I understand that oral surgery and/or dental extractions include inherent risks such as, but not limited to the following:
1. Injury to the nerves: Numbness to the cheeks, tongue, lips, and/or any tissues of the mouth. This numbness may be temporary which may last from hours to a few months.
2. Bleeding, bruising, and swelling. Bleeding may occur during and/or after surgery, as well as swelling after surgery. Swelling may happen but normally subsides after 48 hours. If in case excessive bleeding occurs, or swelling appears to be severe, please notify us as soon as possible.
3. Dry Socket: A dry socket is a condition after a tooth extraction where there is loss of blood clot that is supposed to fill the socket from which the tooth was extracted. As occurrence of this leaves the nerves exposed and thus, is very painful. This may develop after 3-4 days post surgery and you must notify us of this occurrence.
4. Sinus involvement. There are some cases where a person's tip of the root of the tooth lie in close proximity to sinuses and the membrane may be perforated during during extraction or surgical procedure or instances where root tips may need to be retrieved from the Sinus. In such cases, sinus may be required to be surgically closed.
5. Infection. Infections may occur due of the non-sterile oral environment after surgery. In case that an infection or swelling occur, especially with fever, please notify us as soon as possible.
6. Fractured jaw, roots, bone fragments, or instruments: In an extraction procedure, fractures may happen due to brittle bones of the patient. In such cases that it will occur, referral to a specialist may be required.
7. Injury to adjacent teeth or fillings: Injury to adjacent teeth or filling may occur during the procedure. This could occur at times no matter how carefully surgical and/or extraction procedures are performed.
8. Bacterial Endocarditis: Bacteria is a normal existence in the mouth. Thus, susceptible to infections transmitted through blood vessels. In some instances, Bacterial Endocarditis could occur. This is a bacterial infection of the heart and any heart problems known or suspected should be notified to us as soon as possible.
9. Unusual reactions to medications given or prescribed: Reactions, either mild or severe, may possibly occur from anesthetics or other medications administered or prescribed. All prescription drugs must be taken according to instructions. Women using oral contraceptives must be aware that antibiotics can render these contraceptives ineffective. Other methods of contraception must be utilized during the treatment period.
I was fully oriented and informed of the purpose of the medical treatment and was able to ask questions and provided sufficient answers. I assume all possible risks, including any harm which may be associated with the procedure. I likewise understand that there guarantees are not absolute concerning recovery from my treatment.
By signing this form, I freely give my consent to the procedure.