The question of whether a dentist will put you to sleep for a tooth extraction depends on the procedure’s complexity and your individual needs. Local anesthesia to numb the site is the standard for all extractions, but various levels of sedation are available to manage pain and anxiety. For simpler extractions, you remain fully awake. For more involved procedures, a dentist or specialist can provide options ranging from feeling relaxed to being completely asleep.
The Spectrum of Anesthesia for Tooth Extraction
The experience of a tooth extraction can be tailored through a continuum of anesthetic and sedative options, moving from localized numbing to full unconsciousness. The most common method, local anesthesia, involves injecting a drug like lidocaine or articaine directly into the tissue around the tooth to block pain signals. This technique ensures you feel no pain at the site, and you remain completely awake throughout the procedure.
A step above local anesthesia is minimal sedation, often achieved with nitrous oxide, commonly known as laughing gas, which is inhaled through a nasal mask. This gas produces euphoria and relaxation, helping to alleviate mild anxiety without causing you to lose consciousness. The effects wear off quickly once the mask is removed, often allowing you to drive yourself home immediately afterward.
For patients with moderate anxiety or for slightly longer procedures, moderate sedation may be used, administered orally with a pill or intravenously (IV). With oral sedation, you become drowsy but remain conscious and able to respond to verbal commands, though you may not remember parts of the procedure. IV sedation provides a deeper state, often called “twilight sleep,” where the sedative is delivered directly into the bloodstream, allowing the provider to precisely control the depth of relaxation.
The deepest end of the spectrum is deep sedation or general anesthesia, which is what most people refer to as being “put to sleep.” Under general anesthesia, you are completely unconscious, unresponsive to stimuli, and have no memory of the extraction.
When Is Full Sleep (General Anesthesia) Necessary?
Full sleep, or general anesthesia, is not the default for a routine tooth extraction but is used when clinical factors or patient needs demand complete unconsciousness. One primary justification is the complexity of the extraction itself, such as the removal of impacted wisdom teeth that are deeply embedded in the jawbone.
Extreme dental anxiety or phobia, known as odontophobia, is another common reason for choosing full sleep. For patients whose fear is so severe that it prevents them from cooperating or sitting still, general anesthesia provides the necessary psychological comfort. It is also used for patients with certain physical or intellectual disabilities who may be unable to remain cooperative or still for the duration of the surgery.
Procedures that involve removing multiple teeth at once, or a combination of extraction and other oral surgeries, may also be performed under general anesthesia. This allows the dental team to complete all necessary work in a single, controlled session. Younger pediatric patients may also receive general anesthesia for extractions to ensure their safety and prevent movement during the surgery.
Who Administers Dental Sedation and Anesthesia?
The professional permitted to administer sedation depends on the depth of the sedative agent and the specific training they have received. General dentists are licensed to administer local anesthesia and minimal sedation, such as nitrous oxide, and often provide oral moderate sedation.
For deeper levels of sedation, including IV moderate sedation, deep sedation, and general anesthesia, specialized training is required, often necessitating a separate state permit or license. Oral and Maxillofacial Surgeons (OMS) receive extensive hospital-based training that prepares them to safely administer all levels of anesthesia, making them the most common providers for procedures requiring deep sleep. They are equipped to manage the patient’s airway and vital signs during these processes.
A third category of provider is the Dental Anesthesiologist, a dentist who has completed a minimum of three years of postgraduate residency focused entirely on administering anesthesia. These specialists often work as mobile providers, coming into a dental office or surgical center to focus solely on managing the patient’s anxiety and pain. This allows the operating dentist to focus only on the extraction.
Preparing for and Recovering from Sedation
For any procedure involving moderate sedation, deep sedation, or general anesthesia, you will be instructed to fast. This means you must not eat or drink anything for a specific number of hours before the appointment. This safety measure prevents the aspiration of stomach contents into the lungs while you are in a deep state of relaxation.
You must arrange for a responsible adult to drive you home and remain with you for several hours following any procedure involving sedation beyond nitrous oxide. Sedative medications impair motor skills and judgment, making it unsafe to drive or operate machinery for up to 24 hours.
Pre-Procedure Attire
Wearing comfortable, loose-fitting clothing is recommended. You should also avoid wearing makeup or nail polish, as these can interfere with monitoring devices that measure your oxygen levels.
After the procedure, it is normal to feel groggy, dizzy, or slightly nauseous as the sedatives wear off. The recovery time varies; while the immediate effects of nitrous oxide dissipate within minutes, the effects of IV sedation or general anesthesia can linger for the rest of the day. You should plan to rest for the remainder of the day, avoid strenuous activity, and refrain from making any important decisions until the effects have completely cleared.