GENERAL DENTAL INFORMED CONSENT
We would like for the patient/POA to have general knowledge of dental procedures. We ask that you review the procedures listed and want you to know that we will have you sign an informed consent prior to each dental procedure.
- Low Dose X-rays: Low dose x-rays are an important tool to aid the dentist in detecting potential issues and disease not visible to the naked We utilize protective shields and aprons for patient safety. Low dose x-rays are required for all new patients of record and will be taken every 6 months.
- Drugs and Medication: Antibiotics, analgesics and other medications can cause allergic reactions causing redness and swelling of tissues, pain, itching, vomiting, and/or prophylactic shock (severe allergic reaction).
- Changes in Treatment: During treatment it may be necessary to change or add procedures because of conditions found while working on the teeth that were not discovered during The presence of dental tooth decay, gum disease, or any dental infection has been shown to affect many other body parts, such as joints and the heart, so it is important to treat any dental infection as soon as possible.
- Local Anesthesia: Local anesthesia may affect your body such as dizziness, nausea, vomiting, accelerated heart rate, slow heart rate, or various allergic reactions potentially requiring hospitalization. Injury to the nerves that can result in pain, numbness, or tingling to the chin, lip, cheek, gums, or tongue which may be present for weeks or monthly, but rarely remain
- Fillings: In some situations, more extensive restoration than originally planned may be required due to additional conditions discovered during tooth Significant changes in response to temperature may occur after tooth restoration such as temporary sensitivity or pain. If the tooth does not respond to treatment with a filling, further treatment such as root canal therapy and/or a crown may be necessary. Fillings may require periodic replacement with additional fillings and/or crowns.
- Extractions: Alternatives will be explained to you (root canal therapy, crowns, periodontal surgery, ) The removal of teeth does not always remove all the infection, if present, and it may be necessary to have further treatment. Some of the risks are pain, swelling, spread of infection, dry socket, loss of feeling in teeth, lips, tongue, and surrounding tissue that can last for an indefinite period of time (days or months), or fractured jaw. Further treatment by a specialist or even hospitalization may be needed if complications arise during or following treatment which would be your financial responsibility.
- Crowns and Bridges: Sometimes it is not possible to match the color of natural teeth exactly with artificial You may wear temporary crowns, which may come off easily so avoid sticky food and candies. You will need to be careful to ensure that they are kept on until the permanent crowns are delivered. The final opportunity to make changes to a new crown, or bridge (including shape, fit, size, or color) must be done at the preparation appointment.
- Dentures (complete and partials): Removable prosthetic appliances include risks and possible failures. This includes gum tissue pressure, jaw ridges not providing adequate support and/or retention, excessive saliva or excessive dryness of the mouth, and general psychological, behavioral, and physical problems interfering with We are not responsible for failures of these types. Breakage is possible by dropping the dentures or chewing on foods that are excessively hard. Full dentures become loose when there is a change in gum tissues. Our obligation is to create a functioning, well- fitting device. Patients must wear the device consistently in order for the dentist to make appropriate and accurate adjustments. Any denture fit issues must be brought to our attention within 30 days of the final denture delivery. Adjustments after 30 days are an additional charge.
- Immediate/Interim Dentures: After the extractions and delivery of the prefabricated immediate denture, there is fast bone loss resulting in space between the dentures and This leads to rapidly increasing looseness and sore spots which must be adjusted frequently. The dentist may recommend a soft or hard reline (additional charge) if the patient experiences discomfort during the healing period to improve fit.
- Endodontic Treatment (Root Canal): There is no guarantee that root canal treatment will save a Complications can occur from the treatment and occasionally metal objects are cemented in the tooth or extend through the root, which does not necessarily affect the success of the treatment. Occasionally additional surgical procedures may be necessary following root canal treatment.
- Complaints: Please contact us directly at firstname.lastname@example.org with any complaints or A manager will handle the complaint and address any issue you may have to your satisfaction. Patients in Texas can submit a formal complaint to: Texas State Board of Dental Examiners, 333 Guadalupe Tower 3, Suite 800, Austin, Texas 78701-3942 or by calling (512) 463-6400.
- Teledentistry: If allowable in your state, you consent to utilizing synchronous (live chat via video) and asynchronous teledentistry (not live). Asynchronous teledentistry utilizes a dental assistant or dental hygienist to collect clinical data and information in-person on behalf of a licensed This information is sent asynchronously (not live) to the licensed dentist to review and provide recommendations. The results of this exam are then communicated to the patient or responsible party. The dentist may not see the patient in-person. You may request to communicate in real-time with the dentist about these findings within 30 days of the consult.
- Clinical Services: All clinical services are rendered by a dentist owned entity including but not limited to Texas Mobile Dentists Inc, Tsang Mobile Dental PLLC, Nguyen Dental Corporation, and Scuyler Kurlbaum DDS Mobile LLC.
- COVID-19: Our clinical teams follow all CDC, state dental board, and OSHA guidelines relating to COVID-19. Read our detailed guidelines at com/covid-19. There is a potential risk of exposure with any human interaction given community spread. Our protocols and procedures err on the side of caution.