Is there any reason why a fully erupted wisdom tooth can't be removed with local anesthetic only if that is what the pt prefers/is comfortable with?

Hooked Roots: Even if the tooth is fully erupted. It still may be a difficult extraction for the oral surgeon. The surgeon may feel that it's best you're asleep to make the whole procedure easier for both of you. This is something you should be discussing with your surgeon. What you want and what you need may be different.

It can be removed: Surgical removal of wisdom tooth can be done under local anesthesia and you may elect to have wisdom teeth removed with local anesthetic only.