All about the local anesthesia for wisdom teeth

local anesthesia for wisdom teeth

Wisdom teeth removal is a common dental procedure, but is feared among the folks due to pain experienced during the surgery. Although the local anesthetic injection given before the surgery numbs the wisdom tooth and gums and makes the procedure painless. In this blog, I will describe all the details you need to know about local anesthesia for wisdom teeth. 

Epidemiology of wisdom teeth removal

According to surveys on the finish population, 90% of 20-year-olds have at least erupted one wisdom tooth, and at 32 years, 67% have had one wisdom tooth removed in the studied population.  

The complexity of the wisdom teeth surgery

Wisdom tooth extraction can range from simple, uncomplicated, to complicated surgical extractions. 

Simple extractions

Erupted wisdom teeth can be easily removed with forceps after laxation. The procedure mimics other tooth extractions with mild pain experienced during and after the surgery. 

Surgical extraction 

Surgical removal of wisdom teeth involves impacted teeth or erupted teeth with flared or curved roots that cannot be removed without removing the bone and soft tissues. The surgery requires adequate anesthesia to make the procedure painless as the procedure is relatively long and requires significant trauma to the tooth surrounding structures. 

Click the link for full article on, 8 First signs of wisdom teeth coming in.

Anesthesia used for wisdom teeth 

Most patients avoid or delay wisdom tooth extractions because of the fear of pain experienced during surgery. Wisdom teeth require adequate anesthesia to make the process pain-free. 

The wisdom teeth extractions are usually carried out under local anesthesia. However, general anesthesia may be given in some circumstances. 

Click the link for full article on, How long does local anesthesia last?

Types of local anesthesia for wisdom teeth removal

There are two types of local anesthesia given for wisdom teeth extractions. 

  • Infiltration anesthesia 
  • Nerve block 

Infiltration anesthesia for upper teeth

Infiltration anesthesia is deposited at local surgical site to numb the tooth and its surrounding soft tissues. The bone of the upper jaw is spongy. It allows the anesthetic drug to penetrate deep into the bone, and that’s why infiltration anesthesia is well suited for upper wisdom teeth extractions.  

The anesthetic injection is given in the furrow between the cheek and gums above the wisdom tooth in the upper wisdom tooth extractions. 

A few drops of anesthetic drug are also deposited towards the roof of the mouth next to the upper wisdom tooth to numb the palatal gums and nerves. Palatial injection is quite painful as the lining of the mouth is tightly adhered to the palatal bone (roof of the mouth).


The following complications can occur from infiltration anesthesia, but the good news is these complications are reversible:

  • Altered sensation in the anesthetized area 
  • Fainting 
  • Allergic reaction 
  • Bruising 
  • Facial paralysis 
  • Infection 
  • Reduced mouth opening 

Nerve block for upper teeth (PSA nerve block)

In some cases, the dentist prefers to give an upper nerve block. The posterior superior alveolar (PSA) nerve block numbs the upper molars (back teeth). It is 95% effective in numbing molars and soft tissues. 

It is given above and behind the upper wisdom tooth, where the PSA nerve descends to enter the bone through a hole. 

The anesthesia is obtained in 5-10 mins and lasts for 60-90mins. The PSA nerve block also numbs the roof of the mouth, so you don’t have to go for painful palatal anesthesia.


This block is associated with eye complications such as bruising, transient double vision (35% cases), blurred vision, and temporary blindness. These complications are temporary and occur due to the penetration of local anesthetic up into the eye socket. 

Nerve block for lower wisdom teeth removal (IAN nerve block) 

Lower wisdom teeth removal requires numbing the main nerve trunk. The compact and dense bone in the back of the lower jaw doesn’t allow anesthetic drugs to penetrate deep into the bone and, therefore, anesthetic drug is deposited before the nerve enters the lower jawbone.

Inferior alveolar nerve (IAN) block is given in the lower jawbone behind and above the lower wisdom tooth before the IAN nerve enters the bone through a hole. The IAN nerve then follows its course in a bony canal and gives branches to lower teeth, gums, skin and muscles. 

By blocking this large nerve trunk, the sensation of the tongue, lower lip, back teeth, and gums are lost. You will feel heaviness in the tongue and lips when the anesthetic becomes effective.


The complications of nerve block are reversible and resolve within 10 mins – 1.5 hours.

  • Pain and reduced mouth opening because of the tear at the injection site. 
  • Facial paralysis may occur due to the penetration of anesthesia into the parotid salivary gland, which lies behind the space where anesthesia is supposed to be deposited.
  • Needle breakage at the site of injection.
  • Bruising due to damage to blood vessel.
  • Drooping eye.
  • Necrosis of the skin of the chin.

General vs. local anesthesia for wisdom teeth – which is better?

Wisdom teeth can be extracted under local or general anesthesia. Local anesthesia is safer because it makes the process painless without losing consciousness and hospital admission. You can also go home as soon as the procedure is done. 

General anesthesia is preferred in anxious, mentally disabled patients, or when the extraction is performed in conjunction with another procedure that requires anesthesia. 

It may be given to extract all four impacted wisdom teeth if you wish to remove all of them at once. 

Click the link for full article on, What to eat after wisdom teeth removal?

The local anesthetics used to numb wisdom teeth

Lidocaine is the most common anesthetic used for local anesthesia. For wisdom extraction, the best results are achieved with 2 or 4% articaine and lidocaine. 


Wisdom teeth extractions are avoided because of the fear of pain during and after wisdom teeth surgery. That’s why local anesthesia is given to numb the tooth so you won’t feel any pain during the procedure. However, pressure is felt during the procedure, which must be differentiated from the pain. 

Infiltration anesthesia is given for the upper wisdom teeth removal and nerve block for the lower extractions.

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