- Prepared to inform you and obtain your consent to start your treatment
- fill out this form and sign it by reading the sections must end.
- Thank you for your time and your participation.
- Tooth extraction; hard to get a shot or routine is a surgical procedure and there's no turning back.
- As with every surgical procedure, there are some risks. These risks are limited to the following
- not are as follows:
- 1. Swelling and/or redness, discomfort in the area of surgery
- 2. Stretch the corners of the mouth due to redness and cracking,
- 3. The development and delayed healing of wound infection,
- 4. Dry socket; usually started a few days after surgery due to inadequate maintenance
- jaw pain; especially wisdom teeth in the lower jaw to shots more often
- are common.
- 5. Especially for large fillings and crowns in the presence of damage to adjacent teeth,
- 6. The gums, lips, tongue, teeth and jaw at the tip of sensory loss, or decreased sensation.
- Especially close to the roots of the nerves in the teeth such as wisdom teeth that can be seen. Almost every
- returns to normal when the numbness, but rarely may be permanent.
- 7. Trismus; depending on the inflammation or swelling of the mouth opening limitation.
- 8. Bleeding severe bleeding is not common. Bleeding for but a few hours
- it continues.
- 9. After shooting, sharp corners and shooting blanks may occur in the bone ladder.
- These are corrected with a new surgical intervention.
- 10. The root part of complete disconnection. Important formations such as nerves or sinuses
- to avoid damage, sometimes small root fragments can be left.
- 11. A relationship sinus; posterior sinus is very close to the roots of the teeth of the upper jaw, and in some cases root
- an opening between the mouth can occur with sinus or the sinuses, and the pieces can escape;
- situations need special attention.
- 12. Jaw fractures; although it is very rare, hard and deeply buried formations in the exterior shots
- it is possible.
- Most of the procedures are routine and significant surgical complications are not expected. Of
- the complications are conditions that are minor and can be treated easily.
External shooting to be done:
Patient or patient's legal representative* – the degree of closeness
Name-Surname : ........................................................................................................
ID number address : ........................................................................................................
Phone : ........................................................................................................
Signature : ........................................................................................................
Physician: ........................................................................................................
Name-Surname : ........................................................................................................
Date signature : ........................................................................................................* Legal Representative: for those under guardianship, The Guardian, parents of minors, in their absence 1. the degree legal heirs (the patient's name next to specify the degree of proximity)
