Extraction(s)

Alternatives to Surgery:  Risks to my health if the above procedure is not performed include but are not limited to:

            Infection;

            Cyst or tumor formation;

            Periodontal (gum) disease; and

            Increased risk for complications if removal is required at a later time.

     nothing

   referral

Possible Complications which have been discussed with me include but are not limited to:

            1.Injury to the nerves, to the lower lip, and tongue causing numbness which could be  permanent;

            2.Bleeding and/or bruising which may be prolonged;

            3.Dry socket;

            4.Involvement of the sinus above the upper teeth;

            5.Infection;

            6.Decision to leave a small piece of root in the jaw when its removal would require             extensive surgery and increased risk of complications;

            7.Injury to adjacent teeth or fillings; and

            8.Unusual reaction to medications given or prescribed.

I understand that a perfect result cannot be guaranteed.  If any unforeseen conditions arise during the procedure, I request and authorize the doctor to do whatever he deems advisable to correct the condition.

I agree to cooperate completely with Dr.Skinner,his staff , and will follow the post operation instructions to the best of my ability for my own comfort and safety.  I have had the opportunity to ask questions concerning these procedures.