As with any dental procedure, you MUST advise us of your medial status, including a complete disclosure of all medication and/or drugs that you are currently taking (with special notice to us if you are pregnant, nursing, have glaucoma, suffer from sleep apnea, or use any type of sleep apnea device).
Absolute or Relative Contraindications for sedation
2. Known hypersensitivity
6. Concurrent use of: alcohol, erythromycin, protease inhibitors for HIV treatment, cyclosporine, grapefruit juice, St. John's Wort, systemic antifungal
1. Chapping of the lips caused by stretching the corners of the mouth during treatment
2. Stiffness of the jaws or limited opening from several days to several weeks, depending on the extent of treatment
3. Temporary amnesia
4. Dizziness, drowsiness, indigestion, muscle weakness, loss of coordination, slurred speech, dry mouth, and confusion
Rare or Infrequent Occurrences
1. Allergic reactions to drugs, ranging from hives to heart failure or anaphylaxis
2. Drug side effects, which may include but are limited to, behavioral problems, diarrhea, low energy, skin rash, accidental falls, apnea, coma, depression, hallucinations, low blood pressure, seizures, sleepwalking, trouble breathing, blurred vision, agitation, headache, and nausea.
THE OFFICE STAFF HAS HAD TRAINING IN MANAGING THESE POTENTIAL PROBLEMS.
Medication, drugs, anesthetics, and prescriptions may cause drowsiness and lack of awareness and coordination, which can be increased by the use of alchohol or other drugs.
DO NOT OPERATE ANY VEHICLE, AUTOMOBILE, OR HAZARDOUS DEVICE FOR 24HRS AFTER TAKING SUCH MEDICATION AND/OR DRUGS.
American Society of Anesthesiologists Fasting Guidelines for Moderate Sedation:
Ingested Material--- Minimum Fasting Period Before Treatment
Clear liquids --- 2hrs
Light meal --- 6hrs
Fatty meal --- 8hrs
Your signature below certifies...
1. Your permission to discuss your dental and sedation treatment with your accompanying adult, spouse, partner, family member, friend, or physician
2. Your agreement to the administration of anesthesia, nitrous oxide/oxygen, and/or oral sedation
3. Your authorization for Dr. Wilson or Dr. Fizer to use his/her best judgment in managing unforeseen conditions which might arise during the course of the procedure
4. That you are both mentally and physically competent to give consent