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Bisphosphonates: Currently taking or have taken in the last five (5) years

IV

Oral

Patients having been treated previously or currently with Bisphosphonate drugs should know that there is a significant risk of future complications associated with dental treatment. Bisphosphonate drugs appear to adversely affect the ability of bone to break down or remodel itself thereby reducing or eliminating its ordinary excellent healing capacity. This risk is increased after surgery, especially from extraction, implant placement or other “invasive” surgical procedures that might cause even mild trauma to bone. Osteonecrosis (death of bone) may result. This is a smoldering, longterm, destructive process in the jawbone that is often very difficult or impossible to eliminate.

The decision to discontinue oral Bisphosphonate drug therapy before dental treatment should be made by you in consultation with your medical doctor.

Please thick each box after reading. If you have any questions, please ask your doctor BEFORE ticking.

Consent

I certify that I speak, read and write English and have ready and fully understand this consent for surgery, have had my questions answered and that all blanks were filled in prior to my initials or signature.

if you have any questions, please ask a member of our team. Please sign (electronically) and date at the bottom of the form to authorize treatment

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Dr Olga Argyros

Practice Principal

Dr Sharon Stern

Specialist Endodontist

Dr Bryar Koyi

Specialist Periodontist and Implantologist

Dr Deborah Lipman

Associate Dentist

Mrs Emma Windust

Dental Nurse

Mrs Karen Brown

Dental Nurse

Mrs Runak Nasir

Trainee Dental Nurse

Miss Luciana Visintin

Dental Hygienist

Mrs Lisa Statham

Receptionist

Mrs Lydia Wedderburn

Practice Manager

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