When baby teeth are loose, or when permanent teeth suffer advanced caries, gum disease, vertical fracture, abscess or complication beyond treatment, they need to be extracted. Some teeth are extracted for orthodontic purpose. We do most of the surgery at our office under local anesthesia. For impacted wisdom teeth, we will refer the patient to local oral surgeon for better care. Oral surgeon can also provide IV sedation or put the patient to sleep while performing the treatment.