Completing extraction of a tooth is not always predictable- the tooth is coming out for a reason, and not because it is healthy! This typically means large decay on the tooth, infection/abscess of the bone or soft tissue around the tooth, or the tooth is impacted under the tissue or bone. Sedation is the only way to ensure the patient is completely comfortable regardless of how difficult the procedure.
Local anesthesia is not necessarily safer for sick patients. Many patients referred to us have complicated medical histories, including cardiac or lung issues. Achieving local anesthesia requires multiple painful injections and is not always completely effective. This can lead to issues due to pain causing elevated blood pressure/heart rate/respiratory rate that can create problems in medically compromised patients. Sedation allows us to control these variables and complete the procedure quickly and comfortably which results in fewer medical complications.
It is not always possible to get the tooth/bone completely numb with local anesthesia. Due to infection/inflammation of the bone or soft tissue around the tooth, local anesthesia alone cannot always achieve complete numbness during the procedure. Sedation allows us to know that the procedure can be completed comfortably. Attempting surgical procedures with local results in increased patient discomfort, a prolonged surgical time, and possibly not being able to complete the procedure.
We are a surgical specialty- this is not dentistry. We are not doing fillings. Surgery on every other part of the body is completed under anesthesia. We are performing highly invasive procedures on the bones and soft tissue of the facial skeleton. Completing these procedures under local anesthesia would not be an option for an ENT or orthopedic surgeon.
The dentist has referred the patient to us for a reason and a general dentist is fully capable of performing extractions under local anesthesia. If the dentist is not comfortable performing the extraction it is because of a highly difficult aspect of the procedure: high risk of a tooth breaking during procedure, risk of injury to nearby structures (sinus cavity, nerve, etc), inability to achieve adequate numbing, or patient specific factors such as a complicated medical history. The ability to provide sedation allows us to complete the procedures comfortably and safely for the patient which is why they are being referred to us!