Informed Consent for Dental Extractions

I consent to extraction(s) of my tooth or teeth.

I understand that, if this tooth or teeth is/are not treated as my dentist has advised me or extracted, my condition may worsen and result in complications, including (but not limted to):

  • Increased infection
  • Loss of additional teeth
  • Pain

Possible complications of the extraction of teeth include, but are not limited to:

  • Infection
  • Bleeding and bruising
  • Dry socket
  • Swelling
  • Injury or fracture of adjacent teeth, fillings, crowns, or bridges
  • Sinus involvement (oral antrul communication) with extraction of upper teeth
  • Paresthesia of the lower lip with extraction of lower teeth
  • Fracture of the jaw
  • Decision to leave a small root or root tip if extensive surgery is required to remove it
  • Allergic reaction to local anesthetic
  • Allergic reaction to post-operative medications

I have discussed the surgery with my dentist and consent to the surgery as described.

I understand that my post-operative care will include refraining from:

  • Smoking for 3 days
  • Spitting for 3 days
  • Drinking through straws for 3 days
  • Heavy exertion for 3 days