Wisdom tooth extraction surgical consent

MM slash DD slash YYYY

Even with proper care, operations still carry some risk of complications occurring.

The surgical site remaining after an impacted tooth is removed is a large one, and healing may be delayed because the body is unable to rebuild the normal tissue as quickly as a smaller site. Fortunately in the upper jaw, healing usually proceeds uneventfully. However, in the lower jaw, healing usually takes longer.

After surgery, you must cleanse the mouth thoroughly after food intake. If anything clings to the stitches or extraction site, the gum tissue, or surgery site- infection or delayed healing may result. There is typically some bleeding afterwards, but this will be slight and will stop on its own after a few hours. If heavy or moderate bleeding persists, please contact our office immediately. The doctor is always available to be contacted if there is a problem.

Lower impacted teeth usually rest on the main nerve to the lower jaw, and are often near the main nerve to the tongue. Sometimes, in spite of all precautions, these nerves are bruised or stretched. The result may be an altered sensation which is often partial or complete numbness of the lower lip, chin, inside of cheek, all teeth on that side, and the tip of the tongue. In most cases, the effect does not last more than a few weeks, improving as the nerve repairs. In some cases, the altered sensation may last several months or years, or may even be permanent. This is very rare in this kind of procedure. The occurrence and duration of this problem is unpredictable. Altered sensation does not affect appearance in any way.

Upper impacted third molars lie against the wall of the sinus. Occasionally, the thin wall of bone cracks slightly and blood seeps into the sinus. In such an event, the patient may notice the presence of blood in their nose. If you follow the prescribed post-operative instructions, this will clear up promptly.

All patients that are about to have impacted teeth removed should understand that adjacent teeth might have been weakened or injured by the presence of the impacted tooth. The injury may not be apparent until the impacted tooth is removed. This often means that these teeth may be sensitive or feel slightly loose. Adjacent teeth must be considered on probation for three to six months after the procedure. Meticulous oral hygiene routine must be followed during this time.

Large fillings or crowns next to impacted teeth may be dislodged during surgery. If necessary, a temporary filling will be placed and you will be asked to return for treatment once healing is complete.

In very rare instances, the removal of impacted teeth from the lower jaw results in a jaw fracture. In some cases, this may be predicted before surgery, and you will be informed of the possibility. In any case, this may occur because the unusual position of the wisdom tooth has weakened the jaw. Every possible precaution is taken to prevent such occurrence.

Unusual reactions, either mild or severe, may possibly occur from anesthetics, or with medications administered or prescribed. All prescription drugs are to be taken as instructed. Women taking oral contraceptives must be aware that antibiotics can render contraceptives ineffective. Other forms of contraceptive must be used during the treatment period.

It is the responsibility of the patient to inform the dentist of any heart problems known or suspected, as well as any other medical condition or allergy that you may have.

It is the responsibility of the patient to seek attention should any problems or concerns occur post-operative. It is very important to follow all post-operative instructions.

By signing this consent I am acknowledging that the fees for this service have been explained to be, and are satisfactory. I acknowledge that Dr. Safari is not a specialized oral surgeon, but rather a general practitioner who has performed numerous successful surgical procedures. I understand that by signing this consent, I am allowing Dr. Safari or his associates to render any treatment that is necessary, including anesthetics and/or medications.

I have had the opportunity to read the information given to me on this consent form, and clearly understand all possible risks stated above. I had had the opportunity to ask any questions I may have.

Once fully read and reviewed, please make sure that the above document is filled out appropriately. By signing below and submitting this document, we are assuming that it has been read in its entirety. All patient signatures will be verified for authenticity in the office.

MM slash DD slash YYYY