During the procedure, the patient will be given local anesthetic and if desired nitrious oxide (laughing gas). This decision will be determined by the difficulty of the extraction as well as the individual needs of the patient. Many of the needed tooth extractions are performed here in our office by Dr. Janowski. However, most wisdom teeth (third molars), impactions, and other difficult extractions are referred to an oral surgeon specialist to better serve the patient's particular situation. As a service to the patient, our office arranges this referral for the patient.