Informed Consents

Facts For Consideration:

Treatment involves repairing damaged areas of tooth above and below the gum line with composite (tooth colored) filling material. Fillings are subject to deterioration and fracture over time. If proper care including regular professional cleanings and brushing/flossing is not emphasized, decay may travel and possibly infect the nerve leading to root canal therapy. Hot or cold sensitivity is a normal reaction to new fillings. Every effort is taken to minimize irritation of the nerve, but if symptoms persist or worsen, root canal therapy and crowns may become necessary as well.

Benefits Of Fillings, Not Limited To The Following:

• A filling is typically used to restore a tooth damaged by decay, fracture, or previous restorations.
• It can also serve to protect a tooth that has had root canal treatment and improve the way your other teeth fit together.
• Fillings can be used for the purpose of improving the appearance of damaged, discolored, misshapen, misaligned, or poorly spaced teeth.

Risks Of Fillings, Not Limited To The Following:

• I understand that during treatment it may be necessary to change or add procedures because of conditions found while working on the internal surface of the teeth that were not discovered upon examination of the external surface such as close proximity of the cavity necessitating root canal procedure or insufficient healthy tooth after removal of cavity requiring a crown, or severe internal crack that renders a tooth unsavable leading to a tooth extraction, decay extending too close to the bone level of the tooth necessitating a gum/bone shortening procedure, and/or insufficient healthy tooth/severe crack that renders a tooth unsavable leading to a tooth extraction.
• I understand that I will receive periodic diagnostic x-rays within the course of treatment.
  I understand that local anesthesia will be used in the course of my treatment. Anesthetizing agents are infiltrated into a small area or injected as a nerve block directly into a larger area of the mouth with the intent of numbing the area to receive dental treatment.

Risks include but are not limited to:

• I understand that preparing a damaged tooth for a crown may further irritate the nerve tissue (called the pulp) in the center of the tooth, leaving my tooth feeling sensitive to heat, cold, or pressure. Such sensitive teeth may require additional treatment including endodontic or root canal treatment.
• I understand that holding my mouth open during treatment may temporarily leave my jaw feeling stiff, sore and may make it difficult for me to open wide for several days. This can occasionally be an indication of a further problem. I must notify your office if this or other concerns arise.
• I understand it is normal for the numbness to take time to wear off after treatment, usually two or three hours. It is possible that during injection, the nerve is injured resulting in a longer period of numbness. Rarely is this condition permanent, although referral to a nerve specialist may be necessary if complications occur. Infection, swelling, allergic reactions, discoloration, headache, tenderness at the needle site, dizziness, nausea, vomiting, and cheek, tongue, or lip biting can occur.
  

Facts For Consideration:

Prior to periodontal treatment, X-rays, gum pocket depth readings, and thorough examination of your oral cavity will be used to determine your gum condition. Treatment involves removing the bacterial substance known as plaque and calculus from the tooth and root surface above and below the gum tissue. To minimize discomfort, local anesthesia may be used.

Treatment involves scaling to remove deposit and root planing to smooth and contour the root and remove remaining debris Medications and/or special mouth rinses will be prescribed to help control the bacteria after treatment. The success of treatment depends in part on your efforts to brush and floss daily and receive regular cleanings as directed.

Benefits Of Root Planing, Not Limited To The Following:

• Regular, professional cleanings create a clean environment; it decreases bacterial load that otherwise would contribute to gum and bone loss, cavities, halitosis (bad breath), and systemic bacterial infiltration.
• Treatment allows gums to heal and reduces the chances of further irritation and infection.
• It makes it easier for you to keep your teeth clean.
• Treatment decreases the cost of replacing teeth lost due to gum disease.

Risks Of Root Planing, Not Limited To The Following:

• Gums may bleed or swell and may experience moderate discomfort for several hours after the anesthesia wears off. Soreness may extend for a few days which may be treated with medication. I will notify the office if conditions persist past a few days.
• Cleaning the plaque and tartar off the tooth surface will stir up the bacterial load and possibly lead to gum infection. To prevent this, we will be prescribing an antimicrobial rinse to be used for approximately one week. If an infection does occur, please contact us to and antibiotics may be prescribed.
• Holding my mouth open during treatment may temporarily leave my jaw feeling stiff and sore and may make it difficult for me to open wide for several days afterward.
• If my gum tissues heal, they may shrink exposing root surfaces that could make my teeth sensitive to hot or cold. Desensitizing agents may be prescribed or additional procedures may be needed to protect the exposed areas.
• I understand it is normal for the numbness to take time to wear off after treatment, usually two or three hours. It is possible that during injection, the nerve is injured resulting in a longer period of numbness. Rarely is this condition permanent, although referral to a nerve specialist may be necessary if complications occur. Infection, swelling, allergic reactions, discoloration, headache, tenderness at the needle site, dizziness, nausea, vomiting, and cheek, tongue, or lip biting can occur.
  

