Extraction & Surgical Extraction Consent Form

Consent for Tooth Extraction

The extraction of any tooth in the mouth is considered a minor oral surgery and as such has some inherent risks to the surrounding tissues. The possible complications relate to the position the tooth is in the mouth. Generally, when a tooth is extracted there can be damage to the adjacent tooth including fracture and broken filling. Regarding upper molars there can be fracture of the supporting bone, root dislodgement into the sinus and possible sinus communication.

You must inform the dentist prior to treatment if you have a coagulation condition, heart condition, or are taking any medications such as bisphosphanates or blood thinners including aspirin. Any further treatment required by an Oral and Maxillofacial Surgeon or another health practitioner will be at your cost.

The dentist will select patients to treat and manage accordingly. The dentist will endeavour to provide you with the best possible care for each situation. Please discuss any concerns about any procedure with the dentist before agreeing to have the procedure completed. You have options for treatment under local anaesthesia, sedation and under a general anaesthetic in a hospital setting. Please note treatment at the hospital will incur further costs.