Oral Surgery Consent Form

The proposed treatment has been explained to me, the expectations, and anticipated results by my doctor. I understand that oral surgery and extractions entail risks that are inherent to the procedure such as, but not limited to the following:

1. Nerve injuries. Injuries to nerves would include those causing numbness of the lips, the tongue, and any tissues of the mouth and/or cheeks or face. The numbness which could occur may be of a temporary nature, lasting a few days, a few weeks, a few months, or could possibly be permanent, and could be the result of surgical procedures or anesthetic administration.

2. Bleeding. Moderate bleeding might occur that may last for several hours. Swelling may happen which is normal after the procedure. This usually subsides after 48 hours. However, should it become severe, it is recommended that the doctor is notified. 

3. Infection. Postoperative infections may happen regardless of how much carefully surgical sterility is maintained. This may be due to the possibility of a non-sterile oral environment. In case this happens, it is necessary that a doctor is notified and the infection should attend to it as soon as possible.

4. Dry Socket. On the occasion that teeth extraction is made, there can be instances where blood clotting happens during the healing process. Pain starts to radiate and is common when the extraction of wisdom tooth is done. It is recommended that this be attended to by the doctor. 

5. Damage to Adjacent Teeth or Fractures. Although extreme care is used all the time, it is possible that adjacent teeth be damaged during the procedure. This may happen especially to a tooth with large fillings or caps. In rare cases, fractures may happen during a procedure and thus, this may possibly require a referral to a specialist. 

6. Opening of Sinus. There are some cases where the root tips of the upper teeth are close to the proximity of the sinuses. In such cases, extraction or surgical procedures may result in perforation of the sinus membrane. In such an occurrence, it may be necessary to have the sinus be surgically closed, or root tips may be needed to be retrieved from the sinus.

7. Trismus. This refers to the limitation or restriction of the jaw opening due to swelling or inflammation. This usually happens after a wisdom tooth removal or when there is a manifestation of the disease or symptoms on the temporomandibular joint. This kind of discomfort may take days or weeks for recovery.

It is also my responsibility to inform my doctor in order to prevent these possible cases, as much as possible:

1. Bacterial Endocarditis. The existence of bacteria in the oral cavity is normal. However, people with a heart condition are susceptible to bacterial infection through the blood vessels and by which  Bacterial Endocarditis, which is an infection of the heart, could occur. For my safety and benefit, it shall be my responsibility as a patient to inform my doctor of any heart conditions or prosthetic joints that I may possibly have.

2. Allergies. Allergic reactions due to medications prescribed or anesthetics administered may possibly occur. Thus, it is my responsibility to inform my doctor if in case I have an allergy to certain medications or drugs.

Informed Consent

By signing this form, I understand that unforeseeable circumstances may arise during the procedure that may result in the need of undergoing a procedure other than what has been set forth in the Agreement. In such case, I authorize my doctor and/or his/her associates to perform such necessary procedure should it be needed as it is deemed best, in their professional judgment.

As a patient and in relation to the procedure specified in this Informed Consent, I have been given an opportunity to ask questions and by which it was responded to properly and to my satisfaction. I assume the possible risks involved in the procedure as well as the possibility of which the desired results may not be guaranteed.

The fees for the service have been explained to me and by which I allow and authorize the undersigned doctor, including his/her associates, render any treatments necessary or recommended for my dental condition, including administration or prescription of anesthetics and/or medications.

Further, I understand that the medications administered or prescribed for this procedure may cause drowsiness or loss of consciousness. I am aware that I am prohibited from consuming alcohol or other drugs during and before the taking of medication. I was given advice to not operate any mechanical device, including driving, that can be hazardous to me until fully recovered.