I understand that oral surgery and/or dental extractions include possible inherent risks such as, but not limited to the following:

1. Injury to the nerves of the lips, the tongue and/or the tissues. These possible nerve injuries can cause numbness, tingling, burning and loss of taste, which may be temporary or could possibly be permanent.
2. Bleeding and/or Bruising: Bleeding could last for several hours. Should it persist in being severe in nature, it should receive attention, and our office should be contacted. Bruising should be expected to occur.
3. Dry Socket can occur when teeth are extracted. This is a result of blood not clotting properly. Smoking, drinking alcohol, using a straw and not following proper post-op instructions can increase the chance of dry socket happening.
4. Sinus Involvement: In some cases, the root tips of upper teeth lie close to the tissues of the sinus. During extraction or surgical procedures, the thin bone and tissues surrounding the sinus membrane may be perforated. Should this happen, it may be necessary to have the sinus surgically repaired.
5. Infection: No matter how carefully surgical sterility is maintained, it is possible that, because of the existing non-sterile or infected oral environment, infections may occur. Antibiotics may be necessary in this situation.
6. Fractured Jaw, Root or Bone Fragments: There is a possibility, even though extreme care is exercised, that the jaw bone, teeth roots or bone spicules may be fractured, which may require a referral to a specialist for follow-up treatment.
7. Injury to adjacent teeth, fillings or porcelain crowns may occur no matter how carefully the procedure is performed. This could result in existing dental work being repaired or replaced.
8. Muscle and/or Jaw Soreness may be noticed following oral surgery. Pre-existing conditions affecting the jaw joints (TMJ) may be aggravated by oral surgery. Clicking, popping, muscle pain, and difficulty opening may be noticed following oral surgery.
9. Unusual Reactions to Medications Given or Prescribed: Reactions, either mild or severe, may possibly occur from anesthetics or other medications administered or prescribed. It is important to take all prescription drugs as prescribed and according to instructions. It is also necessary and important for you to inform your dentist or oral surgeon of any and all medications that you are on.
10. IT IS MY RESPONSIBILITY to contact the dentist and seek attention should any undue circumstance occur post-operatively, and I shall diligently follow all pre-operative and post-operative instructions given to me.

*INFORMED CONSENT: I have been given the opportunity to ask any questions regarding the nature and purpose of oral surgery and/or the extraction of teeth. I do assume all possible risks. I am giving consent to allow Pemberton Valley Dental’s dentist to render any treatment and/or medications necessary for my dental conditions.