Anesthesia Options for Wisdom Teeth Surgery

I have to get my upper left wisdom tooth removed. Should I get the needle or go to sleep? What should I be aware of?

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Anesthesia Options for Wisdom Teeth Surgery

I have to get my upper left wisdom tooth removed. Should I get the needle or go to sleep? What should I be aware of?

A: Let me just give you the quick version of the dialogue I give my patients in this common question.

Having had my wisdom teeth taken out myself and having taken wisdom teeth out, I think I can give you a clear and concise way of making this decision for yourself.

There are three ways to be anesthetized when taking wisdom teeth out.

  1. Local anesthesia (as if you were getting a filling done)
  2. Twilight / semi-conscious sedation (a needle in the arm and you’re a big groggy and unaware of your surroundings, but not fully asleep)
  3. General anesthesia (the same you’d get for heart surgery).

The latter two can often involve complications and make your recovery more difficult and more unpleasant due to the half-life of these drugs. I find that many people have actually recovered from the surgery and afterward, are still recovering from the drugs that are still in the bloodstream.

This is not to say that you should not use these latter two methods. For some people, it is mandatory due to anxiety, fear, or complexity of the surgery. There are a time and place for these methods. However, I feel many patients too quickly defer to their peers suggestions and surgeons recommendations.

What I recommend for the majority of my patients is expertly administered local anesthesia and a healthy dose of nitrous oxide. The local anesthesia completely blocks the pain and the nitrous oxide manages anxiety and produces an amnesic effect that, in the end, is the near equivalent (in terms of awareness) of the last two methods of anesthesia mentioned in the list above.

There is some truth to the notion that semi-conscious sedation and full anesthesia are recommended for the convenience of the oral surgeon. These deeper states certainly can speed things up, making the surgical procedure quicker and more efficient and reducing time involved communicating with the patient. Unfortunately, you will also find that insurance doesn’t cover these last two deeper methods, potentially making them an expensive proposition.

Nitrous is also not covered by insurance, but costs a fraction of what the deeper states of anesthesia cost. Another worry that I have is that, under those deep states of anesthesia, your muscles relax to a point where the surgeon may inadvertently over-open your jaw to gain access and to facilitate the removal of the teeth. In the long run, this could cause weeks or months or even longer states of TMJ, joint pain, jaw joint pain, and muscle pain.

Under local anesthesia and some nitrous, this is less likely to occur. This jaw and muscle issue also adds to the long recovery times previously mentioned.

In the end, this is a decision that you have to make for yourself. If the first option I listed makes the most sense for you and your oral surgeon, your recovery will be shorter and, in the long run, less of an issue.

In the end, it becomes a personal decision. Discuss with your oral surgeon all of the above and the two of you will be able to make the right decision for your case.

More focus is put on what goes on during the surgery in terms of anxiety and pain when the focus, I believe, should really be put on what happens within the first 18 hours after the surgery. Effective pain management is key during this time. We’ll bring up the topic of wisdom teeth surgery recovery in a later post.

Sometimes very effective during wisdom teeth surgery – if you’re choosing the first option – is to bring an iPod with some of your favorite music. However, be forewarned that the one song that you play just before the nitrous kicks in will be the song you always associate with the butterflies in your stomach just before your surgery. To this day, the song Johnny Come Home by Five Young Cannibals brings back the feelings from that day.

Mark Burhenne DDS

Read Next: Wisdom Teeth Surgery: 6 Ways to Recover Faster

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  1. This is a very helpful article I must say!

    I am having my wisdom teeth removed in the next two weeks. I am doing it at a local hospital, I am terrified as ever but after reading this article I am sure everything will go accordingly. Atleast I am schooled now 🙂


  2. You can certainly see your expertise in the work you write.
    The arena hopes for even more passionate writers such as you who aren’t afraid
    to mention how they believe. All the time go after your heart.

  3. I have to get all of my remaining top teeth and all 4 wisdom teeth removed. They have told me that they will prescribe valium to take an hr before my appointment. Does this have the same effect as nitrous? I am a wreck just thinking about being awake for all of it…pleas e help shed some light on this. They keep telling me with the valium and local I will be fine but I tend to get extremely anxious and my heart races. Thank you in advance!

    • I’m just like you with anxiety and increased heart rate. May I ask how it went? We’re you put to sleep?

      • Beth umholtz says:

        My daughter didn’t go to sleep today while having 4 wisdom teeth removed! Is this normal? She heard and felt it all! I am so mad! She sad she screamed! I went to ask how she was doing! They said we will let you know when she is done! She is very anxious! But I think this was rediculous!

        • Mark Burhenne, DDS says:

          Hi there, Beth.

          Actually, many people have wisdom teeth removed without full sedation. The dentist should have used something to numb her, but she still would be able to feel the pressure. She should have not been in pain, but depending on her personality, this could be scary. I hope this helps.

  4. Thank you for helping me to ease my own fears. My teenage son will be having his four wisdom teeth out next week using nitrice oxide and a local. I was worried that I would be traumatizing him by not pushing for him to get put out. Our oral surgeon did say it was our choice but that recovery would be quicker this way ( my son’s concern) and that he would be aware, but not care. We are bringing the music. I cannot thank you enough for such a down to earth description of the options.

  5. I appreciate this very much. My 19 yo son went in for the eval without me and came back with an estimate for general anesthesia. I was surprised at this, and surprised to hear from his friends that they all went under. This was informative and I will have a conversation with the doc!

  6. It is a good option to go for sedation dentistry if you are anxious of visiting to a dentist. A dentist uses local anesthesia while doing wisdom tooth extraction surgery. The levels of the sedation are different for different surgeries. I thought about the option of using needle for myself but it is looking very tough for me.

  7. My top right wisdom tooth is coming back through and I would love to be completely under the whole time. Mostly because I can’t handle the pain and discomfort. Is it normal for your wisdom tooth to come back through?

  8. At different occasions I had my root canal done (in one tooth) and a wisdom teeth taken out (it was like normal tooth- well developed). Both under local anesthesia without any issue. I could feel the pressure but no pain. I like local vs. general because I could see/feel what’s going on. If anything wrong happens (e.g. wrong tooth is worked on), I would know and stop it. With local very little maintenance after the procedure.

    But, my case can’t be applied everywhere because I have higher tolerance for pain and also I am mostly fearless person. I only shared my experience.

  9. hi, i am having my bottom right wisdom out in 3 days… & would like to know if getting local and nitrous is better than being put out? if so? i ask why? & will i feel anything??? i have reall bad anxiety.. and would like to know…

  10. Gabrielacuevas says:

    I need my two bottom wisdom tooth out. The Dr. submitted a request for general anesthesia but the insurance denied it so I called the office and told them you it’s okay I want to do it local and the receptionist said okay we can schedule dije did then they called me that they sent the request with more detail so it gets approved because the Dr. doesn’t want to it without general anesthesia because he has to cut a bone. I really don’t want to be put under anesthesia do I have to or by law can I refuse to get general anesthesia?

  11. Braden Bills says:

    I’m going to need to have my wisdom teeth taken out. It’s nice that there are different anesthesia options for that! It would be nice to be completely unconscious for the procedure.

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