Extraction Consent


  • The consequences of not performing necessary extractions may include:

    • Continuation, growth, and/or spread of infection
    • Pain and swelling
    • Systemic infection, such as fever, sepsis, and (in rare cases) death
    • Aspiration (inhaling) of loose teeth or tooth fragments

    Though rare, the following complications may occur during or after dental extractions:

    • Pain and swelling
    • Injury to neighboring teeth, restorations, or soft tissues
    • Reversible or irreversible nerve damage
    • Dry socket (a painful, noninfectious complication)
    • Infection
    • Adverse reactions to medications, anesthesia, or substances used for the extraction
    • Retained fragments of teeth in the jaw (if the risk of removal outweighs the benefit)
    • Perforation of the maxillary sinus, possibly requiring further treatment
    • In rare cases, fracture of the jaw requiring further treatment

    I understand that tooth extraction is an elective procedure, and there are often alternative treatments, such as a root canal and restoration or performing no treatment at all. My dentist has described other options, invited me to ask questions, and I am electing to proceed with the extraction.

    I will follow the verbal and written postoperative instructions and return for a follow-up appointment if requested.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY