For Extraction with Bone Graft

Patient Consent Information

You have the right to be informed about your diagnosis and planned surgery so that you can decide whether to have a procedure or not after knowing the risks and benefits.

Whether an extraction procedure is easy or difficult, it is still a surgical procedure. All surgeries have some risks. They include the following and others:

1. Swelling, bruising, and pain.

2. Possible infection that might need more treatment.

3. Changes in the bite or difficulty in opening the mouth because of stress on the jaw joint (TMJ) may
happen.

4. Possible damage to other teeth close to the ones being taken out, (more often those with large fillings
or caps), or other tissues of the face or mouth might be harmed.

5. It is very rare that the bones of the jaw will break, but it is possible in cases where the teeth are buried
very deep in their sockets.

6. Healing could taken longer.

7. The place where the tooth was taken out could be very painful (dry socket).

8. I might have a reaction to a medicine.

9. Sharp ridges or bone splinters may form later at or near where the tooth was taken out. These may
need another surgery to smooth or remove.

10. The hole where the tooth had been might need more care, or small pieces of the tooth root might be
left there to prevent damage to very important things like nerves, or a sinus (a hollow places above your
upper back teeth).

11. Upper back teeth are often close to the sinus and sometimes the tooth or a pieces of root can get
into the sinus and need more treatment. An opening may occur from the sinus into the mouth that may
need more treatment.

12. The roots of the lower teeth might be very close to the sensory nerve and after the surgery, there
might be pain or a numb feeling in the chin, lip, teeth cheek, gums, or tongue. It is possible that you might
lose your sense of taste. This might last for weeks or months and can be permanent.

BONE GRAFTING PROCEDURE

The procedure of bone grafting involves taking a segment or segments or bone from And transferring it to
where there isn’t enough bone support (usually for placing dental implants).

I have been informed of alternative methods of treatment to bone grafting. The risks of those choices have been presented to me.

3. My doctor has explained to me that unique risks to bone graft procedures include:

A. Injury or damage to the blood supply of teeth near the place where the graft came from or was put
that might need root canal treatment of the injured tooth. You might even lose the tooth.

B. An infection that might badly affect the new bone graft and need more treatment.

C. Scarring where the cuts were made inside the mouth. The scarring might also be seen on the skin over
the area where the cuts were made.

D. A bone infection (Osteomyelitis) may begin. This can last a long time and may need long-term
antibiotic therapy and/or more surgical treatment.

E. Unexpected exposure of the screws, wires or mesh used to fix the bone graft requiring their loss or
premature removal, and possible loss of the bone graft.

F. Injury to nerves that control the sensitivity in your face. This might result in numbness, tingling, pain, or
other sensory disturbances in the chin, lip, cheek, face, teeth, gums or tongue. This can last for several
weeks or months, or may be permanent.

G. The graft might not join together with the natural bone. There could be other reasons that the bone
graft might be lost.

H. To add to the bone graft, natural pieces of donor bone, or other kinds of synthetic bone are often
packed around the bone graft. These pieces might also lose their vitality and be lost. Sometimes this
happens over some period of time.

I. Biologic or synthetic membranes or mesh are often used to contain and protect the graft. Some may
need a second procedure to remove them; or some may be unexpectedly lost. If so, graft may be
adversely affected.

J. This bone grafting procedure may involve more than one (1) stage. Including: procedures to take and
place the first graft; additional bone grafting procedures to add needed bone to the recipient site;
procedures to remove various devices to attach the graft (screws, wires, mesh, membranes); and
procedures for soft tissue augmentation. If planned, dental implants may be placed during an additional
stage, or weeks or months of further healing may be needed before the bone graft is strong enough to
place implants.

4. I understand that I need to have the dental implant(s) put in when the graft is ready. If too much time
passes, the bone graft may resorb (“melt away”) and there won’t be enough bone into which an implant
can be placed.

5. If my doctor finds a different condition that expected and feels that a different surgery or more surgery
needs to be done, I agree to have it done.

YOUR OBLIGATIONS FOR IV SEDATION OR GENERAL ANESTHESIA IS:

A. Because anesthetic medications cause prolonged drowsiness, you MUST be accompanied by a
responsible adult to drive you home and stay with you until you are sufficiently recovered to care for
yourself. This may be up to 24 hours.

