From the board-certified surgical team at Galleria Oral & Maxillofacial Surgery in Roseville, CA — serving Rocklin, Folsom, Granite Bay, and the Sacramento region.
Every case is different; this article is general education to help you ask better questions, not a substitute for an individual evaluation.
Your dentist spots impacted wisdom teeth on an X-ray and says you need them out. Sometimes they offer to do it themselves. Sometimes they hand you a referral. Either way, you're left deciding where to have surgery — often without much information about why it matters.
Both routes are legitimate. The right answer depends on your specific case, and it's worth understanding the difference before you book.
The Training Difference
General dentists complete four years of dental school and are licensed to perform extractions, including some wisdom teeth. Many are skilled at it, particularly with straightforward cases, and some pursue significant additional continuing education in surgery and sedation.
Oral and maxillofacial surgeons complete dental school and then four to six additional years of hospital-based surgical residency. That residency covers complex extractions, facial trauma, jaw reconstruction, pathology, and — critically — several months of formal anesthesia training on a hospital anesthesia service. Board certification through the American Board of Oral & Maxillofacial Surgery requires passing rigorous written and oral examinations beyond residency.
In practical terms: extractions are one part of what a general dentist does. Surgery is the entirety of what an oral surgeon does.
When Your Dentist Can Handle It
A general dentist is often a reasonable choice when:
- The wisdom teeth are fully erupted and visible in the mouth
- The teeth are upright, not angled or sideways
- The roots are simple and not curved or hooked
- The roots sit well away from the inferior alveolar nerve
- You only need one or two teeth removed
- You're comfortable with local anesthesia or nitrous oxide
- You have no complicating medical conditions
Under those conditions, the procedure is genuinely routine.
When a Referral to an Oral Surgeon Makes Sense
- Impacted teeth, especially fully bony impactions requiring bone removal
- Roots close to the inferior alveolar nerve, visible on a panoramic X-ray or CBCT scan
- All four teeth being removed in one appointment
- IV sedation or general anesthesia — you want to be asleep for it
- Upper teeth close to the maxillary sinus, where a sinus communication is a risk
- Curved, hooked, or unusually shaped roots
- Cysts, lesions, or pathology around the tooth
- Significant dental anxiety or a special-needs patient
- Medical complexity — bleeding disorders, anticoagulant therapy, bisphosphonate history, immunosuppression, cardiac conditions
- A previous failed or abandoned extraction attempt
If your dentist refers you, that's not a red flag about your case. It's usually good judgment about matching the procedure to the appropriate setting.
What Anesthesia Capability Really Means
This is the difference most patients underestimate.
For a single erupted tooth, local anesthesia is perfectly adequate. For four impacted third molars — a 45- to 60-minute surgery involving incisions, bone removal, and sectioning of teeth — most patients strongly prefer IV sedation. Compare the full range in our guide to sedation options for wisdom teeth removal.
Providing IV sedation safely in an office setting requires anesthesia training, a state permit, appropriate monitoring equipment (pulse oximetry, blood pressure, ECG, capnography), emergency airway equipment and medications, and a team trained in advanced life support. Oral and maxillofacial surgeons build their practices around this capability. Most general dental offices don't.
If sedation matters to you — and for most people facing four impacted teeth, it does — that alone often decides the question.
Eight Questions to Ask Before You Book
- Are you board-certified by the American Board of Oral & Maxillofacial Surgery?
- How many wisdom teeth procedures like mine do you perform?
- What imaging will you use — panoramic X-ray or 3D cone beam CT?
- How close are my roots to the nerve, and what does that mean for my risk?
- What anesthesia options do you offer, and who administers them?
- What's your written estimate of my out-of-pocket cost after insurance?
- What happens if I have a problem at 9 p.m. on a Saturday?
- Who do I reach if I have questions during recovery?
The last two matter more than patients expect. Post-operative access is a meaningful part of the care you're paying for. For a sense of the financial side, see our wisdom teeth removal cost guide.
Why 3D Imaging Changes the Conversation
A standard panoramic X-ray is a flat, two-dimensional image. It can show that a root appears to overlap the nerve canal, but not whether the root is beside it, above it, or wrapped around it.
A cone beam CT scan renders the anatomy in three dimensions. That distinction directly affects surgical planning — including whether a coronectomy (removing the crown and intentionally leaving the root tips undisturbed) might be the safer approach for a tooth sitting directly on the nerve. If your teeth are close to the nerve, ask whether 3D imaging is part of the plan.
Finding Care in the Sacramento Region
If you're searching for wisdom teeth removal in Roseville, Rocklin, Folsom, Granite Bay, Lincoln, El Dorado Hills, Auburn, or Sacramento (see the locations we serve), look for:
- Board certification verifiable through the ABOMS
- In-office anesthesia with documented training and monitoring
- Advanced imaging available on site
- Referral relationships — surgeons that local general dentists consistently refer to have earned it
- Consistent, recent patient reviews, particularly ones describing communication and follow-up
- Transparent estimates provided in writing before treatment
Frequently Asked Questions
Is it more expensive to see an oral surgeon?
Often somewhat, reflecting specialist training, anesthesia capability, and advanced imaging. For complex impactions, that's what makes the procedure appropriate rather than optional.
Do I need a referral to see an oral surgeon?
Generally no — most oral surgery practices accept patients directly. Some insurance plans require a referral for coverage, so check your policy.
Can my dentist remove two and an oral surgeon remove the others?
Possible, but it usually means two recoveries and two anesthesia experiences. Most patients prefer one appointment.
What if my dentist already started and couldn't finish?
This happens, and oral surgeons see it regularly. Call promptly rather than waiting.
How do I verify board certification?
The American Board of Oral & Maxillofacial Surgery maintains a public directory of diplomates.
Meet the Team at Galleria
Dr. Alexander Antipov is a Diplomate of the American Board of Oral & Maxillofacial Surgery with over 15 years of surgical experience and a preferred referral partner for more than 100 Northern California general dentists (see our referring doctors page). Dr. André-David Kahwach completed his DDS with honors at UCSF and his MD and oral/maxillofacial surgery residency at Loma Linda, with advanced anesthesia training.
Our Roseville office provides 3D imaging, in-office anesthesia across the full range of options, and written treatment estimates before you commit to anything.
Call (916) 783-2110 or schedule a consultation.
911 Reserve Drive, Suite 150, Roseville, CA 95678.
