain experience after simple un-
complicated tooth extraction and to see if there is a
need to prescribe analgesic drugs after such a proce-
dure. The effect of patient gender, age, smoking, and
educational level, the operators’ status, and the ex-
tracted teeth quantity, side, and location also were
investigated.
Patients and Methods
SUBJECTS
Two hundred patients (100 females, 100 males)
were selected randomly from patients undergoing

911
912
simple (intra-alveolar) tooth extraction at the oral and
maxillofacial unit at the dental teaching clinics at
Jordan University of Science and Technology (JUST).
The following selection criteria were used for subject
inclusion:
1. The patient is medically fit and healthy, over 18
years old and not on any regular medication.
2. The extraction is done using forceps and/or el-
evators without any surgical intervention.
3. The teeth are asymptomatic.
Teeth were classified into sound, mobile, grossly
carious, or chronically inflamed (with radiographi-
cally evident periodontal or apical involvement).
PROCEDURES
Undergraduate and postgraduate students carried
out the extractions but a single investigator made all
the assessments. Approval of the Human Ethics Com-
mittee at JUST was obtained. After informed consent,
a semistructured baseline interview was conducted at
the patients’ first visit before treatment. The interview
included baseline assessments of general and dental
pains experienced previously using numeric scales
(NSs). The patients received NS pain assessment
forms and separate envelopes to be used in conjunc-
tion with telephone follow-up interviews on the
evening of the day of the extraction, the following
evening, and then every second evening for 1 week.
After the initial interview, tooth extraction was car-
ried out.
Pain assessment was recorded during 4 telephone
interviews and 1 personal interview at the next ap-
pointment at the clinic. During each interview the
patients were asked if they have experienced any pain
and, if so, to assess the intensity of their pain on the
10-mm NS (“No pain” to “Worst pain possible”). The
assessment was then put in a separate envelope
marked for each day. The character of pain was indi-
cated (yes/no) using 4 descriptors according to the
McGill Pain Questionnaire: constant pain, shooting
pain, dull pain, and pain when chewing or biting. In
addition, each interview included a report of the use
of painkillers. The type and dosage of medication was
also noted.
INSTRUMENTS
During the initial interview each patient was asked
to make NS assessments of his/her experience of
previous general and dental pains, rated from “No
pain” to “Worst pain possible.” The proposed painful
situations included “cutting one’s finger,” “wasp-
stings,” “spraining one’s ankle,” “having a vaccination
(IM injection),” “burning one’s finger,” and “having a
sore throat.” Previous dental pain was assessed in
ANALGESICS USE AFTER SIMPLE TOOTH EXTRACTION
relation to recalling having experienced “examination
with a dental probe,” “having your teeth polished,”
“dental injection,” and “drilling.” Mean NS assess-
ments for previous general pain and dental pain were
used for analysis.
STATISTICAL ANALYSIS
Simple descriptive statistics using SPSS (SPSS Inc,
Chicago, IL) were used and differences in frequencies
and proportions between groups were analyzed with
Pearson’s ␹2. Due to skewness in data, nonparametric
statistics (Mann-Whitney U test) were computed to
test significance between groups according to scale
assessments. To investigate the repeated pain assess-
ments, a Friedman’s 2-way analysis of variance
(ANOVA) between measurements was calculated.
Analysis of variance (2-way ANOVA) of pain assess-
ments were computed for different variables. A non-
parametric correlation analysis between variables was
made using the Spearman rank correlation method.
Tukey test was used to determine which of the vari-
ous tooth states had effect on mean pain intensity.
Results
A total of 180 patients agreed to participate in the
study; 36 (20%) failed to comply with follow-up. The
remaining 144 patients were included. Sums of 12
patients with postextraction complications were ret-
rospectively excluded leaving 132 patients (72 fe-
males, 60 males) for analysis; their age and gender
distribution is shown in Figure 1.
The preoperative diagnosis of teeth extracted was
as follows: sound (9.8%), mobile (12.1%), grossly de-
FIGURE 1. Age and gender distribution of participants included in
the study (n ⫽ 132).
Al-Khateeb and Alnahar. Analgesics Use After Simple Tooth Ex-
traction. J Oral Maxillofac Surg 2008.
AL-KHATEEB AND ALNAHAR
FIGURE 2. Frequency of pain reporting during the postextraction
period.
