A tooth may require an extraction if it has been compromised by extensive decay or loss of bone support due to gum disease or infection. Most dental extractions can be carried out under local anesthetic by a general dentist. Complicating factors such as curved roots, nearby anatomical structures, and impaction. Or decay extending under the gum may require the tooth to be removed surgically. Your dentist will be able to determine the best procedure after assessing the tooth with an accompanying x-ray.