, Consent for Periodontal Treatment


Medway Smile – Consent Form

    Consent for Periodontal Treatment

    Periodontal treatment is a dental procedure during which the teeth are cleaned above and below the gums. The intended benefits of the procedure include the elimination of active periodontal disease (also called gum disease) aiming to prevent the loss of teeth.

    As with all medical procedures there are risks and potential complications which you must be aware of before you can give your consent to proceed..

    Expected complications
    • Numbness lasting a few hours.
    • Soreness of the gums lasting a few days.
    • Requirement for maintenance cleaning in the future.

    Common risks and complications
    • Trauma to other parts of the mouth including adjacent teeth, gums, cheeks, tongue etc.
    • Some teeth will still be sensitive for some time after the procedure.
    • Inability to clean the tooth well enough to control the periodontal disease.
    • Cosmetic changes to the gums.

    Rare risks and complications
    • Trauma to tissues underneath the tooth including bone, sinus, nerves supplying other teeth etc.
    • Allergic reaction to something used during the procedure.

    Periodontal treatment is not successful 100% of the time even if all parts of the procedure go as planned. Therefore some teeth that have undergone this procedure will require further treatment or might require extraction.

    Alternative options
    • 1. Referral to a specialist in this field who may be able treat the tooth better via the use of a microscope and specialist equipment etc.
    • 2. Treating the tooth in a different way such as extraction.
    • 3. Refusing treatment but this will result in a high risk of further loss of gum strength ultimately leading to loss of some teeth.

    By signing below I acknowledge that this procedure has been explained to me and I have had time to ask questions, consider my options and am happy to proceed. I am also aware that I have the right to seek a second opinion from another dentist at any time.


    Sign:

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