Consent for Wisdom Tooth Removal

  1. I have agreed to have my tooth extracted under the care of 3 Step Smiles Dental Practice.
  2. My dentist has explained to me the nature of the procedure, which involves carefully lifting up a flap of gum to expose the wisdom tooth, after which the dentist will section the tooth and remove the roots.
  3. I am aware that extracting a wisdom tooth can be performed in the NHS. However, I prefer to have this surgery in this private dental practice.
  4. As with any dental procedure, I am aware there are several risks associated with wisdom tooth removal, which include, but are not limited to:
    • Root fracture.
    • Pain, swelling, bleeding, bruising, limited mouth opening.
    • Temporary or permanent paresthesia (Altered sensation).
    • Temporary or permanent dysesthesia (Abnormal sensation).
    • Dry socket.
    • Infection.
  5. I declare that my dentist has explained to me the nature of the procedure along with the associated risks.
  6. If I have any questions or do not understand any aspect of the proposed treatment, I will contact 3 Step Smiles Dental Practice.
  7. By signing this form, I am aware of and understand the risk associated with this procedure.

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