Informed Consent for Oral and Maxillofacial Surgery

Alternatives to Surgery:  Risks to my health if these teeth are not removed include, but are not limited to:

1. Infection
2. Cyst or Tumor Formation
3. Periodontal (gum) disease
4. Increased risk for complications if removal is required at a later time

Possible complications which have been discussed with me include, but are not limited to:

1. Injury to the nerves to the lower lip and tongue causing numbness, which could possibly be permanent.
2. Involvement of the sinus above the upper teeth
3. Bleeding and/or bruising which may be prolonged
4. Dry Socket/Infection
5. Injury to adjacent teeth or fillings
6. Decision to leave a small piece of root in the jaw when its’ removal would require extensive surgery and increased risk of complications
7. Unusual reaction to medications given or prescribed
8. Boney edges
9. Fractured Jaw

I understand that a perfect result cannot be guaranteed.  If any unforeseen conditions arise during the procedure, I request and authorize the doctor to do whatever he deems advisable to correct the condition.

I agree to cooperate completely with Dr. Spurr and will follow post-operative instruction to the best of my ability for my own comfort and safety.  I have had the opportunity to ask questions concerning these procedures.