Grafting of Gum Tissue Consent Form
I hereby understand the recommended treatment for mycurrent dental needs is to have a gum graft. I understand the cost per graft and it is my responsibility topay the balance per tooth upon the work being completed as Bloor Dental Health Centre is a nonassigned office. I understand that I will need to receive an anesthetic. I also understand that I will begiven specific post-operative instructions to take home with me on the day of surgery and that I mustfollow them to maximize the success of the graft.
After your surgery, if you experience any of the following but not limited to please contact our office for an appointment:
- Prolonged bleeding
I am aware that any of the following may compromise my gum graft:
- Carbonated drinks
- Seeds and crusty foods
I understand that I may experience any of the side effects mentioned above, or all, but not limited to and still wish to go ahead with the grafting of the gum tissue that was recommended by and will be done by Dr. Lawrence Freedman at Bloor Dental Health Centre.
Please be advised that parathesia may occur in either jaw from the administration of the anesthetic. I understand that this is a possible outcome when having my gum graft done. I also understand that at the end of the surgery if I fail to follow the specific postoperative instructions that are given to me the day of surgery that is at my own risk and Dr. Lawrence Freedman will not be held responsible.