Consent for Dental Extractions

Dental extraction is the permanent removal of a baby or permanent tooth.

Patient Name(Required)
DD slash MM slash YYYY
Risks:

  • Post-operative discomfort, bleeding, swelling, bruising, persistent numbness (extremely rare with baby teeth)
  • Fracture of tooth
  • Retained small root fragments (may be left in jaw for resorption or eruption at a later date)
  • Loss of adjacent fillings or injury to nearby teeth of soft tissues
  • Aspiration or swallowing of tooth

Space Maintenance:

  • In some cases, a “spacer” may be recommended to hold open the empty space left by a lost baby tooth. This may help save the position for the developing permanent tooth that will eventually grow into the position

I, as the parent/guardian hereby consent to tooth extractions in conjunction with dental treatment. I am aware of the benefits/risks involves with this procedure, and I have had the opportunity to have my questions answered. I have read and fully understand the consent.

DD slash MM slash YYYY
Call Today
  • Popular Searches
  • Hide Popular Searches