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Are you put to sleep to have a tooth pulled?

Having a tooth pulled can be an anxiety-provoking experience for many patients. The thought of having a tooth extracted from your mouth may conjure up images of intense pain and discomfort. However, modern dental techniques have made tooth extractions a much less painful procedure than in the past. One question that often arises is whether you need to be put to sleep, or undergo general anesthesia, for a simple tooth extraction.

Local Anesthesia vs General Anesthesia for Tooth Extractions

For most routine dental extractions, only local anesthesia is required. This involves injecting an anesthetic agent like lidocaine or novocaine around the tooth and gumline to numb the area. With local anesthesia, you remain awake and conscious during the extraction procedure. The dentist will make sure the area is fully numb before attempting to remove the tooth.

General anesthesia provides a deeper level of sedation and is usually reserved for more complex extractions that require surgery, such as removal of impacted wisdom teeth or multiple teeth in one visit. With general anesthesia, you are put in a controlled state of unconsciousness while the tooth extraction takes place. You will not be aware of anything happening during the procedure and will not experience any pain or discomfort.

Here are some key differences between local and general anesthesia for tooth extractions:

  • Local anesthesia only numbs the localized area around the tooth, while general anesthesia affects the whole body.
  • With local anesthesia you remain awake and conscious, but with general anesthesia you are fully asleep.
  • Local anesthesia wears off relatively quickly (within a few hours), while general anesthesia requires a longer recovery period to fully wake up from the sedation.
  • Local anesthesia is administered simply with injections to the mouth, whereas general anesthesia is induced through intravenous medications or inhaled gases.
  • Extractions under local anesthesia can be performed at a regular dentist office, but general anesthesia requires facilities and monitoring capabilities of hospitals or surgery centers.
  • Local anesthesia costs significantly less than general anesthesia, which requires additional medication, equipment and specialist fees.

For most simple or non-surgical extractions, such as pulling a damaged molar or cracked tooth, local anesthesia is able to provide sufficient numbness and pain control. However, general anesthesia may be recommended for complex impactions or people with dental phobias who experience extreme anxiety.

When General Anesthesia is Necessary for Tooth Extractions

Here are some of the most common situations where general anesthesia is required for a tooth extraction:

  • Impacted wisdom teeth – Wisdom teeth are positioned at the very back of the mouth, making them difficult to numb sufficiently in some cases. They also often require surgical cutting of gum tissue to access and remove the impacted tooth.
  • Multiple extractions – Taking out numerous teeth in a single visit often requires a deeper sedation method like general anesthesia to keep the patient fully relaxed.
  • Children or patients with special needs – Young patients and those with intellectual or developmental disabilities may have difficulty cooperating with local anesthesia alone.
  • Infected teeth – Teeth that are severely infected are often more painful, so general anesthesia can provide greater comfort.
  • Complex tooth roots – Teeth with curved or hooked roots can be very challenging to extract if only local anesthesia is used.
  • Dental phobia – Patients with an intense fear of dental procedures may request general anesthesia to remain completely unaware of the extraction process.
  • Low pain tolerance – Some people are unable to tolerate the pressure or sensations during an extraction, even with sufficient local anesthesia.

For the majority of simple extractions of teeth without complications, local anesthetic is used successfully by dentists. However, general anesthesia provides an option for more complex cases or patient populations who require deeper sedation for tooth removal procedures.

What to Expect During Local Anesthesia for Tooth Extraction

If your dentist determines that local anesthesia alone will be sufficient for your upcoming tooth extraction, here is a general timeline of what you can expect during your appointment:

  1. Numbing injections – The dentist will first use a very thin needle to inject anesthetic around the base of the tooth and into the gumline. You may feel some slight pinching or pressure during the injections.
  2. Waiting for numbing – It takes several minutes for the anesthetic to take effect in the mouth tissues. Your tongue and cheek area around the extraction site will gradually start to feel numb.
  3. Testing and re-numbing – The dentist will verify that the area is fully numbed by poking it with a dental instrument. If you still feel any sensation, more anesthetic may be administered.
  4. Extraction process – Once completely numb, the dentist uses instruments like elevators and forceps to loosen and remove the tooth. You may feel pressure or tugging but should not feel sharp pain.
  5. Gauze placement – After the tooth is extracted, a piece of gauze is placed over the empty socket to bite down on and stop bleeding.
  6. Numbing wears off – Within a few hours, sensation will return to your mouth as the anesthetic completely wears off.

