A general dentist can remove wisdom teeth, but this ability depends on the procedure’s complexity and the patient’s specific oral health circumstances. Wisdom teeth, or third molars, are the last set of teeth to emerge, typically appearing between the ages of 17 and 25. Many people lack the necessary jaw space for these molars to erupt properly, often leading to impaction or growth at an unfavorable angle. The decision to proceed with extraction in a general practice setting or refer to a specialist is based on a detailed assessment of the tooth’s position and the anticipated difficulty of removal.
The Scope of the General Dentist
A general dentist is qualified to perform many routine extractions, which are classified as “simple extractions.” This method is suitable for a third molar that has fully erupted into the mouth and has a relatively straight root structure, allowing for clear access.
During a simple extraction, the dentist uses instruments like an elevator to gently loosen the tooth from the periodontal ligament and forceps to remove it. This process involves minimal manipulation of surrounding tissue and bone. Since the tooth is visible and accessible, the procedure is generally faster and requires only local anesthesia. Simple extractions result in less post-operative swelling and a shorter recovery time for the patient.
When a Specialist is Necessary
Complex cases involving third molars often require a referral to an Oral and Maxillofacial Surgeon (OMS). An OMS is a dental specialist who has completed extensive hospital-based surgical and anesthesia training after dental school. This advanced training is necessary for procedures that fall under the category of surgical extraction.
The primary reason for referral is impaction, where the tooth is trapped beneath the gum tissue or embedded in the jawbone. Impaction is categorized by depth and angle, such as soft tissue, partial bony, or full bony impaction, all requiring a more invasive approach. Proximity to major anatomical structures is also a factor; the roots of lower third molars may be related to the inferior alveolar nerve, which provides sensation to the lower lip and chin. If a patient requires deep intravenous (IV) sedation or general anesthesia for comfort, an OMS is the appropriate provider, as they are trained to administer and monitor these levels of anesthesia safely.
Pre-Extraction Assessment and Planning
Before any extraction is scheduled, a thorough diagnostic process must be completed to determine the procedure’s complexity. This assessment begins with a clinical examination and a review of the patient’s medical history. The fundamental diagnostic tool is the panoramic X-ray, which provides a two-dimensional view of all teeth, jawbones, and surrounding structures in a single image.
The panoramic film allows the clinician to analyze the third molar’s angulation, root morphology, and relationship to the second molar. It also shows the path of the inferior alveolar nerve canal, visualized as two parallel lines running through the mandible. If the two-dimensional image suggests an intimate relationship between the nerve canal and the tooth roots—indicated by signs like root darkening—a Cone-Beam Computed Tomography (CBCT) scan may be ordered. The CBCT provides cross-sectional slices that accurately map the precise spatial relationship between the tooth and the nerve, which helps minimize the risk of nerve injury and confirms the appropriate surgical plan or referral.
What Happens During the Procedure
The patient experience during wisdom tooth removal is managed through various pain control and anesthesia options chosen based on the case complexity and patient preference. For simple extractions, local anesthesia, which numbs the specific area, is often sufficient, sometimes combined with nitrous oxide (laughing gas) for mild relaxation. Complex or surgical extractions commonly utilize IV sedation, often called “twilight sleep,” which minimizes anxiety and awareness, or general anesthesia, where the patient is fully unconscious.
A surgical extraction involves making an incision in the gum tissue to access the impacted tooth. The surgeon may need to remove a small amount of surrounding bone with a surgical drill to create a pathway for removal. To minimize bone removal and trauma, the tooth is often sectioned, or cut into two or more smaller pieces. Once all fragments are removed, the site is flushed with sterile saline to clean the socket, and sutures are placed to close the gum tissue. A folded gauze pack is placed immediately over the extraction site to encourage the formation of a blood clot, which initiates the healing process.