Please read each paragraph. If you have any questions about your proposed treatment, please ask your Doctor BEFORE initialing or signing this form.
Taking teeth out is a permanent process. Whether the procedure is easy or difficult, it is still a surgical procedure. All surgeries have some risks. They include but are not limited to the following:
1. Swelling, bruising and pain.
2. Stretching of the corners of the mouth that may lead to cracking or bruising. Cuts within the mouth or on the lips.
3. Possible infection that might need more treatment.
4. Dry socket that presents as jaw pain beginning a few days after surgery, usually needing additional care.
5. Possible damage to other teeth close to the ones being taken out, more often those with large fillings or caps. This may result in additional need for teeth repair or loss.
6. Possible loosening of adjacent tooth or teeth.
7. Numbness, pain, or changed feelings in the lips, chin, teeth, gum and/or tongue (including possible loss of taste). This is due to the closeness of tooth roots (mainly with wisdom teeth) to the nerves which can be injured or damaged. Usually the numbness or pain goes away, but in some cases may be permanent.
8. Trismus – only able to open mouth a little, causing difficulty chewing. This is most common after wisdom teeth are taken out. Sometimes it happens because of jaw joint problems (TMJ), mainly when TMJ disease is already there. This can also be associated with infection.
9. Bleeding – oozing can often happen for several hours, but a lot of bleeding is not common.
10. Sharp ridges or bone splinters may form later at the edge of the hole where the tooth was taken out. These may need another surgery to smooth or remove.
11. Sometimes tooth roots may be left in to avoid harming important things such as nerves or a sinus (a hollow place above your upper back teeth). Additional treatment and surgery may or may not be indicated.
12. The roots of the upper back teeth are often close to the sinus and sometimes a piece of root can get into the sinus. An opening may occur from the sinus into the mouth that may need more treatment.
13. It is very rare that the jaw will break, but it is possible in cases where the teeth are buried very deep in their sockets, or if there is other medical or pathological conditions that predispose me of this risk.
14. If my Doctor finds a different condition than expected and feels that a different surgery or more surgery needs to be done, I agree to have it done.
CONSENT FOR BANKED BONE (freeze-dried, lypophilized, demineralized, xenografts) OR BONE SUBSTITUTES
Donated, processed or artifical bone substitues are used to supplement the patient’s bone. If used such materials may have separate risks that include but are not limited to the following:
15. Rejection of bone particles / bone graft materials at the recipient sites for some time after surgery.
16. The remote chance of infectious disease transmission including prion, virus, bacteria, fungi from processed bone.
17. Pain, swelling, change in sensation and other post-operative issues of recipient and/or donor area for a prolonged time which may restrict mobility and activity or require additional treatment.