ORAL BIOPSY CONSENT FORM

Procedure Description -  I understand that my provider has recommended an oral biopsy, which involves the removal of a small portion of tissue from my mouth (e.g., gums, cheek, tongue, palate, or jaw) for diagnostic purposes. The removed tissue will be sent to a pathology laboratory for microscopic examination. Additional procedures and follow-up may be required depending on the biopsy results.

Purpose of the Procedure - The biopsy is being performed to help diagnose abnormalities such as:

• Lumps, bumps or growths
• Persistent sores or ulcers
• Discolored patches
• Suspected infection or inflammation
• Cysts
• Precancerous changes or cancer
  
  

Risks and Complications- As with any surgical procedure, there are potential risks, including:

• Pain, discomfort, or swelling
• Bleeding
• Infection
• Delayed healing
• Scar tissue formation
• Numbness or changes in sensation (temporary or permanent)

Anesthesia - I understand that local anesthesia will be used to numb the area.

Alternatives - I understand that I may decline the biopsy, but I have been informed of the potential risks of doing so, including the possibility of delayed or missed diagnosis.

Post-Procedure Instructions

• Slight bleeding is normal. Depending on the procedure you will be provided with instruction on how it should be managed.
• Depending on the procedure, you will be provided with prescription or instructions on over-the-counter pain relievers (e.g., ibuprofen or acetaminophen) as needed.
• You will be instructed to be on a soft, cool or lukewarm diet. Avoid spicy, crunchy, or hot foods for 2–3 days.
• No smoking during the healing period.
• Depending on the procedure, you may be instructed not to brush the area for some time and will be provided with medicated or warm salt water (½ tsp salt in 1 cup water) rinse in the meantime.

Consent and Acknowledgment- I confirm that:

• I have read and understood the information above.
• All of my questions have been answered to my satisfaction.
• I understand the purpose, risks, and alternatives to the procedure.
• I voluntarily consent to the oral biopsy.