Informed Consent for Oral and Maxillofacial Surgery

Alternatives to Surgery: Risks to my health if the above procedure is not performed include but are not limited to:

• Infection
• Cyst or tumor formation
• Periodontal (gum) disease
• Increased risk for complications if removal is required at a later time

Possible complications have been discussed with me include but are not limited to:

• Injury to the nerves, lower lip, and tongue causing numbness which could be permanent
• Bleeding and/or bruising may be prolonged
• Dry Socket
• Involvement of the sinus above the upper teeth
• Infection
• Decision to leave a small piece of root in the jaw when its removal would require extensive surgery and increased risk of complications
• Injury to the adjacent teeth or fillings
• Unusual reaction to medications given or prescribed

I understand that a perfect result cannot be guaranteed. If any unforeseen conditions arise during the procedure, I request and authorize the dentist to do whatever they deem advisable to correct the condition.

I agree to cooperate completely with the doctor and will follow post-operating instructions to the best of my ability for my own comfort and safety. I have had the opportunity to ask questions and address concerns in regards to this/these procedure(s)

Following Your Oral Surgery- Instructions

1. Bite on gauze until bleeding stops.  This may take one to four hours depending on the surgery.
2. Be careful that you do not dislodge the blood clots from the surgery site.  It is important that the blood clot stays in place for several days after the surgery.
3. Do not use straws.  Do not stick your tongue or fingers into the surgical site.  Do not chew food near the surgical site.  Refrain from smoking, alcohol and hot liquids.  All of these actions will dislodge the blood clots from the surgical site.
4. Starting tomorrow, gently rinse your mouth frequently with a solution of 1/2 teaspoon of salt in a glass of warm water.  Continue this rinse for a few days.
5. Take all medications as directed for as long as indicated.
6. If discomfort persists contact our office.
7. Diet: Cold or lukewarm liquids may be taken for the first 4-6 hours.  After this, any soft food is permissible.
8. Bleeding: It is normal for the saliva to be streaked with blood for a day.  If frank bleeding is present, fold sterilized gauze into a firm wad and place it directly on the bleeding area. Maintain firm pressure by biting on the gauze.  Gauze may be substituted with a soaked black tea bag.  The tannic acid in tea has a clotting effect.
9. Swelling and Discoloration: Is to be expected in certain areas usually reaching its maximum two days after surgery.  It will disappear gradually and is no cause for concern  If desired, ice packs may be applied for the first 4-6 hours only alternating for 20 minutes on and 20 minutes off.
10. Sutures: If required, are removed without discomfort in about 5-7 days (an appointment will be made for you).
11. Do not hesitate to call the office if in doubt.

Dry Socket

• Happens when you lose your blood clot from:
  • Smoking
  • Sucking
  • Spitting
  • Alcohol
  • Using a straw
  • Getting food in the hole
• Happens 2-3 days after extraction
  • Extraction Monday - pain Wednesday/Thursday
  • Extraction Friday - pain Sunday/Monday
• Intense pain and bad taste
• Please call the office, area needs to be cleansed
• May require another procedure at additional cost