Informed Consent for Dental Extractions
I consent to extraction(s) of my tooth or teeth.

I understand that, if this tooth or teeth is/are not treated as my dentist has advised me or extracted, my condition may worsen and result in complications, including (but not limted to):

- Increased infection
- Loss of additional teeth
- Pain

Possible complications of the extraction of teeth include, but are not limited to:

- Infection
- Bleeding and bruising
- Dry socket
- Swelling
- Injury or fracture of adjacent teeth, fillings, crowns, or bridges
- Sinus involvement (oral antrul communication) with extraction of upper teeth
- Paresthesia of the lower lip with extraction of lower teeth
- Fracture of the jaw
- Decision to leave a small root or root tip if extensive surgery is required to remove it
- Allergic reaction to local anesthetic
- Allergic reaction to post-operative medications

I have discussed the surgery with my dentist and consent to the surgery as described.

I understand that my post-operative care will include refraining from:

- Smoking for 3 days
- Spitting for 3 days
- Drinking through straws for 3 days
- Heavy exertion for 3 days

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