Al-Khateeb and Alnahar. Analgesics Use After Simple Tooth Ex-
traction. J Oral Maxillofac Surg 2008.
cayed (70.4%), or chronically inflamed (7.6%). Extrac-
tion was unilateral in 93.9% of cases, and single teeth
were extracted in 83.3% of cases. Most (93.2%) of
teeth extracted were away from midline, and post-
graduate students did 82% of extractions.
REPORTING OF POSTEXTRACTION PAIN
On the evening of extraction, 81.8% of patients
reported feeling pain. The frequency of pain report-
ing dropped gradually, reaching 15.9% at day 7 pos-
textraction (Fig 2). Generally, a higher percentage of
females reported having postextraction pain through-
out the postoperative period (Fig 2). This gender
difference in pain reporting was statistically signifi-
cant only on day 3 and 5 postextraction (P ⫽ .020 and
.039, respectively).
PAIN INTENSITY SCORES
The intensity of the pain (on NS) showed a similar
pattern (Fig 2). The pain intensity assessments peaked
on the evening of extraction when the mean pain
intensity score reached 4.4 for the females (range,
0-10; median, 4), and 2.8 for males (range, 0 to 10;
median, 2). There was a drop in mean pain intensity
score on each subsequent postextraction day until
day 7 when the mean pain intensity score reached 0.7
for females (range, 0 to 10; median, 0) and 0.3 for
males (range, 0 to 2; median, 0).
There was a significant correlation between the
mean pain intensity score at the extraction evening
and at day 1 postextraction (Spearman ␳ ⫽ 0.707; P ⬍
.01), whereas the correlation was lower between ex-
traction evening and days 1 and 7 postextraction
(Spearman ␳ ⫽ 0.264, 0.439; P ⬍ .01). The mean pain
intensity score at day 7 was correlated significantly
913
with the value at day 5 (Spearman ␳ ⫽ 0.783; P ⬍ .01)
but less significantly correlated with the value at day
3 (Spearman ␳ ⫽ 0.579; P ⬍ .01). There was also a
significant difference between males and females at
the evening of extraction and on days 1, 3, and 5 (P ⫽
.007, .014, .018, .012, respectively), but at day 7 there
was no significant difference (P ⫽ .128).
One-way ANOVA analysis showed that there was a
significant effect of tooth status before extraction on
the postextraction mean pain intensity scores (F ⫽
3.42, P ⫽ .019). Tukey test was used to determine
which of the various tooth states had effect on mean
pain intensity. It was found that chronically inflamed
teeth, followed by grossly decayed teeth, caused the
highest mean pain intensity scores. Nonsmokers
showed significantly higher mean pain intensity
scores compared with smokers (t test, P ⫽ .004).
The t test showed that there was no significant
effect on mean pain intensity scores either by the
operator’s level of experience (post- or undergradu-
ate) (P ⫽ .582), or the quantity (single or multiple)
(P ⫽ .93), side (uni- or bilateral) (P ⫽ .529), or
position in relation to midline (P ⫽ .293) of teeth
extracted, or patient’s educational level (P ⫽ .828).
The age category related to the levels of pain during
the postoperative follow-up period is shown in Figure 3.
Although subjects in their 20s, 70s, and 80s seem to
report more intense pain, especially during the initial
postoperative period, 1-way ANOVA analysis showed
that age alone, and age and gender together have no
significant effect on mean pain intensity scores re-
ported by the participants throughout the follow-up
period (P ⫽ .49, .67, respectively).
CHARACTER OF PAIN
Patients who had postextraction pain described the
character of their pain as either constant when chew-
ing, shooting, or dull. The distribution of the pain
FIGURE 3. Age distribution as related to the pain intensity during the
postoperative period.
Al-Khateeb and Alnahar. Analgesics Use After Simple Tooth Ex-
traction. J Oral Maxillofac Surg 2008.
914 ANALGESICS USE AFTER SIMPLE TOOTH EXTRACTION

Table 1. PAIN CHARACTERS REPORTED BY PARTICIPANTS THROUGHOUT FOLLOW-UP PERIOD

Postextraction Day
Character Gender Evening % 1 % 3 % 5 % 7 %

Constant Male 5 3.8 0 0.0 1 0.8 0 0.0 0 0.0

Female 24 18.2 5 3.8 4 3.0 2 1.5 1 0.8
Shooting Male 4 3.0 4 3.0 1 0.8 0 0.0 0 0.0
Female 13 9.8 11 8.3 5 3.8 1 0.8 1 0.8
Mild Male 33 25.0 25 18.9 14 10.6 7 5.3 7 5.3
Female 18 13.6 21 15.9 19 14.4 17 12.9 13 9.8
When chewing Male 8 6.1 10 7.6 7 5.3 3 2.3 2 1.5
Female 3 2.3 14 10.6 12 9.1 5 3.8 5 3.8
None Male 10 7.6 21 15.9 37 28.0 50 37.9 51 38.6
Female 14 10.6 21 15.9 32 24.2 47 35.6 52 39.4
Total 132 100 132 100 132 100 132 100 132 100
Al-Khateeb and Alnahar. Analgesics Use After Simple Tooth Extraction. J Oral Maxillofac Surg 2008.

