Consent Oral Surgery
____________________________________________________ I hereby authorize
Dr. Bryan Bauer to perform the following procedure __________________________
The doctor has explained to me the proposed treatment and the anticipated results. I understand there are possibly alternative forms of treatment. The doctor has explained to me that there are certain potential risks involved with this procedure and include:
- Postoperative pain, swelling and bleeding.
- Dry socket, pain in tooth socket typically occurring 2-3 days after extraction.
- Stretching of the mouth corners resulting in cracking and/or bruising.
- Postoperative infection that may require more treatment.
- Restricted mouth opening for several days or longer.
- Injury to surrounding teeth and dental work.
- Injury to a nerve resulting in numbness or tingling of the chin, lip, gums, cheek, teeth and/or tongue on the operated side. This may persist from a few days to several months and in very rare instances permanently.
- Opening of the maxillary sinus (a normal body cavity or space above upper teeth) requiring an additional surgery.
- Decision to leave a small piece of the root in the jaw when removal would require extensive surgery.
- Broken jaw and/or temporomandibular (jaw) joint trauma or damage.
Unforeseen conditions may arise during the procedure that require a different approach to the extraction and/or additional procedures. I herby authorize the doctor to perform these procedures as he, in his professional judgment, deems necessary. I have had an opportunity to discuss with Dr. Dettmer/Bauer my concerns with this treatment. I have provided the office with my current medical history and all health history and medications I am taking. I agree to follow the post-operative instructions as set forth by the doctor.
Patient, parent, or guardian