I understand that the purpose of the procedure/surgery is to treat and possibly correct my diseased oral/maxillofacial tissues. The doctor has advised me that if this condition persists without treatment or surgery, my present oral condition will probably worsen in time, and the risks to my health may include, but are not limited to the following: swelling, pain, infection, cyst formation, periodontal (gum) disease, dental caries (decay), malocclusion, pathological fracture of the jaw, premature loss of teeth, and/or premature loss of bone. I have been informed of possible methods of treatment if any.