Anesthesia Options for Wisdom Teeth Surgery

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Hi, I’m Dr. B, practicing functional dentist for 35 years. I graduated from the Dugoni School of Dentistry in San Francisco, CA in 1987 and am a member of the American Academy of Dental Sleep Medicine (AADSM), Academy of General Dentistry (Chicago, IL), American Academy for Oral Systemic Health (AAOSH), and Dental Board of California. I'm on a mission to empower people everywhere with the same evidence-based, easy-to-understand dental health advice that my patients get. Learn more about Dr. B

Q: 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

Learn More: Wisdom Teeth Surgery: 6 Ways to Recover Faster