characters is shown in Table 1. Mild pain was expe- pains experienced previously were due to “burning”
rienced by the majority (38.6%) of patients on the (mean NS of 7.45) and “drilling” (mean NS of 4.77),
evening of extraction, and the percentage remained respectively. Pains caused by burns, intramuscular
relatively high (15.2%) on day 7 postextraction. injections, sprains, and cuts were scored significantly
One-way ANOVA analysis was used to explore ef- higher by females than males (P ⬍ .05), and pain from
fect of gender on the character of pain reported. drilling and dental injections were scored significantly
Participants reported different characters of pain higher by females (P ⬍ .05).
without significant differences at days 0, 1, 5, and 7 (P The effect of previous general and dental pain expe-
⫽ .23, .19, .40, .87, respectively). At day 3, there was riences on the postextraction mean pain intensity scores
a significant difference between genders (P ⫽ .010) was obtained by using the Pearson correlation test. Al-
with females reporting more throbbing pain. though there was no significant correlation between
USE OF ANALGESICS any of the previous general pains and mean NS, there
was a significant correlation between mean NS and
It was found that 55.3% of participants used anal-
previous dental injection pain at the level of 0.01.
gesic drugs at the evening of extraction. This percent-
age dropped steadily on subsequent postextraction
days until day 7 when 6.8% of participants were still
using analgesic drugs (Fig 4). To see if there were
statistical differences between females and males in
the use of analgesic drugs, univariate ANOVA was
done. It was found that females used analgesic drugs
significantly more than males throughout the fol-
low-up period (P ⬍ .05) except at day 7 (P ⫽ .112).
Most participants used either paracetamol (27.3%)
or NSAIDs (22.7%). Using the ANOVA test, it was
found that patients with high mean pain intensity
scores used a combination of more than 1 analgesic
drug type; and those taking a single type of analgesic
drug had lower mean pain intensity scores (F ⫽ 9.39,
P ⫽ .000). Participants who did not use any type of
analgesic drugs had the lowest mean pain intensity
scores of the whole sample.

PREVIOUS EXPERIENCE OF GENERAL AND

DENTAL PAIN
The strongest general and dental pains experienced
previously by males were due to “burning” (mean NS
of 5.20) and “probing” (mean NS of 3.11), respec-
tively. As for females, the strongest general and dental
FIGURE 4. Frequency of using analgesic drugs during the postextrac-
tion period.
Al-Khateeb and Alnahar. Analgesics Use After Simple Tooth Ex-
traction. J Oral Maxillofac Surg 2008.
AL-KHATEEB AND ALNAHAR
Discussion
It is surprising that despite being one of the most
common oral surgical procedures, the literature gives
very little attention to pain after simple tooth extrac-
tion. Indeed, most previous studies focus on either
postoperative pain after surgical removal of impacted
third molars, or on the effectiveness of different phar-
maceutical agents in combating postoperative se-
quelae. To the best of our knowledge, this is the first
study that presents a detailed analysis of pain experi-
ence after simple, uncomplicated tooth extraction.
Our results showed that almost 82% of patients
experienced moderate pain (with a mean pain inten-
sity score of 3.6/10) on the evening of extraction day;
and up to 16% of patients continued to experience
this postextraction pain after a week. Among the
previous studies that superficially allude to pain after
simple tooth extraction, Cheung et al5 found that
healing of normal uncomplicated extraction alveolus
caused moderate to severe pain. Adeyemo et al6
found that uncomplicated extraction socket healing
was associated with mild or moderate pain up to the
third day after extraction in 9.6% of cases whereas
2.4% of patients had mild pain throughout the sev-
enth postextraction day. Garcia et al7 pointed out that
pain after simple tooth extraction is less severe com-
pared with complicated extraction that involves bone
removal and tooth sectioning. They also found that
regardless of the type of extraction, pain declined
between days 1 and 5 postsurgery. The moderate
intensity of postextraction pain can be explained by
the little amount of tissue damage that a simple ex-
traction incurs. Previous studies8 support the opinion
that postoperative pain reported by patients was sig-
nificantly less when using minimal incisions, small
mucoperiosteal flap reflection, or flapless surgery.
