Aziz Bohra, DMD, MS

13065 W. McDowell Suite A101, Avondale, Arizona 85392

623-935-0004

Consent for Gingival Flap Procedure/Gingivectomy

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Gingivectomy: A type of surgery used to remove excessive tissue or reduce pockets. It involves not only removal of the tissue, but scaling and root planning of the affected teeth. This procedure is performed with local anesthesia.

All dental treatments have an associated risk. Periodontal surgery of any type may result in bleeding, swelling, bruising, pain, infection, sore jaws, loose / discolored fillings and crowns, recession, tooth sensitivity to hot and cold, caries exposure, mobility, numbness, need for tooth extraction, and or tooth fracture. I understand that every person responds to treatment differently. Therefore, it is impossible for the doctor to predict how long the healing period may require or if time away from normal routines may be necessary.

I understand that smoking may significantly interfere with healing and cause disease reoccurrence.

The post-operative instructions were reviewed and a copy provided for my records.

I understand every reasonable effort will be made to ensure that my condition is treated properly. However, it is not possible to guarantee perfect results or no risk of disease reoccurrence.

I understand if no treatment is rendered or if active treatment is interrupted or discontinued, my periodontal condition would likely continue and worsen. This may result in pain, swelling, bleeding, infection, recession, mobility, decay, staining, bone loss, and tooth loss.

Untreated periodontal disease may also affect on your systemic health. Studies have shown exacerbation of systemic conditions such as cardiovascular disease, diabetes, and respiratory disease. Periodontal disease has been associated with increased risk of pancreatic cancer. Pregnant women may be at an increased risk of a premature and low birth weight baby.

I have been advised of my alternatives to this treatment and understand what has been proposed thoroughly. All questions have been answered in regards to the proposed treatment:

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