Possible Complications of Dental Procedures
( ) LOCAL ANESTHESIA:
They explained that local anesthesia is administered via injection, substances that
cause reversible blockade of pain sensation, to make the treatment without pain.
The local anesthesia may cause, among other things, ulceration of the mucosa at
the injection site, pain, limitation of the mouth opening movement, decreased in
blood pressure, syncope, urticaria, asthma, angioneurotic edema, and in rare
cases ventricular fibrillation, or death, which may require urgent treatment.
( ) CONSERVATIVE DENTISTRY:
The main purpose of these treatments is to remove the affected hard tissues, pulp
protection, and restoration, to preserve the tooth and its function, restoring at the
same time, whenever possible, the appropriate aesthetics.
They explained that it is possible the appearance of a greater sensitivity, which
usually disappear spontaneously, and that, especially in deep caries, can produce
effects on the dental pulp that will require endodontic treatment, so the tooth will be
fragile and may be necessary to carry out other reconstruction or placement of a
prosthetic crown.
I also understand that I may not be satisfied, aesthetically, with the shape and color
of the tooth after the treatment, because the qualities of direct restorations will
never be identical to their healthy appearance.
( ) ENDODONTICS
The main purpose of the intervention is the elimination of pulp tissue when it
becomes inflamed or infected, or with a granulomatous or cystic process, filling the
pulp chamber and root ducts, preserving the tooth.
I have been advised that, even the technique is practiced correctly, it is possible
that the infection or cystic or granulation process, cannot be completely eliminated,
so you may need retreatment or periapical surgery after a few weeks, months or
even years.
They also told me that it is possible the occurrence of postoperative sensitivity,
change the color of the crown, the weakening and fracture of the tooth and the
breaking of any instrument that might require other treatments.
() PROSTHESIS
The main purpose is the total or partial replacement of missing teeth, or the
anatomical
reconstruction
of
teeth
that
have
lost
structure.
The operation consists in the preparation of the mouth by carving the adjacent
teeth, or the proper management of soft tissue, and in making the impression to
prepare the models.
They have been told that the removable prosthesis can cause nausea, ulcers,
aches, mobility in case of low bone support, which requires a process of adaptation
that may require alterations and can be a long time, so must go periodically to visit
the dentist.
() SIMPLE EXTRACTION
The procedure involves the extraction of a tooth from its alveolus, under local
anesthesia, that after performed the diagnostic tests have been estimated
accurately, has ruled out the implementation of restorative dentistry procedures, so
that it becomes impossible to preserve .
Despite having taken all the measures that have been considered necessary, may
cause an infection, a profuse bleeding, rupture of the crown of the tooth,
lacerations in the mucosa, displacement of the root to the maxillary sinus or other
structures, fracture of the intraradicular partition wall, or maxillary tuberosity,
temporomandibular joint dislocation, and even fracture of the jaw, which does not
depend on the successful implementation of the intervention, they are
unpredictable, in which case the physician will take accurate measurements, and
continue the extraction.
( ) ORAL SURGERY
Are the surgical interventions that are performed in the oral cavity to remove
impacted teeth, infections, cysts or tumors affecting the jaws and / or soft tissues of
the oral cavity or tongue, or to remodel these tissues to seat correctly dental
prosthesis.
They have been told that these operations, to clarify the incision of the oral mucosa
or tongue, edematous processes can occur, inflammations, infections, hematomas,
pain, mucosa lacerations, which does not depend on the form or mode of
intervention performed, and its proper performance. They also explain that by their
proximity, regardless of the technique used and its proper implementation, may be
injured some other structure such as the inferior alveolar nerve or its terminal
branches, or the lingual nerve, which involves anesthesia or numbness of the lip or
chin area, which may be temporary or permanent, or the maxillary sinus could be
the cause of sinusitis.
() Periodontics
Periodontal treatment aims the elimination of the etiological factors that cause
disease of the tissues that support the teeth, through scaling techniques and root
planing or periodontal surgery to prevent periodontal disease progression and
ensure the maintenance of the teeth over time, function and aesthetics.
I understand that even when carried out a successful implementation of the
technical processes can occur edematous, swelling, pain or sores in the mucous
membranes.
They also explained that it is possible to increase sensitivity and tooth mobility,
which should normally disappear spontaneously or by conducting subsequent
treatments. Also will produce a lengthening of the teeth as a result of the
elimination of the diseased tissue.
I also understand that cause of the characteristics of periodontal disease, the
required objective cannot be obtained, in whole or in part, irrespective of the
technique and its proper implementation.
() OTHER:
Intolerance or allergies to anesthetics or medications required for treatment,
ulceration of the mucosa in the injection point of anesthesia, pain, nausea,
hematomas or discoloration of the skin or mucous membranes, limited movement
of mouth opening, decreased blood pressure, and ventricular fibrillation may
require emergency treatment.
Inflammation, abscesses, bleeding, infections, bone sequestration, oral antral
communications, oral nasal or fistula formation, increased sensitivity postoperative,
weakening and fracture of teeth or portions of bone, or infectious processes.
Sensitive or motor disorders such as anesthesia, paresthesia, hyperesthesia or
movements alterations or muscle function.
Need for other surgical procedures or treatments, accessories and tests, which
should be performed at this clinic by their staff or even in other clinics and other
professionals in dentistry.
In case of implants, transplantation, of teeth or other tissues or materials, their loss
or need to be replace due to intolerance, infection or abnormal masticatory forces.
OTHER: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
APPROXIMATE DURATION OF TREATMENT:
It is expected that the dental treatment indicated in this document take
approximately ___________ months, however, also I understand that it can take
more time, during which I must visit the dentist regularly according to the
scheduled appointments, and especially during and after treatment, I must look
carefully my dental hygiene through the techniques indicated above.
INFORMED CONSENT AND DECLARATION OF ACCEPTANCE OF RISKS FOR
ODONTOLOGY
The Undersigned _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ _ _ _ _ _ _ in my personal capacity as a representative of a minor _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
I DECLARE:
That Dr _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ explained me that I must receive
dental treatment of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ __ _ _ and explained and clarified in a vocabulary that is
understandable to me, the size, scope and possible consequences, effects or
inconvenience of the treatment above.
Some of the possible complications, sequelae, disorders, risks or pre-, trans-or
postoperative discomforts , are the following: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
I declare that if these complications occur, I accept the discomforts and risks
mentioned and those listed as derivatives of the treatment. Any notes or Additional
clarification is written on the back of this sheet and shall be fitted with the signature
of the patient or the responsible person.
DENTIST'S INSTRUCTIONS:
I understand that failure the follow instructions that the Dr _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ indicated to me, the treatment may not have the expected success or
complications may arise and need other interventions or treatments, without any
implication that the previous have been executed incorrectly or without proper
scientific and technical capacity required.
Therefore, I manifest that I am satisfied with the information received and
understand the scope and risks of the treatment.
In these conditions:
CONSENT
I am agree that you can make me the dental treatments specified at the beginning
of this document.
In _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date_ _ _
_ _ _ _ _ _ _ _ _ _ _ __
The patient or legal representative: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
DR. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Witness _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _