Melatonin Sedation Content

Melatonin Sedation Consent

 

 

The following is provided to inform our patient, or the parent/guardian of our patient under the age of 18 years, of the choices, risks and potential consequences related to receiving dental treatment under melatonin sedation and to enable them to be better informed concerning conscious sedation. The amount of sedation medication administered will be determined on an individual basis.

When sedated, you will still be able to communicate with your dentist while dental treatment is being provided. Even though this sedation has proven to be safe and effective, you should be aware of important cautions and considerations identified in this form. Read each of the following paragraphs and initial to indicate you understand and agree with treatment protocols:

I understand that the purpose of sedation is to receive dental care more comfortably. I understand that this sedation is not required to receive dental care and that I could receive dental care without sedation. I understand that sedation has risks and limitations and that on occasion unusual reactions to sedative medications such as emotional disturbances or allergic reactions may occur requiring further attention.

I grant permission for the dentist to discuss my medical condition and dental treatment with my significant other person, person accompanying me following the surgery, physician, or other relevant healthcare provider if deemed necessary for my health and safety. I understand that there are alternatives to sedation, including no sedation, local anesthetic only, or being referred elsewhere for treatment.

I understand that there are risks or limitations to all procedures. For sedation, these may include inadequate sedation or failure to achieve the desired level of sedation that may require proceeding with the planned procedure without full sedation, or may require the procedure to be delayed or rescheduled for another day. I understand that conscious sedation is not sleep and if I want to be put to sleep I will need to seek care elsewhere and a referral may be provided.
I understand that melatonin sedation is a drug induced state of reduced awareness and may create a decreased ability to respond. I understand that while under the influence of this medications during dental treatment, I will not be able to approve variations in the intended treatment. If, during the procedure, a change in treatment is required, I authorize my dentist to make changes in treatment they deem necessary in their professional judgement that are consistent with the standard of care.
I have informed my dentist of all medical conditions, allergies, medications or drugs I am currently taking, previous reactions to anesthesia, and pregnancy and/or nursing a child.
I understand that I should:

  • refrain from operating a motor vehicle
  • refrain operate heavy equipment
  • refrain from make important decisions
  • be accompanied by and responsible adult

For at least 24 hours after taking Melatonin sedation

I have received written pre-procedure and will receive post-procedure instructions and agree to adhere to those instructions, including not driving for the rest of the day or operating machinery for 24 hours following my procedure. I have had the opportunity to have another adult translate the information contained in the consent form to me if needed.
I hereby consent to receive dental treatment with local anesthesia and melatonin sedation. I certify that I have read or have had explained to me the contents of this consent form and I fully understand the information contained herein. All of my questions have been answered to my satisfaction and I consent to receiving conscious sedation with my dental care.