In the current study, it was found that the pre-
extraction status of a tooth had a significant effect on
the pain intensity perceived after extraction. The
chronically inflamed teeth caused the highest mean
pain intensity scores. Our findings are in line with
those of other investigators9,10 who found that post-
operative pain increased 3-fold in patients undergoing
surgical extraction of symptomatic third molars as
compared with those with asymptomatic teeth. The
reason for this is probably attributed to the synergistic
effect of various inflammatory mediators (produced
by the pre-existing inflammatory condition) that pro-
duces a long-lasting increase in the activity of noci-
ceptors.11 Furthermore, it has been shown that the
expression, in dental pulpal tissue, of substance P,
vasoactive intestinal peptides, and neuropeptide Y
are all increased significantly with caries-induced pul-
pal inflammation.12-15 Therefore, inflamed teeth,
where the nociceptors are already sensitized due to
915
previous inflammation, and carious teeth with excited
nerve endings will produce more pain when ex-
tracted as compared with noninflamed ones where
nociceptors are not sensitized.
The number of teeth extracted was found in this
study to have no significant effect on the mean pain
intensity scores obtained. This is in contrast with
previous studies about surgical procedures. For exam-
ple, Penarrocha et al16 found that the increase in
number of teeth treated with periapical surgery in-
creased pain postoperatively. The reason our results
are different from those of others might be due to the
fact that simple tooth extraction does not incur
enough tissue damage to induce sensitization of no-
ciceptors.
In this investigation, females reported more pain as
compared with males. This is in agreement with the
findings of most previous studies that reported that
female patients experience significantly more pain
than males.17-19 However, Capuzzi et al20 found that
young male patients experience significantly more
pain than young females. Furthermore, other studies
showed no gender differences in terms of pain expe-
rience.21,22 The difference between genders in pain
reporting and intensity found in this investigation was
explained by Wiesenfeld-Hallin19 who stated that gen-
der differences are attributed mainly to differences in
biologic mechanisms and partly to psychologic and
sociocultural factors. They suggested that normal
males have a higher level of activity in the endoge-
nous analgesic system compared with normal fe-
males. Furthermore, pain sensitivity, tolerance, and
threshold in women vary with the stage of menstrual
cycle.23
We found that there was no significant effect for
the side (uni- or bilateral) on the mean pain intensity
score. This contrasts with the experimental work of
Sabino et al24 who found that the activation of trigem-
inal nucleus neurons bilaterally after tooth extraction
induced more pain sensation compared with ipsilat-
eral neuron activation. The reasons why our results
differ from others is probably attributed to the small
number of teeth extracted bilaterally (n ⫽ 8). Sabino
et al24 also found that extraction of central incisors in
the rat induced substance P receptors internalization
of both ipsilateral and contralateral neurons. On the
other hand, molar extraction induced only ipsilateral
substance P receptor internalization. They suggested
that structures damaged around the midline induced
more pain. In our study, however, there was no sig-
nificant effect for the tooth position in relation to the
midline on the mean pain intensity scores. This may
be attributed to the lower number of extracted teeth
around the midline (n ⫽ 9).
We found that there is not a significant effect on
mean pain intensity scores by the operator level of
916
experience. This contrasts with findings of Troullos
et al25 who indicated that the degree of tissue damage
is dependent on the expertise of the operator. Morin
et al,17 investigating implant insertion, found that se-
nior surgeons produced significantly less pain than
the fourth year resident. Capuzzi et al20 found that the
expertise of the surgeon significantly affects the level
of postoperative pain. They found that impacted third
molar removal by surgeons with considerable or av-
erage expertise resulted in less postoperative pain as
compared with surgeons with little expertise. Fagade
and Oginni,26 investigating intraoperative pain per-
ception in tooth extraction, found that the attending
surgeon’s status affected pain scores. Our result can
be explained by the fact that tooth extraction was
simple, using forceps or an elevator that are not ex-
pected to cause a significant amount of tissue injury.