B. During recovery time you should not drive, operate complicated machinery or devices, or make
important decisions.

C. You must have a completely empty stomach. IT IS VITAL THAT YOU HAVE NOTHING TO EAT OR
DRINK FOR SIX (6) HOURS PRIOR TO YOUR ANESTHETIC.TO DO OTHERWISE MAY BE LIFETHREATENING!

D. However, it is important to take any regular medications (high blood pressure, antibiotics, etc.) or any
medications directed by us, with only a small sip of water.

INFORMATION FOR FEMALE PATIENTS
1. I have told my doctor that I use birth control pills. I have been told that the birth control pills might not
work if I take them with some other medicines (like antibiotics) and I could become pregnant. I agree to
talk to my own doctor to start some other type of birth control while I am being treated, and continue to
use the other birth control until that doctor says I can stop it.

2. I have informed my doctor of my pregnancy status, and if I am receiving IV sedation or nitrous oxide,
there is no chance that I am pregnant.

CONSENT

I understand that my doctor can’t promise that everything will be perfect. I have read and understand the above and give my consent to surgery. I have given a complete and truthful medical history, including all medicines, drug use, pregnancy, etc. I certify that I speak, read and write English. All of my questions have been answered before signing this form.

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Post-Operative Instructions

POST-OPERATIVE INSTRUCTIONS FOR EXTRACTION
The following information applies when grafting material has been placed into extraction sites to help preserve your jawbone in preparation for possible implant replacement of the extracted tooth.

Your bone graft is made up of many particles. You may find some small granules in your mouth for the first several days. Do not be alarmed by these. Its normal to have some of them come out of the graft site and into your mouth. There are some things you could do to minimize the amount of particles that become dislodged:

Immediately Following Surgery

• Do not disturb or touch the wound.
• If a gauze pad has been placed over the surgical area, it should be kept in place for 30-45 minutes. After this time, the gauze pad should be removed and discarded. If the bleeding or oozing still persists, insert another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.
• Unless otherwise instructed, take your first dose of ibuprofen (Motrin or Advil) 400 mg (2 tablets) before the local anesthesia wears off
  to decrease the initial pain. If you feel it is necessary, you may take the prescribed pain medication.
• If it is necessary to take a prescription medication for pain, you may take it in conjunction with the ibuprofen or staggered with the ibuprofen.
• Avoid rinsing or spitting for 2 days to allow blood clot and graft material stabilization.
• Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
• Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.
• Do not smoke
• Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

Pain
For moderate pain, ibuprofen (Motrin or Advil) 400mg (2 tablets) should be taken every three to four hours on a regular schedule. By taking this pain medication regularly and keeping the blood levels constant, the medication can work better and often less prescription narcotic pain medicine is necessary.

If you cannot take ibuprofen, you can take two, regular strength (325mg) acetaminophen (Tylenol), or one extra strength (500mg) every three to four hours, keeping in mind that no more than 4 grams may be take in 48 hours. The prescription medication may have some of this medication in it as well and should be taken into account.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. You may take the prescription medicine it in conjunction with the ibuprofen or staggered with the ibuprofen.

Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Bleeding
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag (regular tea, not herbal) for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. In some cases you will be provided with ice packs. Plastic bags filled with ice, ice packs, or frozen peas should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Diet
Drink liquids after intravenous anesthesia. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

Oral Hygiene
No rinsing of any kind should be performed until the second day following surgery. Following the second day, gentle rinsing is allowed but not too vigorously as you can again disturb some of the bone graft granules You can brush your teeth the night of surgery, but avoid the surgical area..

REMEMBER: A clean wound heals better and faster.

Activity
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

Discoloration
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics
Antibiotics are not always given, but if you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea & Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

Wearing Your Prosthesis
Wearing of partial dentures, flippers, or full dentures after surgery will vary by patient. Please be sure to clarify with the doctor when you can wear your prosthesis. This is commonly discussed in the preoperative consultation.

Finally
Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. If the sutures are not the dissolvable type, they will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So its really nothing to worry about. Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you, your dentist. It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office.