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Tooth extractions are commonly performed in the United States, occurring in approximately 80% of privately insured adults by the age of 25 years. Among all patients, researchers have estimated that about half undergo at least one extraction by the age of 25 years, while 70% undergo at least one extraction by age 60 1. Wisdom tooth removal is a specific tooth extraction surgical procedure aimed at removing one or more wisdom teeth, which are the four permanent adult teeth located at the back of the mouth. If a wisdom tooth does not have sufficient room to grow (i.e. is an impacted tooth), this can result in pain, infection or other dental challenges, and an individual will likely need to have it removed. Wisdom tooth removal may be carried out by a dentist or an oral surgeon and requires anesthesia.
A dentist or oral surgeon can opt to use one of three types of anesthesia, depending on the expected complexity of the wisdom tooth removal and their patient’s comfort level 2.
With local anesthesia, a dentist or oral surgeon administers anesthesia via one or more injections adjacent to the site of each wisdom tooth extraction. Prior to the injection, the dentist or surgeon will likely apply a substance to the patient’s gums to numb them. The patient remains awake during the tooth extraction, and, although they might feel pressure or movement, they shouldn’t experience any pain 3. Local anesthesia is safe and incurs very few side effects. Post-surgically, the patient may experience numbness in the cheeks, lips, and gums for a few hours.
If an individual is particularly anxious about their wisdom tooth removal procedure, their dentist or surgeon may provide them with a sedative to help them relax. Sedation anesthesia is usually administered through an intravenous line in the patient’s arm, suppressing their consciousness over the course of the procedure. In parallel, the patient will also receive local anesthesia to numb their gums. The patient will not feel any pain and will have a very limited memory of the procedure.
General anesthesia is rarely needed for wisdom tooth removal but is an option. A patient may inhale an anesthetic medication or have an intravenous line in their arm, or both. They lose consciousness during the procedure and the surgical team closely monitors their medication, temperature, breathing, fluids, and blood pressure. The patient will not experience any pain and will not have any memories of the wisdom tooth extraction. Local anesthesia is also provided to help assuage postoperative discomfort. In this case, a patient should still be able to return home on the same day as the procedure. However, they will not be able to drive themselves home after undergoing general anesthesia, and a family, friend, or caretaker will need to assist them.
Irrespective of the anesthesia approach, it is essential to follow the dentist or oral surgeon’s instructions with regard to any bleeding, pain management, swelling or bruising, activity, and beverage, food, and tobacco consumption. This will ensure a swift and healthy recovery 2.
There are many different options for anesthesia for wisdom teeth removal in order to ensure maximal safety patient well-being throughout the procedure. The decision of which option to use is based on the dentist or oral surgeon’s preference and patient-related factors.
References
1. Schroeder, A. R., Newman, T. B., Girod, S., Hashemi, S. & Häberle, A. D. Estimated Cumulative Incidence of Wisdom Tooth Extractions in Privately Insured US Patients. Front. Dent. Med. 3, 48 (2022). DOI: 10.3389/fdmed.2022.937165
2. Wisdom tooth extraction – Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/wisdom-tooth-extraction/about/pac-20395268. (Accessed: 14th April 2023)
3. Wisdom tooth removal – How it’s performed – NHS. Available at: https://www.nhs.uk/conditions/wisdom-tooth-removal/what-happens/. (Accessed: 14th April 2023)
