Periodontal debridement and root planning procedure consent

Periodontal disease (gum disease) occurs due to the inflammation of the gums which is caused by plaque that has not been removed. Plaque then hardens in calculus, which forms alongside and underneath your gums. This build up creates a pocket between the gum and the tooth that is difficult to clean without appropriate gum treatment. If the disease progresses and is left untreated, it may lead to irreversible damage to the teeth, gums and supporting bone, which may lead to possible loss of teeth.

The pre-planning for periodontal treatment requires a comprehensive examination with a full medical history, relevant diagnostic tests and radiographs for thorough discussions and planning. Certain medical conditions, nutritional implications, or those that smoke, or drink alcohol have high risks of limiting the successful outcome of the procedure and may adversely affect gum healing.

A comprehensive periodontal analysis and charting will be completed at the initial debridement appointment to determine a base line. Regular periodontal charting will be completed throughout the maintenance phase of treatment in order to monitor disease progression.

The procedure for periodontal debridement involves numbing up the areas where there are deep pockets and removing build-up of plaque and calculus on tooth roots beneath the gum line, using specialised dental instruments. Removing the build-up will leave the root surface clean and smooth and allow the gums to heal and reattach to the tooth. If a filling or crown is contributing to gum disease, (i.e., overhang) the filling may need to be reshaped or replaced, to allow the gum to heal.

After debridement, the gums will be tender and sore in the initial days and require gentle home maintenance over the following weeks. Instructions will be given on how to improve your oral hygiene using improved brushing and flossing techniques. Specialised products and techniques will be demonstrated in order to achieve optimal gum health. Smoking cessation is advised, as smoking increases the risk of gum disease and reduces the success rate of treatment.

During the review appointments following the initial debridement, an evaluation of the gums will be done to determine if the gums have responded well to treatment and if oral hygiene is good, a program to maintain your oral health will be developed. Future root debridement may need to be repeated during the maintenance stage if areas begin to show signs of disease progression. If the gums have not responded appropriately, further treatment, such as periodontal surgery may be required.

Risks

Periodontal treatment may not be successful in all cases. There is no method that will accurately predict or evaluate how the gums or bone will heal and a second procedure may be required if the results are not satisfactory, and a full fee will be incurred.

Complications that may result from periodontal treatment procedures include but are not limited to: (the ones which are marked are applicable to your treatment).

Post debridement infection, bleeding, pain, swelling, bruising, discomfort.
Tooth or gum sensitivity/injury/mobility.
Periodontal abscess
Loss of tooth due to lack of supporting structure
Transient or on rare occasion permanent numbness of the lip, tongue, chin, gum, palate from anaesthetic-very rare.
Jaw joint tenderness or restricted ability to open for a few days/weeks.
Allergic reactions
Delayed healing
Gum shrinkage/recession.

Treatment Risks

Adverse reactions to the anaesthetic, drugs, medications:

On some rare occasions, patients may have an adverse reaction to the anaesthetic or medications that are used or prescribed. These reactions usually take place within the first two hours and can include pale appearance, palpitations, diaphoresis, dizziness, nausea, and a more serious anaphylactic reaction can occur. It is important to disclose all medical history including list of allergies, medications, natural remedies, herbal, or any non-prescription medication to void and prevent these adverse outcomes and appropriately manage the procedure.

Post-Debridement Risks

Post Debridement Care (bleeding, swellings, pain, bruising, joint pain, prolonged numbness):

After periodontal treatment, patients may feel quite sore and tender over the next couple of days and may notice minor bruising and swelling as with most surgical procedures. The swelling, tenderness, pain, bruising and prolonged numbness from the anaesthetic should settle over the next couple of days and weeks but the exact duration of these complications may not be determinable. There is a slight chance they may become permanent and irreversible. It is important to attend follow-up appointments in order to manage healing and to let the dentist know if the pain, tenderness or prolonged numbness is still present or has increased over time.

Delayed Healing:

The ability for gums to heal after deep debridement and root planning varies between individuals so do not be alarmed if the area is healing quickly or slower than expected. During the review appointments, the healing of the gums will be assessed and managed appropriately if the healing process is not going as expected. In some cases, a secondary debridement may be required if an area is not healing appropriately.

Oral Hygiene Care:

After the periodontal debridement, it is extremely important to exercise delicate brushing techniques. Optimal oral hygiene is critical and pays a vital role in the success of periodontal treatment. This will be demonstrated and discussed with you by the dental practitioner. Additional oral hygiene instructions or mouth-rinses may also be recommended if needed.

