I understand that periodontal disease destroys the gum and bone, causing tooth loss. Either the surgical or non-surgical treatment may cause prolonged bleeding, short or long-term sensitivity to hot or cold food and drinks, chemicals, touch or air. Pastes or gels usually reduce the sensitivity, and permanent sensitivity is very rare. As with other dental procedures there could be pain, swelling or infection after the dental procedure. The success of the procedure is not guaranteed, and one or more teeth may need root amputation, root canal therapy, or extraction after the periodontal procedure, at an additional cost to the patient. After the procedure, there could be some recession of the gum causing the teeth to appear longer, providing spaces between the teeth where food and other debris could accumulate. Frequent, timely evaluations and maintenance visits will be necessary. Periodontal disease is a chronic disease. We recommend periodontal follow up or recall-cleanings every 3 to 6 months. Many dental appliances and procedures, including fillings, crown, bridges, and partials, can have an adverse effect on the periodontal condition and must also be periodically evaluated. Very frequently, non-surgical treatment is followed by surgical treatment, the cost of which is not included with the initial non-surgical treatment. You could reduce your chances of needing surgery, by closely following your dentists instructions and recommended follow-up care. I understand that dentistry is not an exact science and that, therefore reputable practitioners cannot properly guarantee results. I acknowledge that no guarantee or assurance has been made by anyone regarding the dental treatment, which I have requested and authorized. I understand and agree that each dentist is an individual practitioner and individually and solely responsible for the dental care rendered to me.