In the present investigation, it was found that there
is not a significant effect of the patients’ educational
level on mean pain intensity scores. This contrasts
with Tanwir et al,27 and Peretz and Mersel28 who
found that pain was a more frequent complaint
among poorly educated subjects than among the ed-
ucated. However, Maggirias and Locker29 found that
pain was more likely to be experienced by those with
higher levels of education.
Smoking has long been identified as harmful to
health. Meechan et al30 identified smoking as a major
predisposing factor in occurrence of painful sockets
after tooth extraction. Smoking has also been associated
with poorer healing after mucogingival surgery and
with higher rates of refractory periodontitis.31 Awaw-
deh et al13 found that there was an increased neu-
ropeptide concentration, such as CGRP, in pulps of
smokers’ teeth compared with nonsmokers’. In this
study, nonsmokers showed significantly higher mean
pain intensity scores compared with smokers. This is
probably related to the analgesic effect of nicotine in
cigarettes.32 Our findings are, however, in contrast
with Tanwir et al27 who found that postsurgical pain
was significantly more in smokers compared with
nonsmokers. On the other hand, while investigating
pain after surgical endodontics, Penarrocha et al16
found that smoking had no significant influence on
postoperative pain.
In our study, the age of the patients had no signif-
icant effect on mean pain intensity scores. This is in
agreement with other studies.16,27,33 On the other
hand, other studies4,20,34 found that pain increased in
older patients, and Maggirias and Locker29 found that
younger patients were more likely to report pain than
older subjects. It has been found in a rat model that
neuronal activity in the spinal dorsal horn is signifi-
cantly greater in aged rats after noxious stimulation35;
and the response to heat and mechanical stimulation
was higher in aged rats.36 It has been hypothesized36
ANALGESICS USE AFTER SIMPLE TOOTH EXTRACTION
that as neuronal cell death is observed in many parts
of the CNS in aged subjects, there will be modification
of the circuits responsible for pain, or new circuits
will form, thus explaining the aging-related hyperal-
gesia. It has also been hypothesized that descending
pain inhibitory signals in aged animals will be im-
paired.37
It was found in this investigation that analgesic
drugs were used most frequently during the evening
of extraction and on day 1 postextraction. After 24
hours there was a decline in the number of patients
requiring analgesic drugs with a decline of the mean
pain intensity scores. Most analgesic drugs used were
paracetamol and NSAIDs. This is attributed to their
availability because they are obtained easily without a
prescription in Jordan. In agreement with our study,
Urquhart38 stated that the main need for analgesic
treatment was in the first 24- to 48-hour period. We
also found that there were significant differences in
analgesic drug use between males and females
throughout the follow-up period. This contrasts with
others who found no gender differences in analgesic
drug use in the postoperative period.18,22,39 Our re-
sults are, however, in line with those of Liddell and
Locker40 who found that there were gender differ-
ences in analgesic drug use due to higher levels of
anxiety reported by females compared with males.
This finding is logical and is highly related to gender
differences in mean pain intensity scores; the females
had higher pain intensity scores that made them use
more analgesic drugs compared with males.
We found a positive correlation between mean
pain intensity scores and previous dental pain expe-
riences. Those who reported higher dental pain ex-
perience with local anesthetic injections had higher
mean pain intensity scores. On the other hand, there
was no significant correlation between any previous
general pain experiences and mean pain intensity
scores. In line with our findings, Maggirias and
Locker29 found that those with high levels of previous
painful dental experience reported significantly more
postoperative pain compared with those of a low
level of previous painful experiences. Also in har-
mony with our findings, Maggirias and Locker29 found
that previous frightening experiences did not signifi-
cantly affect pain reporting and intensity. However,
Bergius et al41 found that there were no significant
differences between females and males in the previ-
ous dental pain experiences. Williams et al42 are of
the opinion that negative dental experience would be
a risk of reporting pain from general dental treatment.
Our results of positive correlation between dental
injection and high postoperative mean pain intensity
scores are probably attributed to fear of a dental
needle that probably increased anxiety, and so in-
creased pain reporting.
 AL-KHATEEB AND ALNAHAR
In conclusion, we have found that patients experi-
enced pain after simple uncomplicated tooth extrac-
tion. The pain intensity peaked at the evening of
extraction and greater than 50% of patients used an-
algesic drugs after tooth extraction. Females experi-
enced pain significantly more than males and the
chronically inflamed teeth caused the highest mean
pain intensity score. We recommend that members of
the dental profession should consider offering regular
analgesic drugs during the first week after tooth ex-
traction.
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