Tooth Extraction: When Should You See an Oral Surgeon Instead of a Dentist?

Tooth extraction is a common dental procedure, often performed to address advanced decay, gum disease, or injury. While general dentists routinely perform extractions, some cases require the advanced training and surgical expertise of an oral surgeon.

Understanding the differences between these dental professionals—and knowing when surgical intervention is necessary—can help patients make informed decisions about their oral health care.

What Is Tooth Extraction?

Tooth extraction is the removal of a tooth from its socket in the jawbone. It may be required for a variety of reasons, including:

 

• Extensive tooth decay

• Severe periodontal (gum) disease

• Fractured teeth that cannot be restored

• Orthodontic treatment planning

• Impacted wisdom teeth

• Advanced infection or abscess

 

There are two main types of tooth extractions:

Simple Extractions 

Performed on teeth that are visible and easily accessible, these procedures typically involve loosening the tooth with a dental elevator and removing it with forceps. General dentists commonly perform simple extractions.

Surgical Extractions 

Used for teeth that are impacted, broken beneath the gumline, or have unusual root anatomy. These extractions may require incisions in the gum, removal of bone, or sectioning of the tooth. They are often performed by oral surgeons.

Dentist vs. Oral Surgeon: What’s the Difference?

Both general dentists and oral surgeons are licensed to extract teeth. However, their training and scope of practice vary:

General Dentists 

General dentists are trained to diagnose and treat common dental conditions, including routine tooth extractions. They are often the first point of contact for dental concerns and can manage most straightforward cases.

Oral and Maxillofacial Surgeons 

Oral surgeons undergo an additional 4–6 years of surgical residency after dental school. Their training includes complex tooth extractions, anesthesia administration, treatment of facial trauma, and management of medically compromised patients.

Referral to an oral surgeon is often based on the complexity of the case, the patient’s health history, and the risk of complications.

When Is Surgical Tooth Extraction Necessary? 

Certain situations make surgical extraction more appropriate than routine extraction. Below are common scenarios that may require specialist care:

Impacted Wisdom Teeth 

Wisdom teeth (third molars) are often unable to erupt fully due to lack of space or misalignment. This can cause pain, swelling, or infection.

Surgical Extraction May be Required If 

• The tooth is partially or completely trapped under the gums

• It presses against adjacent teeth

• It causes recurrent infections (pericoronitis)

• Imaging shows proximity to nerves or sinuses

 

These extractions often require careful technique and may involve sectioning the tooth and removing bone.

Severely Broken or Decayed Teeth 

When a tooth fractures below the gumline or is extensively decayed, standard extraction tools may not be sufficient. The dentist may need to reflect gum tissue, remove bone, or break the tooth into sections—techniques best handled by a surgical specialist.

Infections That Spread Beyond the Tooth

Infections that extend into facial tissues or affect the airway require urgent surgical care. Oral surgeons are trained in procedures such as incision and drainage and can administer IV antibiotics or sedation if necessary.

Teeth Near Vital Structures 

Teeth located close to the inferior alveolar nerve, mental foramen, or maxillary sinus carry a higher risk of surgical complications. Advanced imaging (like CBCT scans) helps identify potential risks, and oral surgeons are equipped to handle these challenges.

Patients with Complex Medical Conditions

Individuals with conditions such as heart disease, bleeding disorders, or diabetes—or those taking anticoagulants—may require additional precautions. Oral surgeons work closely with medical providers to ensure safe treatment, including adjustments to medications or anesthesia protocols.

Signs You May Be Referred to an Oral Surgeon

Dentists typically perform a clinical and radiographic evaluation before deciding on a referral. You may be referred to an oral surgeon if:

 

• The tooth is impacted or has irregular root structure

• There’s evidence of deep infection or abscess

• The tooth is fractured below the gumline

• You require IV sedation or general anesthesia

• You have a complex health history

• A previous extraction attempt was unsuccessful

What to Expect During Surgical Extraction?

