The main difficulty with removing lower molar teeth (including wisdom teeth) is the difficulty in ensuring profound anaesthesia.
The lower jawbone is dense and nerve blocks may be successful only about 50-60% of the time (if insufficient waiting time and only a single block is utilized). Patients with heavy musculature and a history of bruxism are more likely to encounter anaesthetic failure because of underlying chronic inflammation in the tissues surrounding their teeth.
This is the main reason why patients and dentists have difficulties with extractions or procedures on lower molars.
General anaesthesia or sedation will help to increase pain threshold by reducing anxiety. This means the local anaesthetic is more likely to work better. The short term amnesia that accompanies these modalities also helps minimize the psychological impact of a painful procedure. General anaesthesia requires the support and oversight of a trained anaesthesiologist in a facility with the requisite emergency life support equipment.
Pre-medication with anti-inflammatories as well as anxiolytic medications (for patients who cannot sleep the night before a procedure) will also help.
