Pain Management E-Form - Advanced Cosmetic Dentistry

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Many of our patients experience very little to no pain at all. This group typically prefers little to no anesthetic. A diversely different group of patients have very sensitive teeth, which may be combined with dental fears. As a result, these patients prefer more anesthetic. Then there is the grey area, the group of people somewhere in between. Since each patient has a uniquely different preference, patient doctor communication is essential to identify your personal inclinations. Please communicate your preferences on this for and at each visit.

Check all that apply to you:

I have more sensitive teeth and gums I require more time in order for the anesthetic to be effective I require and prefer a higher dose of anesthetic Anesthetic wears off very quickly. For longer procedures, I will need additional anesthetic added during treatment. I have been tested and have an allergic or hypersensitive to “sulphite” I have had an experience were the local anesthetic caused my heart rate to increase.

Sedation Dentistry

In addition to our scientific approach and our attention to gentle clinical care, we offer other time proven and safe pain control technologies. These all will help make your dental experience more pleasant. The following is a list of options available to our patients. Please remind our team at least 24 hours before your appointment, if you would like to combine any of the following with your treatment.

NITROUS GAS

Nitrous gas is a wonderfully safe, time tested sedative agent which will help you feel more relaxed so you have a more pleasant experience.

This is a great option for patients who have very sensitive gum tissues. If your routine cleanings are generally uncomfortable consider the option of using nitrous gas.

Nitrous gas is also a good option when a patient has not had regular dental cleanings and has deep tartar build up. The use of Nitrous will allow the hygienist to be more aggressive and comfortably remove long standing tartar.

Nitrous alone or in combination with other techniques is a great way to make the numbing process easier.

Please fill out our: Nitrous Gas Pre-Op Consent

Your Preferences Regarding Prescription Strength Pain Killers

Pain relievers are a great option. And come in various strengths. Since every person has a different disposition regarding the use or non use of pre or post treatment pain relievers, please share with our team which option best describes your preference:

PRESCRIPTION STRENGTH PAIN RELIEVER

Pain relievers are also a great option. And come in various strengths. Since every person has their own unique preferences regarding the use or non-use of prescription medications, we need to know your preference. Please share with our team at least 24 hours before you appointment which option best describes your preference:

Check all that apply to you: *

I do not want any prescription strength pain relievers. I will probably not take an over the counter pain relievers but please write a prescription just in case. I simply want to avoid any after treatment discomfort, please give me a strong pain reliever. I would like prescription strength pain relievers. (See next question)

I have used the following pain relievers and found it works well for me:

VALIUM

The use of Valium before your appointment will help to relax you for your dental visit. Valium will make you drowsy/sleepy. Valium has no pain killing properties. Many of our patients choose this option. Especially for more involved surgical procedures or longer visits. *

I understand if I take Valium I cannot drive, I will need to arrange a ride home. I do not have any of the following Contraindications: Alcohol Intoxication, Misuse or Excessive Use of Drugs, Myasthenia Gravis, Wide-Angle Glaucoma, closed angle glaucoma, Severe Chronic Obstructed Lung Disease, Decreased Lung Function, Lung Disease, Liver Problems, Severe Liver Disease, Severe Renal Impairment, Temporarily Stops Breathing While Sleeping, Pregnancy, A Mother who is Producing Milk and Breastfeeding

ANTIBIOTICS

Decrease risk of post treatment infections. After treatment dental infections can occur after virtually any surgical or restorative dental procedure. But because some dental procedures have such a low occurrence of infections, we do not always recommend the use of antibiotics. Please check all that apply: *

I have a compromised medical history and have tendencies not heal well. I am prone to dental infections. I prefer to take antibiotics if there is a slight risk of infection. I do not want antibiotics for all dental procedures. I prefer to deal with the low possibility of post treatment dental infections. For higher risk procedures, I prefer to follow professional recommendations of Dr Landers. I will not take antibiotics for any surgical or dental procedures.

STEROIDS

Patients who want to decrease the risk of post treatment swelling and bruising can request a Pre-treatment steroid therapy.

Note: You can choose any one or all of the above techniques to make your dental experience more pleasant. Since we plan ahead for your specific needs, please inform the staff before your reserved appointment time.

Check Off Items Below To Indicate The E-Forms You Filled Out On Our Website:

What Happens Next

It’s required that we keep your online information private and secure. Accordingly you will need to create and enter a 4-6 digit ID number on any E-form filled out on our site. Retain this 4-6-digit number as you will need to provide it to our scheduling coordinator. In turn, they will download your online information and save it to a new account hosted on our private secure server.

Your best option is to call our office in advance of your appointment date. This will allow extra time for Dr Landers to review the E-forms you took your time to fill out.

When you Call Please provide the Following E-form Information:

1. First & Last Name

2. The Names of E-Forms You Fill Out Online

3. The 4-6 Digit Number You Entered On The E-Forms.

We Will Use This ID Number To Attach Your E-Forms “Privately” To Your New Account At Our Office

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Contact Us Today! 312-263-7823

To keep your information private and secure, please enter a 4-6 digit ID number of your choice below. Retain this 4-6 digit ID number as you will need to provide our office staff with that number during your appointment so we may retrieve your submission. You may also call our office beforehand and provide us with that number. *

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Pain Management Patient Communication E-Form

Summary