Cheyenne Advanced Dental Arts

L. Scott Brooksby, DDS, DICOI

Consent for Oral Surgical Procedures

You need to understand that during and following extraction of teeth some or all of the following may occur. With this

knowledge we will do all that we can during the surgery to prevent or minimize these problems. We will also provide for you

a list of instructions which should also help minimize these problems.

1. Swelling is quite common. This is your body's reaction to the procedure and will usually subside.

2. Discomfort is usually mild to moderate, however in some instances it may be more intense. Appropriate pain medication will be

prescribed. In some instances a dry socket may occur, requiring treatment in the office.

3. Restricted opening may result especially after lower wisdom teeth have been removed.

4. Discoloration or bruising may appear near the surgical site.

5. Numbness of the lip may occur in rare instances after surgery.

6. It is possible that during the extraction of teeth a tooth or filling may fracture. In rare cases it is also possible that the jaw may fracture.

7. During the extraction of upper teeth it is possible that a part of the tooth may dislodge in to the sinus. This may result in a transient sinus

infection and in some instances require surgical removal.

Although each of these things is possible, every precaution will be taken to make your surgery as uneventful as possible.

I have read and understand the above.

______________________ ____________________________________

Date Signature of Patient/ Guardian