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CONSENT FOR EXTRACTIONS

Consent for Extractions

NAME OF PATIENT

TOOTH #

Purpose of Treatment:  Extractions are considered for: orthodontic reasons, severely decayed teeth, infected teeth with severe periodontal disease, impacted teeth or for the prevention of future infection or problems. After removal of a tooth an artificial bone graft may be placed into the socket to preserve the jawbone.

 

Potential Complications: The following is not a list of all potential complications, but it does cover most common ones.

 

Pain: Varies individually and can be controlled with medication.

 

Bruising, Swelling and Difficulty Opening: Generally, resolves within one week.

 

Bleeding: A small amount of bleeding is not unusual for a day and should stop by applying firm pressure with gauze. More than this is unusual and requires attention by the dentist.

 

Infection: The chances of post-op infection increase with smoking and poor oral hygiene. Should an infection develop, you may require additional oral antibiotics or IV in a hospital setting, dressing the wound or sometimes incision and draining. Other symptoms of infection include severe pain, non-resolving swelling, foul odor, fever and chills.

 

Numbness: Surgery in the jaw is often close to the nerves and there is no test that can accurately predict where nerves lie. Damage to the nerve can result in temporary or permanent changes in the sensation of the affected area. This may include numbness, tingling, painful sensations or a loss of taste. While occurrences are uncommon, very little can be done if they occur.

 

Fractures: Broken jaw bones are a rare complication. The risk does rise with older patients and when the bone is severally resorbed. Should a fracture occur, wiring of the jaw or wearing a splint or denture may be necessary.

 

Retained Roots and Sharp Bony Edges: Small pieces of the root may remain in the jaw if it is decided that its removal would complicate the surgical outcome. Another surgery may be required to smooth the edges.

 

Sinus Problem: Surgery in the upper jaw may be complicated by the position of the sinus. Should a tooth or root be lodged into the sinus, future surgical procedures may be required to remove it. Opening of the sinus is also possible and may require medication or surgery to repair it.

 

Damaged Adjacent Teeth: Sometimes, an adjacent tooth or its supporting structure may be damaged. The chances of damage increase if the adjacent tooth is weak, has a large filling or crown. Subsequent problems may necessitate either root canal or extraction of the affected tooth. 

 

CONSENT:  I have read the above information and the dentist has explained the points that are pertinent to my situation, and I have been given alternatives. I understand this information and that there is no guarantee given that the proposed treatment will be successful in correcting the condition. Prior to surgery I may not be experiencing any pain or problems and I realise there is a risk of failure, relapse and selective retreatment or worsening of the present condition despite care provided. My questions have been addressed.

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