Odontectomy (Surgical Removal of Impacted Tooth) Consent Form

1. Nature of the Procedure
I understand that odontectomy (surgical removal of an impacted tooth) involves:
– Making an incision in the gum and sometimes removing bone around the tooth.
– Sectioning the tooth if necessary for easier removal.
– Closing the surgical site with stitches (sutures).

2. Purpose of the Procedure
The purpose of this surgery is to:
– Remove an impacted or problematic tooth that may cause pain, infection, crowding, or damage to
nearby teeth.
– Prevent or treat swelling, decay, gum disease, cysts, or other complications associated with impacted
teeth.

3. Risks and Possible Complications
I understand that, although rare, the following risks may occur:
– Pain, swelling, or bruising after surgery.
– Bleeding or delayed healing.
– Infection that may require antibiotics or further treatment.
– Dry socket (loss of blood clot, causing delayed healing and pain).
– Temporary or permanent numbness/tingling of the lips, tongue, chin, or gums (especially with lower
wisdom teeth).
– Sinus involvement or opening (with upper teeth), possibly requiring further treatment.
– Jaw stiffness, difficulty opening the mouth, or TMJ discomfort.
– Tooth or restoration fracture, damage to adjacent teeth or fillings.
– Rare but possible need for additional surgery or extraction of neighboring teeth.

4. Alternatives
I understand that alternatives to odontectomy include:
– Leaving the impacted tooth untreated (with the risk of infection, cyst formation, or damage to nearby
teeth).
– Other treatment as recommended by the dentist, depending on my case.

5. Post-Operative Care
I understand that after surgery, I must follow instructions such as:
– Taking prescribed medications.
– Applying cold compress to reduce swelling.
– Eating a soft diet and avoiding hot, hard, or spicy foods.
– Not smoking, using straws, or spitting forcefully to avoid dry socket.
– Attending follow-up visits for check-up and suture removal if needed.

6. Patient Acknowledgement
I have had the procedure explained to me, including its purpose, risks, benefits, and alternatives.
I understand that no guarantee has been made regarding the outcome of the surgery.
I have had the opportunity to ask questions, and my questions have been answered to my satisfaction.

    Patient's name*:

    Witness' name (if applicable):

    Date*:


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