A general dentist or specialized surgeon of the mouth, called an oral or maxillofacial surgeon, will perform tooth and tooth root extractions [source: WebMD]. Some general dentists don't like to extract teeth, so they'll refer all extractions to an oral surgeon. Periodontists (dentists who specialize in treating periodontal disease) and cosmetic dentists may also perform tooth extractions [source: AAP].
Your dentist or oral surgeon will first determine the difficulty of the tooth extraction, based on the condition and position of the tooth (such as if it's fully or partially impacted). A tooth with advanced periodontal disease, for example, is easier to extract than a healthy tooth with long roots because the tooth and gums surrounding it have deteriorated so much. Wisdom teeth generally have their own issues for removal, including teeth that have already come through the gums; soft-tissue impaction, where the tooth is lying under the gum; partial-bony impacted, where the tooth is partially erupted and partially stuck in the jaw; and full-bony impacted, where the tooth is completely stuck in the jaw [source: WebMD].
There are two types of tooth and tooth root removal procedures. The first one is called a simple extraction, which is performed on a tooth that has already erupted. A dentist uses forceps or a "dental elevator" placed between the gum and tooth, to loosen it and remove it completely [source: Colgate]. There is usually no cutting into the gum during this procedure. The second type of tooth removal is called a "surgical extraction," where an oral surgeon needs to cut into the gum line to expose the tooth and roots for extraction.
Most tooth extractions are done with the same local anesthetic used when filling a cavity. According to Dr. Rosenberg, it's usually up to the patient to decide if he prefers sedation in addition to local anesthesia. Sedation methods include nitrous oxide (commonly known as laughing gas), an IV sedative that goes directly into the patient's bloodstream or an oral sedative [source: WebMD]. A dentist may recommend general anesthesia instead of local if several teeth will be removed in the same surgery or if the patient has significant anxiety over the procedure. If general anesthesia is used, another person is needed to accompany the patient home after the procedure.
Next up, learn how to care for your mouth after a tooth has been removed.