INFORMED CONSENT
Drs. Skinner and Siglin
General Dentistry
LIMITATIONS AND RISK OF TREATMENT
Orthodontics
The following information is routinely provided to anyone considering orthodontic treatment in our office. While recognizing the benefits of a pleasing smile and healthy teeth, you should also be aware that orthodontic treatment, like any treatment of the body, has inherent risks and limitations. These are seldom enough to rule out treatment, but should be considered when deciding to wear braces. Please read this consent carefully and ask your Orthodontist to explain anything you do not understand.
Patient Responsibilities-Treatment will not be completely successful unless the patient complies with the directions given by Dr. Skinner/Dr Siglin and our office staff members. Lack of cooperation will probably result in excessive treatment time and compromised results. Orthodontic force systems are designed to be working continuously, yet we will see patients once every four to six weeks, so it is important to be particularly attentive to the following so that unwanted changes do not occur:
1. Care of the appliance: lost, broken, or bent appliances disrupt the treatment plan. Unwanted tooth movement may occur if an appliance is not working as designed. Be sure to notify us promptly if part of the appliance is broken or distorted.
2. Meticulous oral hygiene: a thorough brushing three times a day and complete flossing once each day is important. Poor tooth brushing increases the risk of decay when wearing braces. Excellent oral hygiene, reduction in sugar intake, being selective in diet, and reporting broken brackets or loose bands as soon as they are noticed will help minimize decay, white spots (decalcification), and gum problems.
3. Regularly scheduled appointments: appliances must be adjusted periodically and treatment progress must be monitored carefully. Missed or rescheduled appointments inevitably prolong treatment.
4. Routine dental visits: the patient should continue to see his/her dentist for regular checkups and cleanings.
5. Requested auxiliary appliances: during treatment we may ask the patient to wear elastics, a headgear, or other devices to enhance the tooth movement. If these devices are not worn as requested, treatment will not proceed as planned.
Goals, Completion & Success of Treatment-We have tried to establish realistic and achievable goals for treatment. We know you share our desire to produce the best results possible. As we begin treatment, we believe that we will be able to achieve those goals. Nevertheless, unforeseen factors may interfere with our intentions. As treatment proceeds, we will keep you informed about treatment progress. If our original goals become unreachable, we will discuss the alternatives with you.
Treatment Duration-We have given you an estimate of the length of time anticipated for treatment. We cannot know exactly how long the treatment will take. Individuals vary considerably in their response to orthodontic forces, so a patient’s treatment time may be more – or less – than our estimate.
It is our general intention to have the treatment move along in a fashion that is consistent with tissue health, minimal discomfort, and long-term stability. Lack of facial growth, poor elastic wear or headgear cooperation, broken appliances and missed appointments are all important factors, which could lengthen treatment time.
Occasional & Unusual Occurrences-At certain times during the treatment and retention, patients may experience a varying degree of discomfort.
They may also notice facial changes and speech changes. Events such as swallowing appliances, chipping teeth, or dislodging restorations occur infrequently. Appliances are designed to have a maximum amount of strength and a minimum amount of injury potential. Nevertheless, accidents can occur and a sharp portion of the appliance could cause injury. On rare occasions, when dental instruments are used in the mouth, the patient may get scratched, poked, or receive a blow to a tooth with potential damage or soreness to the oral structures. It is possible to swallow or inhale small parts of the appliance that fall into the back of the throat at any time, including during routine office visits. The risk is increased when a patient ignores advice and recommendations. Everyone working in the office will be particularly attentive to preventing accidents.
Late Growth Changes- Occasionally, a person who has grown normally and average proportions may not continue to do so. If growth becomes disproportionate, the jaw relation can be affected and original treatment objectives may have to be compromised. Skeletal growth disharmony is a biological process beyond the orthodontist’s control. Unusual skeletal patterns and insufficient or undesirable facial growth can compromise the orthodontic results; effect a facial change and cause shifting of teeth during retention. Surgical assistance may be recommended in these situations.
