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Informed Consent for Dental Extraction

Informed Consent for Dental Extraction

Precautions must be taken for Dental Extraction in certain circumstances. You MUST inform the dentist prior to treatment if you:
1) have any of the following medical conditions:
• coagulopathy;
• heart condition;
• history of rheumatic heart disease;
• artificial heart valves;
• blood clotting disorders (Haemophilia, Von Willebrand’s disease, etc.);
2) are taking any of the following:
• blood thinning medication (Warfarin, Aspirin, etc.);
• medication affecting the bone (for osteoporosis, bone cancer, Paget’s disease).

Potential Complications
Dental Extraction is considered a minor oral surgery and has some inherent risks to the surrounding tissues. The possible complications relate to the position of the tooth in the mouth.
Potential complications that can occur during Dental Extraction include:
• Fractured tooth fragment – The tip of the tooth root can fracture during the procedure. If the root fragment is small, there is no infection present, and the area where the tooth fragment is located is not planned for orthodontic movement or a dental implant, then it may be left in the jaw. Leaving the tooth root in the jaw also minimizes damage to any adjacent structures.
• Displacement of tooth fragment - It is possible that a fragment of the tooth root can be pushed into soft tissue spaces or into the sinus. This will likely require surgical retrieval.
• Damage to adjacent teeth – A small degree of leverage against adjacent teeth is required during the procedure. This may inadvertently cause fracture of the teeth, or any restorative material (fillings, crowns, etc.) associated with that tooth.
• Nerve damage – The roots of the lower teeth can be in very close proximity to nerves that give feeling to your teeth, lips, and tongue. These nerves can potentially be damaged during the procedure, and can cause numbness to the areas they supply. Depending on the severity of the damage, the numbness can be temporary or permanent.
• Weakness of fracture of the jaw – The pressure applied in removal of the tooth may cause small cracks or splits within the jaw bone. In some cases, fragments of the jaw bone may also be removed together with the tooth. This may result in pain and swelling after the procedure. In very rare cases, if the lower jaw bone is very thin, there is a chance fracture of the jaw bone can occur, in which the jaw may need to be fixed to heal properly.
• Oro-antral communication – The roots of the upper teeth can be in very close proximity to the floor of the sinuses in the maxilla (upper jaw). If the floor of the sinus is perforated during the extraction, a communication can be between the mouth and the sinus which is called an “oro-antral communication”. Management of the communication will depend on the size, which can range from monitoring as it heals, to carrying out procedures to close the communication.
• Inability to extract tooth – In rare circumstances, it is possible for the dentist to be unable to remove the tooth. Reasons can include, but are not limited to, complicated anatomy, poor access, fusion of the tooth to the jaw bone, poor patient co-operation. In this situation, a referral to an Oral Surgeon may be required.
Potential complications that can occur after Dental Extraction include:
• Bleeding – especially if taking blood thinning drugs (such as Warfarin, Aspirin, Clopidogrel, or Dipyrdamole). A spare pack of gauze will be provided to aid in stopping the bleeding, but if bleeding does not stop, contact your dentist for further management.
• Dry socket – After a Dental Extraction, a blood clot forms in the socket to protect the bone and nerves underneath. If the blood clot was poorly formed or becomes dislodged/dissolved after a few days, the socket is exposed to air, food, fluid and anything else that enters the mouth. This is called a “dry socket”, and can cause considerable pain. People who smoke are at a considerably higher risk of “dry socket” than patients who do not smoke. “Dry socket” can usually be quite readily managed by the dentist by flushing out the socket and placing sedatives in the socket.
• Delayed healing and wound infection – If an extraction is particularly difficult, the bone in the socket can become compressed and lead to a lower degree of blood flow in the bone. This results in discomfort and a delayed healing. The socket can occasionally beome infected, especially in patients who are obese or diabetic. This is readily managed by the dentist.
• Swelling and bruising - Local area may become swollen and bruised, but this will typically resolve in 7 days with maximal swelling from the third to fourth day after the procedure.
• Bone fragments – Bone fragments may emerge from the socket during the healing phase at around 6-8 weeks, which can often be mistaken for pieces of tooth. This can be very disconcerting for patients, but this is a normal healing response as the body gets rid of dead bone it no longer needs after the tooth is removed.
Alterative Treatment Options
Depending on the reason for extraction, there may be alternatives to extraction. If teeth require extraction:
• due to deep decay, it may be possible to save them by performing a Root Canal Treatment;
• due to poor periodontal (gum) health, it may be possible to preserve the teeth through scaling and root planing;
• to create space to align teeth, it may be possible to create space either with stripping, expansion or skeletal anchorage;
• for cosmetic purposes and be replaced with a prosthetic replacement, it may be possible to consider veneers or crowns instead;
• to facilitate construction of a denture, it may be possible to construct the denture around existing teeth.

The total cost of dental extractions is as outlined in the treatment plan. The full amount of each individual extraction is due on the day of the service.

Teeth requiring Dental Extraction:

• I have read and understand the conditions and information in this Consent Form.
• I have discussed the information contained in the Consent Form concerning Dental Extraction with my dentist, and am satisfied with the answers that I have received.
• To my knowledge, I have given an accurate report of my physical and medical history.
• I have had explained to me the cost of the treatment and I accept responsibility for that cost.
• I authorise my dentist to provide me with Dental Extraction(s).