I understand that both the dentists and dental assistants may treat me
or my child for the following dental procedures that may be necessary to
provide dental treatment. I not only understand that I will be given
explanation of performed treatments, but understand that the normal
procedures for a first time patient may include a comprehensive or
limited exam, dental cleaning, fluoride application, sealants and
radiographs (x-rays) as necessary. However, this is subject to change
depending on numerous factors including patient’s behavior, amount of
future work needed and time.In general terms the procedures you or your child may need include:
Decay exists between your child’s teeth and it is crucial to make sure they know how to floss and brush.
- OR -
Decay exists on the chewing surface due to inadequate brushing.
The tooth cannot be restored due to decay.
The tooth will not fall out on its own because there is a tooth that has not been resorbed by the body.
Both my child’s treatment and suggested alternative methods of
treatment, as well as the advantages and disadvantages of each, will be
fully explained to me. We will advise you that although the best
results are expected, there is no way within reason, of anticipating
complications. Therefore, it is not possible to guarantee the results
of the treatment. I recognize that some risks are associated with
dental procedures: however, I also understand that the occurrence of
such risks is remote.
I understand and accept that certain complications may be fatal or require medical intervention.