Wisdom Tooth Removal Consent Form

There will be some pain, swelling and bleeding following a tooth extraction. This may require pain-relieving medication. Bleeding is usually minor and easily controlled by applying pressure. 

There are some risks / possible complications, which include: 

1. Infection of the extraction socket (dry socket). This may cause some pain and discomfort, but is usually easily managed by the dentist. 
2. Biting of the numb lip which may cause damage after the teeth have been removed. Children should be watched closely by your parent/ guardian until the numbness wears off. 
3. Damage to the Inferior Alveolar Nerve on each side of the mandible (lower jaw). This nerve passes very close to the root of the lower wisdom tooth (often in contact with it) and gives feeling to the lower teeth, lower lip and chin on that side. This nerve is very close to the area of surgery, with a slight risk of some damage to the nerve. This may cause numbness of the lower teeth, lower lip and chin. This may be temporary (6–12 months) or permanent. 
4. Damage to the Lingual Nerve on each side of the Mandible (lower jaw). This nerve passes very close to the tongue side of the lower wisdom tooth and posterior mandibular teeth and gives feeling and taste to that side of the tongue. This nerve is very close to the area of surgery, with a slight risk of some damage to the nerve. This may cause numbness and loss of taste to that side of the tongue. This may be temporary (6–12 months) or permanent. 
5. Tooth fracture. The tooth root tip may break off in small pieces – less than 1-2mm – when the tooth is taken out. The dentist may not remove those pieces if there is a chance that the nerves or other structures may be damaged during removal. 
6. Damage to adjacent teeth growing tightly against the wisdom teeth during removal of the wisdom teeth. 
7. Weakness of the jaw due to removal of the wisdom teeth. The jaw may break during the procedure or during the healing period.
8. Sinus perforation. If the upper teeth are close to the sinuses, removal may cause a hole between the mouth and the sinus. This may need further surgery and specialist oral surgeon referral.

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