Tooth removal, formally known as extraction, is a common procedure in dentistry necessary when a tooth is damaged, diseased, or compromises overall oral health. The decision of which dental professional performs the extraction depends entirely on the complexity of the procedure required. Simple, visible teeth can often be removed by a general practitioner. More complicated cases involving surgery or specialized sedation are typically referred to a surgical specialist. The level of invasiveness and potential complications are the primary factors that dictate the appropriate provider.
Routine Extractions Performed by General Dentists
General dentists, who hold a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree, are fully qualified to perform straightforward extractions. These procedures are classified as “simple” because they involve removing a tooth that is fully visible above the gum line and has a relatively intact structure. The tooth is generally loose or easily accessed with dental instruments.
A simple extraction is non-surgical and does not require an incision into the gum tissue or the removal of surrounding bone. The dentist uses an instrument called an elevator to gently loosen the tooth from the periodontal ligament and then removes it with forceps. These routine procedures are commonly performed on teeth that are severely decayed, fractured above the gum line, or are being removed for orthodontic treatment. Local anesthesia is used to numb the area, allowing the procedure to be completed comfortably within the general dental office setting.
When Specialized Care is Needed: Oral and Maxillofacial Surgeons
When an extraction involves complications or requires surgical intervention, the patient is usually referred to an Oral and Maxillofacial Surgeon (OMS). OMS is one of the twelve dental specialties recognized by the American Dental Association, signifying advanced, specialized training beyond general dental school. An OMS completes a rigorous hospital-based surgical residency program lasting a minimum of four to six years. This extensive training prepares them to manage the full range of surgical procedures involving the mouth, jaws, face, and surrounding structures.
The OMS is the appropriate specialist for surgical extractions required when a tooth is not easily accessible. This includes teeth that are impacted, meaning they are partially or completely trapped beneath the gum line or jawbone, such as wisdom teeth. These procedures often necessitate making an incision in the gum tissue and sometimes require the removal of overlying bone or sectioning the tooth into smaller pieces. Complex cases like teeth broken off below the gum line or those with severely curved or tangled roots also fall under their expertise.
The OMS is uniquely trained to administer all levels of sedation and anesthesia, including intravenous (IV) sedation and general anesthesia. This is often necessary for longer or more anxiety-provoking surgical extractions. The OMS also manages extractions for patients with complex medical histories, such as those on blood-thinning medications or those with compromised immune systems. Specialized surgical planning is necessary to mitigate risks in these cases.
Determining the Right Specialist for Your Procedure
The general dentist serves as the initial point of contact and primary assessor, determining whether a case is routine or requires specialized surgical expertise. This initial assessment involves a detailed clinical examination and analysis of diagnostic imaging, such as X-rays or three-dimensional cone-beam computed tomography (CBCT) scans. The dentist looks for specific anatomical and procedural factors that necessitate a referral to a surgeon.
A referral is triggered when the tooth’s position is too close to major anatomical structures, such as the inferior alveolar nerve in the jaw or the maxillary sinus cavity. The degree of impaction, especially with wisdom teeth, is a significant factor, as is the presence of surrounding pathology like cysts or tumors. The need for deep sedation or general anesthesia, which general dentists are typically not qualified to administer, is another common reason for immediate referral.