Medical History Information
Please understand that it is important that you divulge any information about your medical history to your dentist.
It is important that you inform us of any medicines that you are taking each time that you come to an appointment, as some medications can cause harmful reactions with dental anesthetics, analgesics, antibiotics, or other medications.
Please be sure to provide us with a list of any drug allergies you have.
Restorations
- I understand that care must be exercised in chewing on fillings until directed by the doctor or staff to avoid breakage or soft tissue damage.
- I understand that a more extensive filling than originally diagnosed may be required due to additional decay.
- I understand that sensitivity may occur after a newly placed filling.
Changes in Treatment
- I understand that during treatment it may be necessary to change or add procedures because of conditions found while working on the teeth that were not discovered during examination.
- I give my permission to the Dentist to make any/all changes and additions as necessary after consultation.
Complications
Complications resulting from the use of dental instruments, drugs, medicines, analgesics (pain killers), anesthetics, and injections include (but are not limited to) swelling, sensitivity, bleeding, pain, infection, numbness and tingling sensation in the lip, tongue, chin, gums, cheeks, and teeth (which is transient but on infrequent occasion, may be permanent), reaction to injections, changes in occlusion (biting), jaw muscle cramps and spasms, temporomandibular (jaw) difficulty, referred pain to ear, neck, and head, nausea, vomiting, allergic reactions, delayed healing, and treatment failure.
The risks of complications from medications used/prescribed with general dental treatment include, but are not limited to, drowsiness, lack of awareness and coordination, nausea, allergic reactions, etc. (which may be influenced by the use of alcohol, tranquilizers, sedatives, or other drugs).
X-rays and Photos
Modern dental x-ray equipment is extremely low-dose radiation. Diagnostic x-rays provide the dentists with valuable information about your teeth and supporting bone that cannot be evaluated otherwise.
Our office takes x-rays or panoramic x-rays to allow us to do a thorough exam for each patient. All patients 6 years and older will receive a full mouth series of intra-oral x-rays. Without these x-rays, we cannot do a complete exam of the entire mouth and jaw.
We may also take photos of our patients as part of their permanent record. We will not release these photos to anyone without your permission.
Specific Problem Examinations
In the event that a patient requests only a specific problem be addressed (i.e.: broken tooth, pain in one area, etc.) this is considered a problem-focused evaluation.
X-rays will be taken in this specific area only, and a complete comprehensive examination will not be done. The dentist cannot diagnose problems in other areas of the mouth.
Please understand that this appointment will be for the treatment/diagnosis of an emergency/urgent need. Any future treatment of other areas will require additional x-rays and a complete exam. You will only be considered a patient of record unless this examination is completed.
Crowns, Bridges, and Veneers
- I understand that sometimes it is not possible to match the color of natural teeth exactly with artificial teeth.
- I further understand that I may be wearing temporary crowns, which may come off, and I must be careful to ensure that they are kept on until the permanent crowns are delivered.
- I realize that the final opportunity to make changes in my new crowns, bridge, or veneer (including shape, fit, size, placement, and color) will be done before cementation.
- It has been explained to me that, in very few cases, cosmetic procedures may result in the need for future root canal treatment, which cannot always be predicted or anticipated.
- I understand that sometimes when taking a final impression, trimming of the gum tissue (gingivectomy) is necessary.
- I understand that cosmetic procedures may affect tooth surfaces and may require modification of daily cleaning procedures.
Dentures—Complete or Partial
- I realize that full or partial dentures are artificial, constructed of plastic, metal, and/or porcelain.
- The problems of wearing those appliances have been explained to me, including looseness, soreness, and possible breakage.