DİŞ ÇEKİMİ HASTA ONAM FORMU

  • In order to inform you and get your consent to start your treatment, you must read this form, fill in and sign the sections at the end. Thank you for your participation and your time. Tooth extraction; Whether it is a difficult or routine extraction, it is a surgical procedure and is irreversible. As with any surgical procedure, there are some risks. These risks can be listed as but not limited to the following: 1. Swelling and/or redness, discomfort at the surgical site, 2. Redness and cracking due to stretching in the corners of the mouth, 3. Development of infection and delayed healing of the wound, 4. Dry socket; jaw pain that begins a few days after surgery, often due to inadequate care; It is more common in lower jaw extractions, especially in wisdom teeth. 5. Damage to the adjacent tooth, especially in the presence of large fillings and crowns, 6. Loss of sensation or decreased sensation in the gums, lips, tongue, teeth and jaw tip. It can be seen especially in teeth with roots close to nerves, such as wisdom teeth. Numbness almost always returns to normal, but very rarely it can be permanent. 7. Trismus; It is a limitation in opening the mouth due to inflammation or swelling. 8. Bleeding-severe bleeding is not common. But bleeding in the form of leakage continues for several hours. 9. Sharp corners and bony steps may occur in the shooting cavities after extraction. These are corrected with a new surgical intervention. 10. Incomplete removal of root fragments. Sometimes small pieces of root can be left in order not to damage important formations such as sinuses or nerves. 11. Sinus relationship; the roots of the maxillary posterior teeth are very close to the sinuses, and in some cases, root fragments may escape into the sinus or an opening may form between the sinuses and the mouth; These situations need special attention. 12. Jaw fractures; Although it is very rare, it is possible to occur in difficult and deeply impacted tooth extractions. Most surgical procedures are routine and major complications are not expected. Complications that occur are also minor and easily treatable conditions. Tooth to be extracted:

Patient or Patient's Legal Representative* – Degree of Affiliation Name and surname : ………………………………………………………………………………………….. T.R. Identity No. Address : ……………………………………………………………….. Telephone : ………………………………………………………………………………………….. Signature : ………………………………………………………………………………………….. Physician: ……………………………………………………………….. Name and surname : ………………………………………………………………………………………….. Date signature : ………………………………………………………………..* Legal Representative: Guardian for guardians, mother for minors the father is the 1st degree legal heirs in the absence of these (Please indicate the degree of closeness next to the name of the patient's relative)