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                   /       /201              


Witness Signature                                                                                 Date                   /       /201        

Xin Wei, DDS, PhD, MS 1st edition 05/30/2010, last revision 12/26/2010