Maintenance

To improve the chance of success, there is a requirement to attend follow-up appointments so that healing can be monitored and assessed. Several review appointments may be required after the initial debridement to check on gum healing and oral hygiene. Following treatment, there is a need for ongoing and lifelong maintenance daily at home with regular check-ups every three months which is not included in the costs of the initial periodontal treatment. This ensures the optimum care for the teeth, implants, prosthesis, and gums.

In essence, for long term success of periodontal treatment you have the following responsibilities:

Following instructions regarding oral hygiene care such as tooth brushing, flossing, interproximal cleaning, and use of savacol mouth rinse as indicated by the dental practitioner.
Attend review appointments to monitor gum health and assess oral hygiene.
Appear for periodic examinations every three months as advised by your dental practitioner. There is an additional fee for these services.

If you fail to maintain the work that has been done and do not attend regular appointments, complications can arise and become untreatable, difficult, and costly to manage. You will be liable to incur the total costs for treatment to correct implications or failures if you do not attend follow up appointments and maintain regular appointments.

Acknowledgement & Consent

I certify that I have been fully informed by my dentist and have carefully read all the information provided on this form and the proposed treatment and the alternatives have been explained to me by the dentist to my satisfaction. I understand what is necessary to accomplish the procedure. I understand the implications and consent to the proposed treatment. I agree to the fees and accept the general and special conditions.
The dentist has carefully examined my mouth. Alternatives to this treatment have been explained.
I have further been informed of the possible risks and complications involved with surgery, drugs, and anaesthesia. I understand that such complications include pain, swelling, infection, discolouration, and acute or chronic pain or dysfunction associated with my jaw joints or muscles. Numbness of the lip, tongue, chin, cheek, or teeth may occur. The exact duration of these complications may not be determinable, and I am aware that there is a slight chance they may become permanent or irreversible. Also possible are inflammation of the vein, injury to existing or surrounding teeth, bone fractures, sinus penetration, delayed healing, allergic reactions to drugs or medications used.
I understand that if I do not proceed with the proposed treatment, any of the following could occur: bone disease, loss of bone, gum tissue inflammation, infection, sensitivity, abscesses, pain, looseness of teeth, and necessity of extraction. Also possible is temporomandibular joint (jaw) problems, headaches, referred pains in the back of the neck and facial muscles, and tired muscles when chewing.
The dentist has explained that there is no method to accurately predict gum and bone healing capabilities in each individual following periodontal debridement
It has been explained that in some instances periodontal debridement may not work optimally. I have been informed and understand that the practice of dentistry is not an exact science; not guarantees or assurances as to the outcome of results of treatment or surgery can be made.
I understand that excessive smoking, alcohol, or sugar may affect gum healing and may limit the success and healing of the gums.
I agree to follow the home care instructions. I agree to report to the dentist for regular examinations and cleans as instructed.
I agree to the type of anaesthesia, depending on the choice of the dentist and follow the instructions that are given to me by the dentist. I understand that I must not operate a motor vehicle or hazardous device for at least 24 hours or more until fully recovered from the effects of the anaesthesia or drugs administered for my care depending on the proposed anaesthesia.
To my knowledge I have given an accurate report of my physical, mental health and medical history. I have also reported any prior allergic or unusual reactions to drugs, food, insect bites, anaesthetics, pollens, dust, blood or body diseases, gum or skin reactions, abnormal bleeding or any other conditions related to my health.
I consent to photography filming, recording and x-rays of the procedure to be performed for the advancement of dentistry, provided my identity is not revealed.
I request and authorise medical/dental services for me. I fully understand that during and following the contemplated procedure, surgery, or treatment, conditions may become apparent which warrant, in the judgement of the dentist, additional or alternative treatment pertinent to the success of comprehensive treatment. I also approve any modifications in design, material, or care, if it is felt this is in my best interest. I understand that regardless of what had been explained to me or my expectations, results and experiences vary from patient to patient.

No Warranty or Guarantee?

I hereby acknowledge that no guarantee, warranty, or assurance has been given to me that the proposed treatment will be completely successful to my complete satisfaction. Each individual and their conditions are unique, thereby it is anticipated that the long-term success cannot be promised.

Disclaimer: The practice of dentistry is not an exact science and therefore, reputable practitioners cannot guarantee results. Please understand that no one can promise that any treatment or dental procedure will be successful or that any risk, complication, or injury will not occur.