Facts For Consideration

1. A conventional denture (removable) is placed in the mouth after all of the teeth have been removed and the extraction sites have healed, usually 6-8 weeks after extraction.
2. An immediate denture is placed at the time the teeth are extracted. To make this possible, measurements and models are taken during the preliminary visit. However, bones and gums can shrink over time, especially during the healing period in the first six months after extraction of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly which may incur a separate charge.
3. A partial denture is a removable appliance usually composed of framework, artificial teeth, and acrylic material. It fills in the spaces created by missing teeth and prevents other teeth from shifting.
4. An overdenture is a type of removable denture that is supported by a small number of remaining teeth or implants. Natural teeth must be prepared to fit the overdenture and provide stability and support for the denture.

I understand the stability and retention of the denture depends on many factors, including the attachment and fit of the denture to natural teeth, implants if any, the amount and type of bone, gum tissue, and saliva as well as my ability in placing and removing the denture. When using natural teeth as support, the teeth acting as support may be filed down to make room for the denture.

There may be gum soreness or discomfort under the denture which can be relieved by the dentist with adjustments and tissue treatment and may take several appointments. I further understand the new denture may feel awkward for a few weeks until I become accustomed to them and the denture may feel loose while my cheek muscles and tongue learn to keep them in place.

Facts For Consideration:

An extraction involves removing one or more teeth. Depending on their condition, this may require sectioning the teeth or trimming the gum or bone tissue. If any unexpected difficulties occur during treatment, I may refer you to an oral surgeon who is a specialist in dental surgery.

Once the tooth is extracted, you will have a space that you may want to fill with a fixed or removable appliance. Replacement of missing teeth may be necessary to prevent the drifting of adjacent and/or opposing teeth to maintain function or for cosmetic appearances. The options of a fixed or a removable appliance will be explained to you.

As in all surgical procedures, extractions may not be perfectly safe. Since each person is unique and responds differently to surgery, the healing process may vary; no guarantees can be made.

Benefits Of Extraction, Not Limited To The Following:

• The proposed treatment should help to relieve your symptoms and may also enable you to proceed with further proposed treatment.

Risks Of Extraction, Not Limited To The Following:

• I understand that following treatment, I may experience bleeding, pain, swelling, and discomfort for several days, which may be treated with pain medication. It is possible infection can follow extraction and must be treated with antibiotics or other procedures. I will contact the office immediately if symptoms persist or worsen.
• I understand that I will receive a local anesthetic and/or other medication. In rare instances, patients have a reaction to the anesthetic, which may require emergency medical attention, or find that it reduces their ability to control swallowing. This increases the chance of swallowing foreign objects during treatment. Rarely, temporary or permanent nerve injury can result from an injection.
• I understand that all medications have the potential for accompanying risks, side effects, and drug interactions. Therefore, it is critical that I tell my dentist of all medications I am currently taking.
• I understand that holding my mouth open during treatment may temporarily leave my jaw feeling stiff and sore and may make it difficult for me to open wide for several days. However, this can occasionally be an indication of a further problem. I must notify your office if this or other concerns arise.
• I understand that the necessary blood clot that forms in the socket may disintegrate or dislodge. This painful condition, called dry socket, lasts a week or more and is treated by placing a medicated dressing in the tooth socket to aid healing. To protect against developing dry socket, I must not smoke, drink through a straw, rinse with water or mouthwash, chew food in that area, or disturb the socket in any way for 24 to 48 hours.
• I understand that the instruments used in extracting a tooth may unavoidably chip or damage adjacent teeth, which could require further treatment to restore their appearance or function.
• I understand that upper teeth have roots that may extend close to the sinuses. Removing these teeth may temporarily leave a small opening into the sinuses. Antibiotics and additional treatment may be needed to prevent a sinus infection and help this opening to close.
• I understand that an extraction may cause a fracture in the surrounding bone. Occasionally, the tooth to be extracted may be fused to the surrounding bone. In both situations, additional treatment is necessary. Bone fragments called “spicules” may arise at the site following extraction and are generally easily removed.
• I understand that tooth fragments may be left in the extraction site following treatment due to the condition and position of the tooth/teeth. Generally, this causes no problems, but on rare occasions, the fragments become infected and must be removed.
• I understand that the nerves that control sensations in my teeth, gums, tongue, lips, and chin run through my jaw. Depending on the tooth to be extracted (particularly lower teeth or third molars), occasionally, it may be impossible to avoid touching, moving, stretching, bruising, cutting, or severing a nerve. This could change the normal sensations in any of these areas, causing itching, tingling or burning, or the loss of all sensation. These changes could last from several weeks to several months or, in some cases, indefinitely.
• I understand it is normal for the numbness to take time to wear off after treatment, usually two or three hours. It is possible that during injection, the nerve is injured resulting in a longer period of numbness. Rarely is this condition permanent, although referral to a nerve specialist may be necessary if complications occur. Infection, swelling, allergic reactions, discoloration, headache, tenderness at the needle site, dizziness, nausea, vomiting, and cheek, tongue, or lip biting can occur.
  

