Wisdom teeth removal is a common surgical procedure, and whether a patient will be intubated (having a tube placed into the windpipe to assist breathing) depends entirely on the type of anesthesia selected. In the vast majority of cases performed in an oral surgeon’s office, intubation is not required because the patient is not placed under the deepest form of anesthesia. The choice of anesthesia is the single most important factor determining the need for specialized breathing apparatus during the extraction.
Anesthesia Options for Wisdom Teeth Removal
Healthcare providers offer several options to ensure patient comfort and safety during wisdom teeth removal. The simplest method is Local Anesthesia (LA), where an injection numbs the surgical area while the patient remains fully awake. This option is typically reserved for the simplest extractions.
A more common choice is Intravenous (IV) Sedation, which administers medication through a vein to achieve a state often described as “twilight sleep.” With IV sedation, the patient is deeply relaxed and may fall asleep, having little to no memory of the procedure, but they still maintain the ability to breathe on their own and can often respond to verbal commands. This option is frequently used for moderately complex wisdom teeth extractions performed in an outpatient setting.
The third option is General Anesthesia (GA), which induces a state of complete unconsciousness, rendering the patient unable to respond to pain or stimuli. This level of anesthesia is reserved for the most complex extractions, patients with significant medical conditions, or those with extreme anxiety. GA is often administered in a hospital or surgical center setting.
When Intubation is Required
Intubation is standard practice almost exclusively when a patient undergoes General Anesthesia. This procedure involves inserting a tube, known as an endotracheal tube (ETT), through the mouth or nose and into the trachea, or windpipe. The ETT connects to a ventilator, allowing the anesthesia team to take complete control of the patient’s breathing, which is necessary because the medications used for general anesthesia cause the muscles, including those responsible for breathing, to relax completely.
The loss of muscle tone under GA also causes the patient to lose protective airway reflexes, such as coughing and swallowing. Intubation provides a sealed, protected pathway for breathing, preventing aspiration (blood, water, or tooth fragments entering the lungs) since the surgery occurs near the airway. In some cases, a Laryngeal Mask Airway (LMA), a less invasive device that seals the airway opening above the vocal cords, may be used instead of a full ETT. The breathing tube is removed before the patient fully wakes up, once they can breathe adequately and protect their own airway.
Airway Management During IV Sedation
Patients receiving IV sedation are typically not intubated because they maintain spontaneous breathing. The goal of this sedation level is to keep the patient comfortable and unaware while preserving their ability to breathe independently. The anesthesia team must still closely monitor and actively manage the airway throughout the procedure.
The surgical team continuously administers supplemental oxygen, usually through a nasal cannula or a small mask, to ensure adequate oxygen saturation. Sophisticated monitoring devices track the patient’s respiratory status, including a pulse oximeter (measuring blood oxygen) and capnography (measuring exhaled carbon dioxide). Capnography provides a real-time assessment of ventilation, allowing the team to detect subtle changes in breathing depth or rate immediately.
If the sedated patient’s airway becomes partially blocked (often due to the tongue relaxing), the surgical team performs immediate, non-invasive interventions. These techniques include manual maneuvers like the jaw thrust or the chin lift, which physically reposition the jaw and head to open the airway. In some instances, an oral or nasal airway device—a temporary tube placed into the mouth or nose to hold soft tissues open—may be used for support. Maintaining a patent airway without a breathing tube is the defining feature of IV sedation for this procedure.