Additional Treatment-Unforeseen circumstances (growth changes, jaw joint discomfort, gum disease) may cause us to recommend a form of treatment not previously discussed. These changes in treatment plan may require additional treatment in our office or with another specialist. If this occurs, we will carefully explain the reasons for a change in the treatment plan and any extra fee before proceeding.
Orthognathic Surgery-Due to complex factors influencing the progress of treatment, it is possible that orthognathic surgery (jaw modification surgery) could be recommended at any phase during the course of the treatment. This procedure is NOT included in the ortho treatment plan fee. It is understood that you have the option to discontinue treatment.
Stability of the Final Result- Teeth have a tendency to rebound to their original position after orthodontic treatment. This is called relapse. Very severe problems have a higher tendency to relapse and the most common area for relapse is the lower front teeth. After removing the braces, retainers are placed to minimize relapse. Full cooperation in wearing the retainers is vital. We will make our correction to the highest standards and in some cases overcorrect the malocclusion in order to accommodate the rebound tendencies. The tooth positions achieved at the end of treatment will not be perfectly stable.
The retainers will enhance the stability of the final result, but even diligent wear of the retainers will not keep the teeth exactly as they were at treatment’s end. The teeth and jaw structures are a dynamic system that constantly changes throughout one’s lifetime. Your orthodontic treatment does not make you immune to this process. All individuals are subject to subtle changes in tooth position. The possibility exists for rotation or crowding of the teeth, or for spacing in between teeth or in extraction sites. Ongoing wear of retainers will minimize these changes. If the patient decides to stop wearing retainers at some point, their teeth will change slowly. Some of the original problems may reemerge.
Decay/Decalcification-The bacteria present in plaque (the white, sticky material that is constantly forming on tooth surfaces) will cause damage if not removed several times each day by thorough brushing and flossing. The bacteria that live in plaque thrive on refined carbohydrates (sugar!).
While undergoing orthodontic treatment, the patient should minimize the amount and frequency of sugar in their diet. Decalcification (permanent white marks) and/or decay may occur if the patient does not cooperate with brushing, flossing and regular checkups with the general dentist. With adults, we ask for increased attention to the prevention of gum disease. If periodontal disease occurs during the course of treatment, it may be difficult or impossible to control the bone loss and subsequent loss of teeth.
Inflammation of Soft Tissues-The wires, brackets, or band attachments used in treatment can sometimes irritate the lips, cheeks, or gum tissue.
These soft tissue irritations usually heal quickly. We will give the patient wax that can help cushion these irritations while they are healing. If the irritation is persistent, you should contact us so that we can solve the problem. Inflammation of the gum tissue may also occur if oral hygiene is
not excellent. Severe gum tissue reactions may require the patient to see a periodontal specialist. Periodontal problems (gum disease) can be present before, or develop during treatment. Periodontal health can deteriorate during treatment, causing gum recession and loss of bone around the teeth. Excellent oral hygiene and frequent cleanings by a dentist can help control this situation.
Root Resorption-Orthodontic forces initiate a cellular response in the supporting tissues surrounding the roots of the teeth. It is this cellular response that allows the teeth to move. Sometimes this response becomes confused, resulting in damage to the ends of the roots of the teeth. Under healthy circumstances, the shortened roots are no disadvantage. However, in the event of gum disease in later life the root resorption could reduce the longevity of affected teeth. It is not possible to predict which teeth might be affected – we will want to take progress x-rays of the patient’s teeth during the treatment process to evaluate whether root resorption is occurring. Not all root resorption arises from orthodontic treatment. Trauma, cuts, impaction, endocrine disorders, idiopathic (unknown) reasons can also cause root resorption.
Devitalization of Teeth-It is possible for the nerve of a tooth to die during orthodontic treatment; especially if it was previously injured or was impacted. This tooth may discolor or flare up during orthodontic movement. Sometimes such injuries are unknown to the patient or parents. The orthodontist cannot detect previous injuries to a tooth; a tooth may die and the reason for it may not be apparent. Root canal treatment may be recommended if such a problem occurs.
