Consent for Oral and Maxillofacial Surgery
And such other additional or alternative procedures that may be found immediately necessary during the course or treatment. I also consent to the use of local anesthetics and/or sedation for the purpose of this treatment.

The nature of and the purpose of this procedure(s), the possible alternative methods of treatment, the risks involved and the possible complications to me are as follows:

ALTERNATIVES TO SURGERY: Risks to my health if this treatment is not completed:

  1. Infection
  2. Cyst or tumor formation
  3. Periodontal disease on these or adjacent teeth
  4. Increased risk for complications if removal is required at a later time

POSSIBLE COMPLICATIONS which have been discussed with me include, but are not limited to:

  1. Pain and swelling
  2. Injury to the nerves of the lower lip, teeth, chin and tongue causing numbness and or pain which could be permanent
  3. Bleeding
  4. Dry socket, which may require an additional appointment to treat
  5. Infection which may require hospitalization to treat
  6. Perforation of the sinus above the upper teeth
  7. Decision to leave a part of the tooth or root in the jaw
  8. Injury to adjacent teeth or fillings which may require repair or loss of those teeth
  9. Unusual reaction to medications given or prescribed
  10. Fracture of the jaw which may require hospitalization to repair
  11. Limited jaw opening (Trismus)
  12. Antibiotics may inhibit the effectiveness of birth control pills

I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained. I agree to cooperate completely and will follow post-operative instructions to the best of my ability for my own comfort and safety. I have had the opportunity to ask questions concerning these procedures and all my questions have
been answered.

Consent and Acknowledgment *

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Patient Reviews

Awesome company
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Carina Barros

Awesome company and super friendly staff!

Very good team!
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Breanna Thorn

I went to Stroud dental on monday for the first time in 13 years..... I was so afraid to go. The experience was amazing. They made me feel comfortable. Jess is very good at her job and gentle. I didnt feel embarrassed or shamed at all. They made sure I got my x Ray's up to date and informed me, my old x Ray's had baby teeth in them. Very good team! Happy I went in and faced my fears.

We highly recommend Stroud Dental!
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Shawna Toole

My husband is terrified of going to the dentist and after convincing him to go to Stroud Dental for the first time he has now been 3 times! The staff is absolutely amazing and made him feel safe and comfortable! He actually looks forward to going to the dentist now. Dr. Peleg rocks and the girls are a hoot. We highly recommend Stroud Dental!

The best experience I have ever had!
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Cassandra Dickson

Stroud dental was the best experience I have ever had! The staff are very knowledgeable and friendly, it was very clean, fast and efficient. thank you for making my smile beautiful! I would highly recommend this dental office.

A wonderful place to bring your children.
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Logan Beau

Stroud Dental is a wonderful place to bring your children. The staff are amazing with my sons, one of which is on the autism spectrum. They are patient and understanding of his quirks. If you’re looking for a great place for dental work check out Stroud Dental.

We couldn’t be more happy.
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Keith Shay Smeets

We have been patients of Stroud Dental for over five years!
They have the most amazing team, who make you feel comfortable, welcomed and part of their family!
They are so patient with our 15 month old daughter, and us!
We couldn’t be more happy with everyone at Stroud Dental!

Family, friendly!
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Dana Donaldson

Family, friendly! Have always been great with my kids. Always a pleasant experience.

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