This form explains the risks, benefits, consequences, and alternatives to Orthodontic treatment; A treatment that deals primarily with malpositioned teeth and the jaws. The form also obtains the patient's consent to perform the treatment.
Informed Consent for Orthodontic Treatment
In general, excellent orthodontic results can almost always be expected with an informed, motivated and cooperative patient. Like any treatment of the body, however, there are some inherent risks and limitations to orthodontic treatment that should be considered in the decision to undergo treatment.
Decalcification (damage to enamel), tooth decay, or gum disease can occur if patients do not brush and floss their teeth thoroughly during treatment. The same problems can occur without orthodontic treatment but the risk is greater to an individual wearing braces or other appliances. Excellent oral hygiene is a must and will be insisted upon. Diet may need to be altered as well to avoid damage to teeth and braces.
Periodontal Disease (gum and bone) disease can develop or worsen during orthodontic treatment due to many factors, but most often due to the lack of adequate oral hygiene. If periodontal treatment develops and cannot be controlled, orthodontic treatment may have to be discontinued prior to completion.
Patient's Cooperation is an extremely important aspect of treatment success. Goals may not be reached or treatment time may be lengthened without a concerted effort from the patient. This includes being on time for appointments, faithful elastic and extra devices wear, and great care for the orthodontic devices. The utmost of patient cooperation is necessary and will be insisted upon.
Relapse is the tendency for teeth to rebound toward their original positions and is a biologic process that is always a possibility. Very severe problems have the highest tendency to relapse, and the lower front teeth are the most prone. Every effort will be made to avoid this including over-correction, and the wearing of retainers. Full cooperation in the wearing of retainers is vital. Despite all the best efforts, however, relapse is still possible. It should be noted that teeth move throughout life whether one has had orthodontic treatment or not.
Length of Treatment depends on a number of issues, including the severity of the problem, the patient's growth and the level of patient cooperation. The actual treatment time is usually close to the estimated treatment time, but treatment may be lengthened if, for example, unanticipated growth occurs, if there are habits affecting dentofacial structures, if periodontal or other problems occur, or if patient cooperation is not adequate. Therefore, changes in the original treatment plan may become necessary. If treatment time is extended beyond the original estimate, additional fees may be assessed.
Root Resorption is the tendency for the tooth roots to shorten during treatment, and is a biologic process that is neither well understood nor predictable. Under healthy circumstances, the shortened roots are usually no disadvantage. However, in the event of gum disease later in life, root resorption can affect the long-term outlook for the affected teeth. It should be noted that orthodontics is only one potential cause of root resorption. Others include; trauma, impaction, root canal treatment and unknown causes. Based on what is known, every effort will be made to avoid root resorption during orthodontic treatment.
Death of a tooth is a possibility during treatment, especially if the tooth has had a blow in the past, been impacted, or had a large filling. If tooth death occurs, it would have occurred eventually, even without orthodontics. A dead tooth may require a root canal in order to be saved.
Temporomandibular Joint (TMJ) problems; pain, clicking or popping noises may occur in or near the jaw joints at any time, including during orthodontic treatment. Possible causes vary widely. A flare-up of a TMJ problem during orthodontic treatment is almost always a result of a pre-existing disorder. We ask our patients to inform us of any changes in joint sounds, pain, etc. Such changes may require separate therapy.
Factors beyond our control can limit our ability to achieve the desired result with our treatment. These can include the insufficient growth of the jaws, oddly shaped teeth, or oddly sized teeth. Such limitations may result in compromises or alternatives in the proposed treatment plan. As well, growth changes occurring after orthodontic treatment may affect the stability of the result.
Retention at the end of your orthodontic treatment you will receive a set of custom removable retainers. These retainers are designed to prevent your teeth from shifting after orthodontic treatment. Retainers will initially be worn every night and eventually every other night. We recommend retention for life to protect your investment into your smile!
[x] I consent to the orthodontic treatment as described above.
Please Sign Here (Patient)
[x] I attest that I have discussed the risks, benefits, consequences, and alternatives to this treatment with the patient who had the opportunity to ask questions, and I believe my patient understands what has been explained.
Please Sign Here (Dentist)
Click on the link below to download this form...