Infection following surgery: I understand that this is unlikely if I use the medications that will be prescribed for me and if I follow all recommended post-operative instructions.

Nerve damage: I understand that in the lower jaw there is a nerve that travels close to the tongue side of my last molar, and that another nerve exits the jawbone near the premolars. This latter nerve will be identified by the dentist in the pre-operative x-rays and / or at the surgery and all precautions will be taken to protect it from injury. However, occasionally, due to post-operative swelling, the nerves may give altered (generally reduced) sensation for a period of days to months before returning to normal. In very rare instances, the change in sensation may be more or less permanent. If nerve function is altered, it could result in tingling and / or a “pins-and-needles” sensation and / or a burning sensation and, most commonly, a numb feeling on the tissues overlying the tongue, inside the lip and the surface of the lip. Muscle movement or facial appearance should not be affected.

Recession: I understand that there is a chance any dental procedure may make it appear as though there has been recession and that some root surface may become exposed. In addition, there may be a reduction in height of the papillae (the triangular gum tissue between the teeth) resulting in spaces developing. These can sometime be corrected by the dentist with the final restoration.

Sensitivity: I may experience some transient hypersensitivity of the treated teeth to hot, cold, sweet or touch. In many instances, the sensitivity will be self-limiting and resolve in a period of days to months, while in other instances I may require additional procedures to treat the source of the sensitivity.

Relapse: I am aware that minor relapse may occur. Every care and attention is taken to ensure an excellent result. Best results are obtained by having continuity of treatment. This is achieved by attending appointments as they are scheduled according to my treatment plan. It is important that you make the necessary arrangements so we may fulfill this commitment.

Failure: I am aware that there is a minor chance that the intended periodontal procedure may not achieve the desired results.

Normal Post-Operative Sequelae: Post-operative pain, discomfort, swelling of the gums and face, abrasions of lips or corners of the mouth, damage to adjacent teeth and restorations, stiffness of the jaw or neck muscles, temporomandibular joint (“TMJ”) discomfort, pain at the IV site (if sedation is given), bruising, or unanticipated allergic reactions.

Modifications / Additional Procedures:I understand that unforeseen conditions may call for modification or change from the anticipated surgical plan. These may include, but are not limited to, (i) extraction of hopeless teeth, (ii) the removal of a hopeless root of a multi-rooted tooth so as to preserve the tooth, (iii) termination of the procedure prior to the completion of all the surgery originally outlined. From time to time, the dentist may make recommendations for the placement of restorations, the replacement or modification of existing restorations, the joining together of two or more teeth, the extraction of one or more teeth, and the performance of root canal therapy. I understand that failure to follow such recommendations could lead to ill effects.

Follow-up Care / Self-Care: I understand that a small number of patients do not respond successfully to periodontal surgery. Periodontal surgery may not be successful in saving the teeth, function or appearance. Because each patient’s condition is unique, long-term success may not occur. Proper maintenance of the teeth and regularly scheduled cleaning visits are vital to the success of this procedure. I understand that it is important for me to continue to see my regular dentist. I will need to come for appointments following my surgery so that my healing may be monitored by the dentist.

Revision: There is no method that will accurately predict or evaluate how my gums and bone will heal. I understand that there may be a need for a revision procedure if the initial results are not satisfactory. In addition, the success of periodontal procedures can be affected by medical conditions, dietary and nutritional problems, smoking, alcohol consumption, clenching and grinding of teeth, inadequate oral hygiene, and medications that I may be taking. To my knowledge, I have reported to the dentist any prior drug reactions, allergies, diseases, symptoms, habits or conditions which might in any way relate to this surgical procedure. I understand that my diligence in performing the personal daily care recommended by the dentist and taking all medications as prescribed are important to the ultimate success of the procedure.

Alternatives: I understand that alternatives to periodontal surgery include: no treatment, with the expectation of possible advancement of my condition which may result in premature loss of teeth; and extraction of teeth involved.

No Guarantee: I acknowledge that no guarantee has been given to me that the proposed treatment will be 100% successful. In most cases the treatment should provide benefit in reducing the cause of my condition and should produce healing which will help me keep my teeth. Due to individual patient differences, the dentist cannot predict certainty of success. There is a risk of failure, relapse, additional treatment or even worsening of my present condition, including the possible loss of certain teeth, despite the best of care.