Consequences If No Treatment Is Administered, Not Limited To The Following:

I understand that if no treatment is performed, I may continue to experience symptoms, which could include pain and/or infection, deterioration of the bone surrounding my teeth, changes to my bite, discomfort in my jaw joint, and possibly the premature loss of teeth.

Facts for Consideration:

Treatment involves restoring damaged areas of the tooth above and below the gumline with a fixed prosthetic. (Crown, Implant Crown, Bridge or Veneer)

Restoration Of A Tooth Requires Two Phases:

1. Preparation of the tooth, an impression sent to the lab, construction and temporary cementation of a temporary crown; and later.
2. Removal of the temporary crown, adjustment, and cementation of the permanent crown after esthetics and function has been verified and accepted. Once a temporary restoration has been placed, it is essential to return in approximately 2-3 weeks to have the permanent restoration placed as the temporary crown is not intended to function as well as the permanent.

Benefits Of Fixed Prosthetics, Not Limited To The Following:

• A fixed prosthetic is typically used to strengthen a tooth damaged by decay, fracture, or previous restorations.
• It can also serve to protect a tooth that has had root canal treatment and improve the way your other teeth fit together.
• They can also be used for the purpose of improving the appearance of damaged, discolored, misshapen, malaligned, or poorly spaced teeth.
• Crowns are used to restore implants. Crowns fused together in multiple units can be used to restore spaces and in such case are called bridges.
• Veneers are a type of fixed prosthetic that is a shell of porcelain that often covers the face of a tooth.

Risks Of Fixed Prosthetics, Not Limited To The Following:

• I understand that during treatment it may be necessary to change or add procedures because of conditions found while working on the teeth that were not discovered during examination.
• I understand that I will receive periodic diagnostic x-rays within the course of treatment.
• I understand that local anesthesia will be used in the course of my treatment. Anesthetizing agents are infiltrated into a small area or injected as a nerve block directly into a larger area of the mouth with the intent of numbing the area to receive dental treatment.

Risks include but are not limited to:

• I understand it is normal for the numbness to take time to wear off after treatment, usually two or three hours. It is possible that during injection, the nerve is injured resulting in a longer period of numbness. Rarely is this condition permanent, although referral to a nerve specialist may be necessary if complications occur. Infection, swelling, allergic reactions, discoloration, headache, tenderness at the needle site, dizziness, nausea, vomiting, and cheek, tongue, or lip biting can occur.
  
• I understand that preparing a damaged tooth for a crown may further irritate the nerve tissue (called the pulp) in the center of the tooth, leaving my tooth feeling sensitive to heat, cold, or pressure. Such sensitive teeth may require additional treatment including endodontic or root canal treatment. Except in the case of implant restoration where there is no natural tooth or nerve involvement.
• I understand that holding my mouth open during treatment may temporarily leave my jaw feeling stiff and sore and may make it difficult for me to open wide for several days. This can occasionally be an indication of a further problem. I must notify your office if this or other concerns arise.
• I understand that failing to replace the temporary crown with the permanent crown could lead to decay, gum disease, infections, problems with your bite, and loss of the natural tooth. In implant cases although not susceptible to decay, gum issues could still arise causing infection. Also bite can be affected.
• I understand that a crown may alter the way my teeth fit together and make my jaw joint feel sore. This may require adjusting my bite by altering the biting surface of the crown or adjacent teeth.
• I understand that the edge of a crown is usually near the gum line, which is in an area prone to gum irritation, infection, or decay. Proper brushing and flossing at home, a healthy diet, and regular professional cleanings are some preventative measures essential to helping control these problems. If the edge of the crown falls deep below the gum tissue a procedure to reduce the gum and bone may be needed to adequately place the restoration.
• I understand there is a risk of aspirating or swallowing the crown during treatment.
• I understand that crowns may not exactly match the color nor shape of my other teeth. Also the crown’s color cannot be altered once in place.
• I understand that cementation may further irritate the nerve tissue (called the pulp) in the center of the tooth, leaving my tooth feeling sensitive to heat, cold, or pressure. Such sensitive teeth may require additional treatment including endodontic or root canal treatment. Except in the case of implant restoration where there is no natural tooth or nerve involvement.
• I understand that I will be approving the aesthetics of the restoration before final cementation and once it is finally cemented it cannot be removed without destroying the restoration.