Extraction of Tooth which can be Saved Consent Form
that can be saved by root canal therapy and if not treated my condition may worsen resulting in compilation including but not limited to:
  • Loss of additional teeth
  • Infection
  • Pain
I understand that Dr. has adviced me against extracting the tooth, but I have chosen to have it extracted and fully understand its consequences including but not limited to:
  • More inclination of periodontal disease
  • Shifting of teeth
  • Additional cost to replace teeth once extracted 
I have had the opportunity to ask questions and receive answers and explanations about my treatment and the risk associated with it, prior to signing this form. After understanding the known material risks as well as the disadvantages of treatment, I consent to the treatment.