A surgical extraction typically involves multiple steps to ensure the procedure is safe and effective:

Preoperative Assessment 

The surgeon reviews your medical history, takes diagnostic imaging (e.g., panoramic X-ray or CBCT), and discusses anesthesia options and potential risks.

Anesthesia Options 

Depending on the complexity, patients may receive:

 

• Local anesthesia

• Oral sedation

• IV sedation

• General anesthesia

Surgical Procedure 

The oral surgeon may:

 

• Make a small incision in the gum

• Remove surrounding bone if needed

• Section the tooth for easier removal

Postoperative Care 

After surgery, patients are given instructions to aid healing, including:

 

• Avoiding strenuous activity

• Eating soft foods

• Managing pain with prescribed or over-the-counter medication

• Using gauze and ice to reduce bleeding and swelling

 

Complications like dry socket, bleeding, or infection are rare but manageable with professional follow-up.

When Can a General Dentist Handle the Extraction?

In many cases, tooth extraction can be performed safely and comfortably by a general dentist. You may not need to see an oral surgeon if:

 

• The tooth is fully erupted

• There are no signs of impaction or infection

• There’s minimal damage or decay

• You have a healthy medical history

• No complex sedation is needed

 

If complications arise during the procedure, the dentist may pause the treatment and refer you to a specialist to ensure safety.

Recovery and Aftercare Tips 

Whether performed by a general dentist or oral surgeon, the recovery process for tooth extraction is important. Here are general aftercare tips:

 

• Avoid smoking or using straws for 24–48 hours to prevent dry socket

• Eat soft, cool foods for the first few days

• Keep the area clean, but avoid vigorous rinsing on the first day

• Take prescribed medications as directed

• Rest and hydrate to promote healing

 

Complete healing of the socket can take several weeks, although discomfort generally subsides within a few days.

Conclusion 

Tooth extraction ranges from straightforward to complex. While many extractions can be handled by a general dentist, certain cases—such as impacted teeth, infections, fractures, or medical complexities—warrant a referral to an oral surgeon.

Understanding when to see a specialist ensures safer treatment, quicker recovery, and fewer complications. Always begin with a consultation from your general dentist—they will help determine the most appropriate path for your individual situation.

Book Your Appointment Today! 

At Stafford Oral Surgery & Specialists, we provide specialized care for complex extractions and surgical procedures. We work closely with referring dentists to ensure that each patient receives the most appropriate and effective treatment. Schedule a Consultation Today!

 

FAQs

How do I know if my tooth extraction is considered complex?

A complex tooth extraction is typically diagnosed based on clinical and radiographic findings. If the tooth is impacted, broken below the gum line, has curved roots, is close to nerves or sinuses, or requires surgical access through gum or bone, it is classified as complex.

Can a general dentist remove wisdom teeth? 

Yes, general dentists can remove erupted wisdom teeth that are fully visible and not impacted. However, if the wisdom teeth are partially or fully impacted, positioned close to the inferior alveolar nerve, or associated with recurrent infections or cysts, an oral surgeon is the appropriate specialist.

Are surgical tooth removals more painful than simple extractions?

While surgical extractions may sound more invasive, pain is typically well-managed with appropriate anesthesia and post-operative care. Oral surgeons use local anesthesia, sedation, or general anesthesia depending on the procedure and patient health. Post-surgical discomfort is common but manageable with over-the-counter or prescribed medications and proper aftercare.

What qualifications does an oral surgeon have beyond a general dentist?

Oral and maxillofacial surgeons are dental specialists who complete an additional 4 to 6 years of hospital-based surgical residency after dental school. Their training includes complex dental surgeries, management of facial trauma, anesthesia administration, and treatment of medically compromised patients. This makes them well-equipped to handle surgical tooth removals and other procedures that require specialized care.

How long does it take to recover from a surgical tooth extraction?

Recovery typically ranges from 3 to 7 days, depending on the complexity of the extraction and your general health. Most patients experience mild to moderate swelling and discomfort for the first 48–72 hours.