• Pediatric Dentistry

    Ph.609-200-5437

    Ph.732-737-7336

    littleteethprinceton@gmail.com

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  • I hereby authorize and direct the dentists of THE LITTLE TEETH WORKSHOP and/ or dental auxiliaries of his/her choice, to first review and then perform upon my child (or Legal ward) in my presence the following dental treatment or oral surgery procedure(s), including the use of any necessary or advisable local anesthesia, radiographs (x- rays) or diagnostic aids.
    1. Review and perform Cleaning of teeth and the application of topical fluoride.
    2. Review and perform Application of plastic “sealants” to the grooves of the teeth.
    3. Review and perform Treatment of diseased or injured teeth with dental restorations (fillings).
    4. Review and perform Replacement of missing teeth with dental prosthesis.
    5. Review and perform Removal (extraction) of one or more teeth.
    6. Review and perform Treatment of diseased or injured oral tissue (hard and/or soft)
    7. Postponing or delaying treatment at this time.
    8. Review and perform Treatment of malposed (crooked) teeth and/or oral developmental or growth abnormalities.
    I understand that there are risks involved in this treatment and hereby acknowledge that these risks have been explained to me, that I have had an opportunity to ask questions regarding the treatment and the risks and that I fully understand the same. By typing my name below I give consent to The Little Teeth Workshop and Dr.Iyer to perform the necessary dental procedures needed.