Incisional Infection/Dehiscence  When most dental extractions are made, the gingiva is elevated from the bone, the tooth is removed and then the flap of gingival tissue is used to close over the opening. There is a risk of this flap not holding or the incision becoming infected which can prolong recovery and/or necessitate a second surgery. The risk is higher if your pet eats hard food or chews on toys during the recovery period.

Jaw fracture  Depending on the number of extractions (especially lower canines) and degree of dental disease damaging the integrity of the jaw bone, there is a risk of jaw being fractured or broken during the procedure requiring surgical correction. The surgical correction may need to be performed at a specialty clinic pending on the location of the fracture.

Fragmented/Retained Tooth Root  During the extraction procedure, a tooth may break or fracture leaving a portion of the tooth below the gum line. In most cases, we are able to go in to retrieve the root. In other cases, the root or fragment is left under the gingiva, which can in rare occasions eventually cause inflammation, pain and possible infection. If these occur, the root or fragment may need to be surgically extracted. In cases of Feline Odontoclastic Resorptive Lesions (FORLs), teeth that lack a periodontal ligament are appropriately treated by amputating the crown and leaving the roots as they are being resorbed by the bone (crown amputations). This is considered a medically appropriate treatment and not considered a complication.

Eye Injuries  In rare occurrences, a dental instrument may slip when working on the upper jaw and injury the eye. Depending on the severity of the injury, the eye may need treated with topical and oral medications to surgically removed of the eye.

Nerve Paralysis  When dental procedure is performed, the mouth is held open to visualize the teeth. Although we do not use retractors that are linked to the nerve injuries, the pressure of manually opening the mouth can cause swelling around the nerves resulting in abnormalities in the face and eye. This nerve damage may resolve on its own, but may also be permanent

I, the undersigned owner or agent of the owner of the pet identified above, certify that I am eighteen years of age or over and authorize the veterinarian(s) at this practice to perform the above procedure(s). I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

• The reasonable medical and/or surgical treatment options for my pet.
• Sufficient details of the procedures to understand what will be performed.
• How fully my pet will recover and how long it will take.
• The most common and serious complications.
• The length and type of the follow-up care and home restraint required.
• The estimate of the fees for all services.

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved. I also understand that my pet’s medical condition may change for better or worse and the attending veterinarian(s) may add or change treatments to fit the needs of my pet’s care as long as it falls within the guidelines of the estimate that was provided to me.

I assume financial responsibility for the services rendered and provide payment via cash, credit card (not American Express), or check at the time my pet is discharged from the hospital. Should unexpected life-saving emergency care be required I elect one of the following: SEE ELECTIONS 1 & 2