Do I need to be put to sleep, and will insurance pay for it?
The short answer
Not necessarily. Wisdom teeth can be removed with numbing alone, light sedation, IV sedation, or general anesthesia. The right choice depends on how involved the surgery is, your health, and how anxious you feel. Plans often cover deeper sedation for more involved surgery, but rules vary.
Your options, from lightest to deepest
- Local anesthetic (numbing): you're awake and feel pressure but not pain. Often enough for simple removals.
- Laughing gas (nitrous oxide): relaxes you while you stay awake. Wears off quickly.
- Oral sedation: a pill before the visit to make you drowsy and calm.
- IV sedation: medicine through a vein. You're deeply relaxed and often remember little. Many people call this “twilight” sleep.
- General anesthesia: you're fully asleep.
Numbing is used with all of them, so the area stays comfortable afterward too.
How to choose
- How involved the surgery is: several teeth stuck in bone often go better with deeper sedation.
- Your anxiety level. It's fine to say you're nervous.
- Your health and medicines. Share your full medical history, including any past problems with anesthesia.
- Practical things: with IV sedation or general anesthesia, you'll usually need to skip eating beforehand and have someone drive you home.
Safety
Oral surgeons train in anesthesia during their residency. Each state sets rules for which dentists can give sedation; for moderate sedation or deeper, that usually means extra training and a state permit. Some offices bring in a dental anesthesiologist, a dentist whose specialty is anesthesia. The ADA updated its sedation guidelines in 2026. It's reasonable to ask who will give the sedation, who monitors you, and what training they have.
Will insurance pay for it?
Sedation and anesthesia are often billed in 15-minute blocks (for example, D9239 and D9243 for IV sedation, D9222 and D9223 for general anesthesia). Coverage varies:
- Many plans cover IV sedation or general anesthesia when it's done with surgical removal of stuck teeth.
- Laughing gas is often not covered.
- Some plans don't cover sedation at all, or only with a medical reason.
- Some plans cover only a set amount of time, such as 60 minutes. If the surgery runs longer, the extra 15-minute blocks may be yours to pay.
Medical insurance sometimes pays part of the anesthesia, so ask the office whether they bill it. See What should it cost? Ask for the sedation to be included in the predetermination, and ask the office how long they expect it to take.
Questions to ask
- What type of sedation do you recommend for me, and why?
- Who gives the sedation, and who monitors me?
- How long do you expect it to take, and how is it billed?
- Does my plan cover this type of sedation?
- What do I need to do beforehand, and do I need a driver?
- Before we schedule, can I get my cost in writing? (A predetermination if I'm using insurance, or a good faith estimate if I'm paying myself.)
When a second opinion makes sense
Reasonable if general anesthesia is recommended for a simple removal and you'd prefer something lighter, or if you have health conditions and want another view on what's safest.