Periodontal Gum Treatment Consent

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Periodontal Gum Treatment Consent


  • Periodontal Infection and Inflammation (Periodontitis)


  • PGT is normally done on a quadrant basis dividing the mouth into 4 quadrants namely Right upper, right lower, left upper and left lower.

  • After LA, PGT is done with help of Ultrasonic Scaler, and a deep root surface Debridement is performed and removal of teeth with questionable prognosis.

  • Dentist will advise on bass method of brushing regular mouth rinses Post op.

  • We may have to consider extraction of teeth which have not responded to treatment in a positive manner.


  • Sensitive teeth, pain, discomfort, infection, swelling, bleeding.

  • Treatment can make teeth more mobile especially if they are not so mobile due to heavy build up of calculus

  • Periodontal disease is not completely curable. It can only be controlled by PGT and periodic scale and polish

  • Outcome of the treatment is highly variable depending on a lot of factors including immune status of patients, how well post‐operative instructions are carried out in home, and smoking which brings down the success rate dramatically

  • Treatment requires one to several visits

Treatment Options:

  • Do nothing (Periodontitis can worsen affecting more teeth)

  • Extraction of affected Teeth and no replacement (can cause supra eruption and mesial drift adjacent teeth)

  • Extraction and tooth replacement with a partial denture/ Implants/Bridge


  • PGT for one quadrant is £75

I fully understand the treatment proposed the alternatives and possible complications.

I have had a chance to ask any relevant questions in relation to this treatment.

I do / do not consent to treatment. (Delete as appropriate).

Name of Patient _________________________________ Date _____________

Signature ______________________________________

Witnessed by ___________________________________ Date _____________

Frankel Dental Care Limited Registered in England and Wales No 07309793

Tel 01344 297001 Fax 01344 297101 Email

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