I understand that there may be alternatives to the extraction of teeth. After considering the various options, I have chosen extraction. I understand that there are various normal complications that can occur despite all efforts to the contrary as a result of the extraction(s) which include but are not limited to:
* Allergic reaction to medications or anesthetics used in the extraction process.
* Pain, swelling, infection, bruising, bleeding.
* Stiffness to the adjoining or nearby muscles.
* Numbness - There is the possibility of injury to the nerves of the face or tissues of the oral cavity during the administration of anesthetics or during the extraction, which may cause a numbness of the lips, tongue, tissues of the mouth and/or facial tissues. This numbness is usually temporary but may be permanent.
* Fracture of the root tips, which may also result in the root tips being left in place or displacement of the root tip into the sinuses and/or place nearby.
* Dry sockets, aspiration and/or swallowing of foreign objects
* Damage to adjacent teeth and/or restorations.
* I further understand that this procedure can also be performed by a specialist and request that this treatment be performed in this office by a general dentist
* The dental care and treatment to be performed has been explained to me and I understand what is to be done and that there is no warranty or guarantee as to any result and/or cure. I may ask the attending dentist for a more complete explanation.
* This is my consent for the extraction, anesthetics, and x-rays to be taken.
* I have read and understand the above and have had all my questions answered to my satisfaction and I agree to proceed with the recommended extraction(s).