INFORMED CONSENT

General Information

Orthodontic treatment offers a vast array of benefits, ranging from improved dental health to heightened self-esteem. Even so, as with other forms of medical and dental treatment, there are certain risks associated with Orthodontics. Fortunately, these risks are minimal and easily dealt with.

It is important that you understand the plan and the expected outcome of your treatment. It is equally important that you know the possible side effects of Orthodontic treatment.

So that you can make an informed decision to accept Orthodontic treatment, please be aware of the following list of “Possible Risks Associated with Orthodontics”.

1. Discomfort

Braces apply pressure to the teeth. Eventually, the teeth start to move. As they move, they become slightly loose, and this may be uncomfortable. Patients generally become accustomed to this within a short period of time. Moreover, the teeth tighten up again after the braces have been removed.

Also, some patients complain of mild pain after placement or adjustment of their braces. The pain generally lasts three to seven days; this is normal. Over-the-counter painkillers usually relieve the pain.

Occasionally, brackets and/or wires become detached or break, which may then cause sharp ends to irritate the soft tissues. Patients should inform the office of any breakages as soon as they occur. We want to repair breakages as soon as possible.

2. Cavities and Decalcification

Braces do not cause cavities – poor oral hygiene does. By brushing frequently and thoroughly, patients can help reduce the likelihood of developing cavities or decalcification (white scarring of the enamel around the outline of the braces). Also, patients must continue to see their Dentist, at least twice per year, for regular check-ups and cleanings.

3. Gum Disease - Gingivitis and Periodontitis

Gingivitis is the inflammation (redness and swelling) of the gum tissue, while Periodontitis is the actual breakdown of the gum and bone surrounding the teeth. The fact is GINGIVITIS HAPPENS … except in the cases where patients maintain impeccable oral hygiene. Periodontitis tends to be an individual reaction to certain types of bacteria that reside in the mouth; hence some patients are more predisposed than others to this breakdown of the periodontal tissue. Again, maintaining immaculate oral hygiene greatly reduces the chances of development or progression of gum disease. Patients who have or develop periodontitis have to see their Dentist (or Periodontist – Gum Specialist) three or four times per year.

4. Root Resorption

Commonly, the root-tips of some teeth shorten (or resorb) during treatment. However, as long as the patient maintains dental health, a small amount of root resorption will not affect their overall oral health. If the condition becomes severe (a rare occurrence), Orthodontic treatment may have to be discontinued before it is completed.

5. Devitalization

Whenever a tooth is moved from one position to another, the nerve of the tooth could potentially become devitalized. This is very rare. However, if it should occur, the tooth would require root canal therapy.

6. Relapse

After the braces have been removed, there is a tendency for some teeth to shift back to their pre-treatment positions. This tendency is greatest during the first six to eight months after removal. Immediately after the braces have been removed, patients are given fixed and/or removable retainers. This is the start of the retention phase. Patient compliance during the retention phase of therapy tremendously minimizes shifting of the teeth. By wearing retainers as instructed, patients can help to maintain the results that have been achieved.

7. Non-Movement

The term ankylosis refers to the fusion of the root of a tooth to the bone surrounding it. From time to time, ankylosis prevents Orthodontic movement of a tooth because the tooth is literally stuck to the bone. In these cases, the ankylosed tooth or teeth may have to be removed.

Additional Information

Necessary Secondary Treatment

Other types of treatment are often required while a patient is undergoing Orthodontic therapy. Extractions, gum treatments and placement of implants are examples of adjunctive treatments to Orthodontics. When called for, patients must ensure that these procedures are performed in a timely fashion. With few exceptions, the secondary treatment procedures are generally not performed in the Orthodontic office, and any fee associated with these treatments is separate from the fee charged for Orthodontic treatment.

Early Termination of Therapy

As Orthodontists, we will use our best judgment in exercising our knowledge and expertise in order to provide each patient with the highest quality care. We value the confidentiality, time, and concerns of all patients. In return, we ask for patient cooperation with respect to keeping appointments, following instructions, and making prompt payments. We reserve the right to discontinue treatment, even though treatment may not be completed, if problems of this nature persist beyond THREE warnings or visits.

All medical and dental treatments carry risks. Fortunately, the tremendous benefits to be had from Orthodontic therapy far outweigh any potential negative occurrence associated with treatment.

ACKNOWLEDGMENT

I, ______________________________, hereby acknowledge that my Orthodontic treatment has been discussed with me, and I understand the benefits, as well as the potential risks, of treatment. I also give permission to the Doctors and Staff of Island Smiles to render my Orthodontic treatment as discussed in our consultation visit.

Signature (PATIENT OR PARENT OF MINOR)