Tooth extraction involves removing a tooth from its socket, a necessary step when a tooth is damaged, decayed, or compromises overall oral health. Because the procedure requires specific expertise to prevent complications like infection or nerve damage, only licensed dental professionals are permitted to perform extractions. These professionals must possess the training to assess the tooth’s condition, understand the underlying anatomy, and manage pain effectively.
The Role of the General Dentist
The General Dentist (DDS or DMD) is the primary provider for most routine extractions. They are fully trained and licensed to perform simple extractions, which involve teeth fully visible above the gumline. Simple extractions apply when the tooth structure is intact enough to be grasped and the roots are relatively straight and accessible.
The procedure begins with administering a local anesthetic to numb the area. The dentist uses an instrument called an elevator to gently loosen the tooth from the periodontal ligament anchoring it to the bone. Forceps are then used to grasp the tooth crown and remove it from the socket. General dentists routinely manage these straightforward cases, including teeth removed for orthodontic planning or those severely decayed.
When a Specialist is Required
When complexity increases, a referral is made to an Oral and Maxillofacial Surgeon (OMS). These specialists complete four to six years of hospital-based surgical residency after dental school, preparing them for advanced surgical procedures. An OMS is required for surgical extractions, which involve teeth that are not easily accessible.
Surgical extractions are common for impacted teeth, such as wisdom teeth that have failed to fully erupt. They are also necessary when a tooth is fractured at or below the bone level, or when the tooth has unusually long, curved, or multiple roots. The surgical approach may involve making an incision, removing surrounding bone, or sectioning the tooth into pieces for safer removal.
Patients with complex medical conditions, such as bleeding disorders or severe heart disease, often benefit from the specialized setting and advanced anesthesia protocols an OMS provides. While the OMS is the most common specialist, a Periodontist may also remove teeth as part of advanced treatment for severe periodontal disease. The OMS is uniquely trained to manage cases requiring advanced sedation options, including deep intravenous sedation or general anesthesia. The distinction between a simple pull and a surgical procedure is determined through a clinical examination and detailed radiographic imaging, such as X-rays.
Clarifying Scope and Safety
The scope of who can legally perform a tooth extraction is strictly limited to licensed dentists and oral surgeons due to the risks involved. Dental Hygienists, Dental Assistants, and general medical practitioners (physicians or nurses) do not possess the specific training or licensing required. Attempting an extraction without proper training presents serious hazards to the patient’s health.
Non-professional attempts can result in severe complications, including uncontrolled bleeding, fractured jawbone segments, or nerve damage. A common risk is incomplete removal, where a root fragment is left behind, leading to chronic infection and pain. Furthermore, non-sterile environments significantly increase the risk of introducing bacteria into the bloodstream, potentially causing systemic infection.