Under local anesthetic alone, you remain fully conscious during the extraction. While you do not feel any pain, you may hear sounds of the dental instruments and feel some movement or pressure in your mouth during the procedure. Inform your dentist right away if you feel any sharp sensations once numbness sets in.

General Anesthesia Protocol for Tooth Extractions

If your dentist recommends using general anesthesia for your tooth extraction, you can expect a more involved process before, during and after the procedure:

  1. Evaluation – You will undergo medical tests to ensure you are healthy enough for anesthesia.
  2. Fasting – For several hours before the extraction, you cannot eat or drink anything.
  3. IV insertion – An intravenous line is started, usually in your arm, to deliver anesthesia medication.
  4. Monitor placement – Sensors will be placed on your body to observe vital signs like heart rate and oxygen levels.
  5. Anesthesia induction – Medication is administered through the IV line, causing you to fall asleep in seconds.
  6. Tooth removal – The extraction is performed while you are in a controlled state of unconsciousness.
  7. Waking up – After the extraction is complete, the anesthetic medications are stopped and you gradually wake up.
  8. Recovery period – You are moved to a recovery area while the anesthesia wears off completely.

Since you are fully asleep and unconscious for the entire extraction process, you will not remember any part of the procedure. General anesthesia creates a pain-free experience so even complicated tooth extractions can be performed comfortably.

Anesthesia Safety Considerations

Both local anesthetics and general anesthesia are very safe when administered by qualified dentists and oral surgeons. However, it is important to keep the following precautions in mind:

  • Be sure to disclose your complete medical history, including any prior reactions or allergies to anesthesia medications.
  • Follow your dentist’s instructions precisely before the extraction, such as fasting or adjusting medications.
  • Arrange for a ride home, as you cannot safely drive after being sedated.
  • Have someone stay with you for several hours after the procedure to monitor side effects.
  • Refrain from making important decisions or operating heavy machinery while residual anesthetic effects remain.
  • Discuss all concerns about anesthesia with your dentist so that the optimal method can be chosen.

Both local and general anesthesia are designed to reduce pain and anxiety around tooth extractions. Discuss your situation with an experienced dentist to determine the best anesthetic option for your needs.

Pros and Cons of Local vs General Anesthesia

When deciding between using local or general anesthesia for a tooth extraction, there are both advantages and disadvantages to each type of numbing method to consider:

Pros of Local Anesthesia

  • Simple injection with fast onset of numbness
  • Wear off quickly allowing normal function
  • Lower costs and usually covered by dental insurance
  • Minimal side effects and quick recovery
  • Performed safely in a regular dental office
  • Patient remains conscious and can communicate

Cons of Local Anesthesia

  • May not be strong enough anesthesia for some patients
  • Can cause temporary numbness of tongue or lip
  • Does not numb deep pain as effectively
  • Anesthetic injection may be uncomfortable
  • Possible allergic reaction in rare cases

Pros of General Anesthesia

  • Patient remains completely unconscious and unaware
  • Allows for extensive, prolonged procedures with no pain
  • Useful for complex extractions or patient apprehension
  • May be the only option for some patients due to medical/behavioral reasons

Cons of General Anesthesia

  • Invasive administration through IV and intubation
  • Deeper sedation has more risks of side effects
  • Requires extensive monitoring of vital signs
  • Longer recovery period after procedure
  • May feel groggy for several hours afterwards
  • Much higher cost compared to local anesthetic

For many routine and minimally invasive extractions, local anesthetic can provide sufficient numbness while avoiding the risks and costs of general anesthesia. However, general anesthesia remains an important option for more complex cases. Talk to your dentist about which choice may be right for your individual extraction scenario.


While both local and general anesthesia effectively numb pain, most simple tooth extractions only require local numbing injections. More complex impactions or patients with dental phobias may need the deeper sedation of general anesthesia. Safety is paramount with both forms of anesthesia, so disclose your health background thoroughly. If you have concerns about pain or anxiety for an upcoming extraction, speak to your dentist about whether local or general anesthesia would be the better fit for your case.