Wisdom teeth, also known as third molars, are the last set of teeth to develop, typically emerging in the late teens or early twenties. They often require extraction because they become trapped or “impacted” in the jawbone or soft tissue, leading to pain, infection, or damage to neighboring teeth. The decision of who performs the extraction—a general dentist or a specialist—is a common question that depends almost entirely on the complexity of the case. While both professionals are trained to remove teeth, their expertise and facility capabilities dictate which one is best suited for a patient’s specific needs.
The General Dentist’s Scope
A general dentist acts as the primary care provider for most routine dental health needs, including simple extractions. They are well-equipped to handle straightforward wisdom tooth removals where the tooth is fully erupted and visible above the gum line. These cases typically involve a tooth with a simple root structure that can be removed without the need for extensive surgical techniques. The procedure usually takes place in the general dentist’s office using local anesthesia to numb the immediate area around the tooth.
The general dentist will use instruments like elevators and forceps to loosen and remove the tooth without the need for incisions. If the tooth presents with signs of an infection, the dentist will often prescribe antibiotics to clear the infection before proceeding with the extraction. A general dentist may choose not to perform the procedure if they determine the case is beyond their comfort level or practice limitations, referring the patient to a specialist to ensure the safest outcome.
The Oral and Maxillofacial Surgeon
The Oral and Maxillofacial Surgeon (OMFS) is a dental specialist who has completed four years of dental school followed by an additional four to six years of hospital-based surgical residency training. This extensive training focuses on the mouth, jaw, face, and neck, including surgical procedures, pathology, and advanced anesthesia techniques. For wisdom teeth, the OMFS is the preferred provider for complicated extractions, particularly those involving impaction.
This specialist is uniquely qualified to manage fully impacted teeth—those completely covered by bone or soft tissue—and teeth growing at challenging angles, such as horizontally or distoangularly. Their surgical skill allows for precise removal of the tooth and any necessary surrounding bone, often involving sectioning the tooth into smaller pieces for easier extraction. Because of their extensive training, they are also certified to administer a wider range of sedation options, including intravenous (IV) sedation and general anesthesia, which provides a more comfortable experience for patients undergoing complex or lengthy procedures.
Determining the Extraction Setting
The choice between a general dentist and an Oral and Maxillofacial Surgeon is based on an assessment of several anatomical factors that determine the extraction’s complexity. A primary factor is the degree of impaction, ranging from a simple soft-tissue impaction to a full bony impaction, where the tooth is fully encased in the jawbone. Advanced imaging, such as dental X-rays or cone-beam computed tomography (CBCT) scans, is used to visualize the tooth’s position and root morphology.
Another consideration is the tooth’s proximity to vital structures, such as the inferior alveolar nerve in the lower jaw, which supplies sensation to the lower lip and chin. If the tooth roots are intertwined with or too close to this nerve, an OMFS’s specialized skill and surgical planning are required to minimize the risk of nerve injury. The patient’s preference for deeper sedation, like IV sedation, also dictates the setting, as this level of anesthesia is routinely and safely provided in a specialist’s office.