Part of the consultation process for any surgical procedure is obtaining informed consent. Informed consent is the process by which the surgeon explains the procedure being done and the risks, benefits and potential complications which can occur from undergoing a procedure. Additionally the consent process implies that with full knowledge of what can occur as a result of the procedure that the patient wishes to proceed with the planned treatment. Most informed consent documents contain many sections including the type of anesthesia to be used, the name of the procedure, the permission to correct any unforeseen complications at the time of surgery and most importantly the potential risks for the procedure itself.
Our most common procedures (third molar removal, tooth extraction, bone grafting and the placement of dental implants) have similar risks. The most concerning of these are related to the anatomy in the areas that the surgery will be performed. In the lower jaw the anatomical concern is for damage to the nerves that run in and around the jaws. These supply the lips, chin, gums, tongue, teeth, cheek and lips. All procedures create inflammation and swelling which can put pressure on these nerves resulting in temporary or permanent numbness to these areas. Typically this numbness or altered sensation will resolve as the area heals over several weeks or months. The nerve tissue that is involved will take much longer to heal than the surrounding bone and gum tissues. The potential for permanent numbness or altered sensation does exist and can be related to several factors including the difficulty of the surgery, the proximity to the nerve, and the patient’s ability to heal.
In the upper jaws the risk of nerve involvement is lower but the back teeth may be close to or in the maxillary sinus. The sinus is an air filled space in the facial bones that allows for normal air circulation. This structure when close to the area of surgery may lead to a post-operative complication known as an oral-antral fistula. This means that the sinus tissue invades the extraction socket area to create a passage from the sinus into the mouth. Many of these will heal on their own over several months. Occasionally however, a fistula may become permanent and require additional surgical procedures to attempt to remove the fistula and close the opening in the gum tissue.
One of the more common complications is the damage to adjacent teeth or dental work. Fillings may become damaged by the movement of teeth during extraction. Crowns may be dislodged or removed. Teeth may become cracked or chipped during extraction. Most of these issues can be resolved with repair of the teeth by the general dentist. Although every effort is made to avoid the involvement of adjacent teeth, damage is sometimes unavoidable. If the damage is significant enough or the tooth that has been damaged is obviously unrepairable the tooth that has been damaged may be removed to prevent the patient from having to return for additional surgery.
It is important for patients, and us as surgeons, to take these risks seriously and fully understand the potential issues that may arise from any and all surgery. Often patients who have complications will say that they didn’t expect this to happen. The truth is that we don’t expect them to happen either. But the potential for complications is the reason that the procedure is discussed in detail at the time of consultation. All questions regarding the possibility of these issues should be asked and addressed before proceeding with planned treatment. All surgery is scary, and luckily complications of any kind are rare. We strive to prevent all unfortunate outcomes or correct problems that may arise. Don’t be afraid to ask questions during the consultation. It is your right as a patient to be fully informed before you agree to have surgery.