Dental Education Lecture: Consent
for
Extraction
DENTIST: Xin Wei,DDS,PhD,MS PATIENT:
Diagnosis: 1. Severe caries 2. Severe periodontal disease 3. Impaction 4. Infection 5. Tooth/teeth unsalvageable
About the Proposed Treatment
An extraction involves removing one or more teeth. Depending on tooth condition, the treatment may require cutting the tooth or gums or removing bone. If any unexpected difficulties occur during treatment, the doctor may send you to an oral surgeon, who specializes in extracting teeth and performing other surgical procedures.
Benefits and Alternatives
The proposed treatments will help to relieve your symptoms and may also enable you to proceed with further proposed treatment. The most common alternative to extraction is root canal treatment. In severe infection and wisdom tooth cases, there is no reasonable alternative treatment that will relieve your symptoms.
Common Risks
1. Bleeding, swelling,
discomfort and infection:
Following
treatment you may experience
bleeding, pain,
swelling
and discomfort for several days, which may
be treated with pain medication. You
may also experience an infection
following treatment, which would be
treated with antibiotics.
The antibiotics
can interfere with effectiveness of oral contraceptives.
Use other contraceptive measures if applicable.
If you take a special osteoporosis medicine or have had head and neck
radiation, you have increased risk of jaw bone infection after extraction.
2. Reaction to anesthetic
and/or sedation:
You
will
receive a local anesthetic and possibly a
sedative (tranquilizer) to keep you
comfortable during
treatment. In rare instances patients have
an allergic reaction to the
anesthetic, which may require emergency medical attention. The anesthetic may
reduce
your
ability
to control swallowing, which increases the
chance of swallowing foreign objects
during treatment. Sedatives may temporarily make you drowsy or reduce your
coordination.
3. Stiff or sore jaw joint:
Holding
your mouth open
during
treatment may temporarily leave your
jaw feeling stiff and sore and may make it
difficult for you to open your mouth wide for several days or longer.
In severe situation, you need to see a TMJ specialist.
Treatment may also
leave the corners of your mouth red or cracked for several days.
4. Dry socket:
The blood clot that forms in the empty tooth socket may disintegrate or become
dislodged. It occurs most often as a result of smoking or drinking through a
straw after extraction. This painful condition
called dry socket lasts a week or more and is treated by irrigation of the
socket with normal saline and/or
placing
medicated dressing in the tooth
socket to
aid
healing.
5. Damage to adjacent teeth:
In some cases, the instruments used in extracting a tooth can
chip
or
damage adjacent teeth, which could require
further treatment to restore their appearance.
6. Opening into sinuses:
With the upper teeth, the roots sometimes extend up beyond the
surrounding bone into the sinuses, the natural cavities in the bone behind your
cheeks. 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. You are rarely
required to have surgery to close it.
7.
Bone fracture:
Depending on the location of the tooth or teeth to be extracted, treatment may
cause
a fracture in the surrounding bone, particularly associated
with lower wisdom tooth for patient over 40 years old. In rare instances the tooth or teeth to be
extracted may be fused to
the surrounding bone. Both situations may
require
further treatment.
8.
Tooth fragments:
Depending on the
condition
and
position
of the tooth or teeth to be extracted,
tooth fragments may be left in the
extraction site following treatment. Generally,
this
causes no
problems, but on rare occasions tooth
fragments become infected and must be removed.
9.
Changes to nerve sensations:
The nerves that control sensations in your teeth, gums, tongue, lips, and chin
run through your jaw. Depending on the tooth or teeth to be extracted
(particularly lower teeth or third molars), in rare instances it may be
impossible to avoid touching, moving, stretching, bruising, cutting or severing
the nerve. This could change the normal sensations in any of these areas causing
itching, tingling, or burning (called paresthesia) or loss of all sensation
(called anesthesia).
These changes could last from several weeks to several months or in some cases
indefinitely. You may need to see a
specialist about this condition.
10.
Bony
spine formation:
After extraction a small piece of bone may protrude underneath the gums adjacent
to the extraction area, produce severe pain and interfere with denture fitting.
The more teeth are to be extracted, the more likely the bony spine will
form. The doctor may suggest a
surgical procedure called alveoloplasty to trim the bony spine.
This procedure can be done during extraction to prevent bony spine
formation or after the bony spine formation.
Consequences of Not Performing Treatment
This course of treatment
will
help
to
relieve
your symptoms. If no treatment were
performed, you would continue to experience symptoms, which could
include
pain
and/or infection, deterioration of
the bone surrounding your teeth, changes to
your bite, discomfort in the jaw joint,
premature loss of these and adjacent teeth
and possibly death.
Tooth/teeth to be extracted: #
Additional Information
Every reasonable effort
will
be made to ensure that your condition is
treated properly, although it is not possible to guarantee perfect results. By
signing
below, you acknowledge that you have
received adequate information about the proposed treatment, that you understand
this
information and that
all
of your questions have been answered fully.
You have
also
received written post-operative
instruction and extra gauze.
1.
I give my consent for the proposed treatment as described
above
2.
I refuse to give my consent for the proposed treatment as
described above. I have been informed of the potential consequences of my
decision to refuse treatment
Patient Signature Date / /201
Dentist Signature
Date
Witness Signature
Date
Xin Wei, DDS, PhD, MS 1st edition 05/30/2010, last revision 12/26/2010