Patient Consent Form for Soft Tissue Management
Soft Tissue Management is an individualized plan to eliminate active infection of the gums and root surfaces of teeth caused by bacterial plaque. I understand that both Dr. Nematollahi and my Dental Hygienist have recommended this program to me based on my periodontal measurements or “gum pocket depths” as well as an evaluation of active bleeding sites and overall tissue redness/inflammation.
I also understand that by accepting this program I will become an active and integral partner in restoring my optimal oral health goals. Furthermore I realize 75-80% of both continued and initial success of my soft tissue management program is based on home care, whereas 20-25% is based on active dental hygiene therapy (applied by my dental Hygienist) as well as continued 3-4 month re-care appointments. Waiting longer then the recommended 3-4 month interval may result in complete relapse or even advancement of my current condition.
I realize that my Soft Tissue Management program is NOT curative, and that we will not regain bone that has been lost from periodontal disease.
I acknowledge that I have received information about the proposed treatment and that there are no guarantees or promises have been made to me concerning the results.
I understand that the recommended interval for my treatment is between 3 to 4 months and that waiting longer then the recommended 3-4 month interval may result in complete relapse or even advancement of my current condition.
I have discussed my treatment with Dr. J Nematollahi /Hygienist and have been given an opportunity to ask questions and have them fully answered.
