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    Consent Form for General and Surgical


    Dental Procedures

     

    1. Pain swelling and discomfort after treatment
    2. Infection in need of medication, follow-up procedures or other treatment.
    3. Temporary, or on rare occasion, permanent numbness, pain, tingling or altered sensation of the lip, face, chin, gums and tongue along with possible loss of taste.
    4. Damage to adjacent teeth, restorations or gums.
    5. Possible deterioration of your condition which may result in tooth loss.
    6. The need for replacement of restorations, implants or other appliances in the future.
    7. An altered bite in need of adjustment.
    8. Possible injury to the jaw joint and related structures requiring follow-up care and treatment, or consultation by a dental specialist.
    9. A root tip, bone fragment or a piece of a dental instrument may be left in your body, and may have to be removed at a later time if symptoms develop
    10. Jaw fracture
    11. If upper teeth are treated, there is a chance of a sinus infection or opening between the mouth and sinus cavity resulting in infection or the need for further treatment.
    12. Allergic reaction to anesthetic or medication
    13. Need for follow-up treatment, including surgery.

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