1. Examination and X-rays
I understand that the initial visit may require radiographs in order to complete the examination, diagnosis, and treatment plan.
2. Drugs, Medication and Sedation
I have been informed and understand that antibiotics, analgesics, and other medications can cause allergic reactions causing redness, swelling of tissues, pain, itching, vomiting, and/or anaphylactic shock (severe allergic reaction). They may cause drowsiness and lack of awareness and coordination, which can be increased by the use of alcohol or other drugs. I understand that and fully agree not to operate any vehicle or hazardous device for at least 12 hours or until fully recovered from the effects of the anesthetic medication and drugs that may have been given me in the office for my treatment.
3. Changes in Treatment Plan
I understand that during treatment, it may be necessary to change or add procedures because of conditions found while working on teeth that were not discovered during examination, the most common being root canal therapy following routine restorative procedures. I give my permission to the Dentist to make any or all changes and additions as necessary.
4. Temporomandibular Joint Dysfunctions (TMJ)
I understand that symptoms of popping, clicking, locking and pain can intensify or develop in the joint of the lower jaw (near the ear) subsequent to routine dental treatment. Should symptoms arise, I will be referred to a specialist and the cost of treatment is my responsibility.
5. Fillings
I understand that care must be exercised in chewing on fillings during the first 24 hours to avoid breakage, and tooth sensitivity is a common after-effect of a newly placed filling.
6. Removal of Teeth (Extraction)
Alternatives to removal have been explained to me (root canal therapy, crowns, periodontal surgery, etc.). I understand the risks involved in having teeth removed: pain, swelling, spread of infection, dry socket, loss of feeling in teeth, lips, tongue, and surrounding tissue (paraesthesia) that may last for an indefinite period of time.
7. General Consent
I consent to the proposed dental treatment and to the taking of clinical photographs/X-rays for diagnosis and treatment planning purposes. I confirm that the information I have provided is accurate and complete.