Impacted Teeth-In attempting to move impacted teeth (teeth unable to erupt normally), especially cuspids and third molars (wisdom teeth), various problems are sometimes encountered which may lead to gum and bone problems, relapse, or loss of teeth.
Temporomandibular Joint Problems-Pain, discomfort, or clicking or popping noises may occur in or near the joint of the jaw at any time, including during orthodontic treatment. This complex sliding joint, which allows for movement of the lower jaw, can be affected by tooth position, bite, or preexisting undetected factors. Tension and stress appear to play a role in the frequency and severity of joint pains. Tooth alignment or bite correction can improve the tooth related causes of TMJ pain, but not in all cases. Some patients are very sensitive to even a slight discrepancy in their bite.
An equilibration (selective smoothing or reshaping of the teeth) or other special treatment may be recommended by your dentist to improve the joint relationship and how the teeth fit together. It is important for you to tell us if there are jaw joint problems so we can deal with them properly.
Muscle Habits-Mouth breathing, digit or lip sucking, tongue thrusting, and reverse swallowing can prevent proper results or cause relapse after braces are removed. Habits present at the beginning of treatment, or that develop during treatment may require you to see a speech therapist or an orofacial myologist.
Smoking-Due to the harmful effects that smoking has on the gums and bone that support the teeth, orthodontic treatment should not be initiated or continued on any patient who smokes. Please initial this paragraph only if the patient is a non-smoker.
Removal of Teeth-Sometimes teeth must be extracted as part of the orthodontic procedure. This will be based on the orthodontist’s judgment of the case. Such removal can include but is not limited to third molar teeth (wisdom teeth) and will not be done by the orthodontist but by a general dentist or an oral surgeon as deemed necessary. This procedure is NOT included in the ortho treatment plan fee.
Injury from Headgear-If improperly handled, headgear may cause injury to the face or eyes, even blindness. There have been a few reports of injury to the eyes of patients wearing headgear. Patients are warned not to wear the appliance during times of horseplay or competitive activity. Headgear that is pulled outward while the elastic force is attached can snap back and poke into the face or eyes. Be sure to release the elastic force before removing the headgear from the teeth. Although our headgears are equipped with a safety system, we urge caution at all times. Headgear instructions must be followed carefully.
Damage to Teeth from Grinding-Abnormal wear of tooth structures is possible if the patient grinds the teeth excessively.
Size and Shape of Teeth-Due to the wide variation in the size and shape of teeth, achievement of the most ideal result (for example, complete closure of spaces) may require restorative dental treatment. The most common types of treatment are cosmetic bonding, crown and bridge restorative dental care and/or periodontal therapy. This is NOT included in the orthodontic treatment plan fee. You are encouraged to ask questions regarding dental and medical care adjunctive to orthodontic treatment of those doctors who provide these services.
Success of Treatment-We intend to do everything possible to provide the best result in every case and it is our opinion that the treatment will be beneficial. However, we cannot guarantee that the proposed treatment will be successful or to your complete satisfaction. Due to individual patient differences, there exists a possibility of failure, relapse, or selective retreatment, despite the best of care. Much of the success of the treatment depends on the understanding and cooperation of the patient.
INFORMED CONSENT AND TREATMENT AUTHORIZATION
I certify that I have read, or have had read to me, the contents of this form. I do realize the potential risks and limitations and have had the opportunity to discuss them with Dr. Skinner/Dr Siglin to clarify any areas I do not understand. I authorize Dr. Skinner/ Dr. Siglin to provide orthodontic treatment I FURTHER UNDERSTAND THAT, LIKE OTHER HEALING ARTS, THE PRACTICE OF ORTHODONTICS IS NOT AN EXACT SCIENCE; THEREFORE, RESULTS CANNOT BE GUARANTEED. I understand the range of treatment options presented, including the one I have chosen. I understand that mid-course treatment alternatives will be discussed if necessary.
I do consent to orthodontic treatment and have been given the option of having a copy of this informed consent.
