• Consent for Extraction of Teeth

  • To perform the following procedures on my child and such additional procedures as are considered necessary based on findings during said procedure extraction of tooth or teeth #     .

    Extraction involves the complete removal of a tooth from the mouth, some extractions may require cutting into the gum and removing supporting bone/ or cutting the tooth into sections prior to removal. This recommended extraction(s) is/are based on visual examination, on any x-rays, and other diagnostic tests taken, and on my doctor's knowledge or my child's medical and dental history. My needs and wants to have also been taken into consideration.

  • Extraction of teeth is an irreversible process and, whether routine or difficult, is a surgical procedure. As in any surgery there are some risks. They include but are not limited to:

    1. Swelling and or bruising and discomfort of the area.
    2. Stretching of the corners of the mouth resulting in cracking or bruising.
    3. Possible infection requiring further treatment.
    4. Dry socket-jaw pain beginning a few days after surgery, usually requiring addition care.
    5. Possible damage to adjacent teeth, especially those with large fillings or crowns.
    6. Numbness or altered sensation in the teeth, lip, tongue, chin, closeness of tooth roots to the nerve that can be bruised or injured.
    7. Possible involvement of the nerve within the lower jaw removal of lower molar teeth resulting in usually temporary but possible permanent numbness and/or tingling on the lower lip, right and left side.
    8. Limited jaw movement due to inflammation or swelling, most common after removal of wisdom teeth. Post-operative bleeding, significant bleeding is not common, but persistent bleeding can be common for several hours.
    9. Sharp ridges or bone splinters may form later at the edge of the socket. These may require another surgery to smooth or remove them.
    10. Jaw fracture while quite rare, it is possible in difficult or deeply impacted teeth. Drug reaction or side effects.
    11. Incomplete removal of tooth fragments to avoid injury to vital structures such as nerve or sinuses, sometimes small root tips may be left in place. Sinus involvement: the roots of the upper back teeth are often close to the sinus and sometimes a piece of the root can be displaced into the sinus, or an opening may occur into the mouth which may require additional care.
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