Orthodontic treatment consent
As with all dental treatment, treatment has possible risk to the dental structures. A discussion of the following potential risks specific to the type of malocclusion was held. The possible risks are not limited to this list, but these were felt to be the most common at the start of treatment. All efforts will be made to detect and limit any such damage.
Root Resorption: Shortening of the tooth during orthodontic treatment. Since there is no method of predicting which cases will have noticeable root resorption, progress x-rays may be requested during treatment to evaluate the condition of the tooth roots. Failure of the patient to allow such screening x-rays will not allow the detection of the problem early in treatment and eliminating the chance to change the treatment objectives and treatment plan to reduce the potential damage to the teeth.
Bone or Tooth Loss: Orthodontic appliances compromise the ability of the patient to clean their teeth and gums properly. Additional effort is required of the patient to maintain their teeth, gums, and supporting bone during the treatment time. Failure to do this can result in gingivitis and periodontitis with a loss of supporting structures. In extreme cases, tooth loss is possible.
Gingival Recession: Movement of teeth and lack of good dental care by the patient can lead to gingival recession. In severe cases, gingival grafting during or after orthodontic treatment may be necessary.
Tooth Decalcification: The lack of diligent dental hygiene during orthodontic treatment can lead to decalcification of the dental enamel, leaving white streaks or spots. These marks are permanent and can only be corrected by placing white dental fillings or porcelain crowns. In extreme cases of prolonged neglect, or in patients susceptible to dental decay, the decalcification can break through the enamel covering of the tooth, resulting in the need for restorative (fillings or crowns) work.
Incomplete Bite Correction: Patient compliance with the treatment instructions is of utmost importance to the success of the treatment. A lack of patient compliance and/or the inherent skeletal resistance of the malocclusion can result in an incomplete bite correction.
Poorly Angled Front Teeth: Due to the skeletal resistance or unexpected growth during treatment, it is possible for the front teeth to finish in a retruded position with the teeth angled back in the mouth. This is predictable in the patients that refuse surgical assistance to the correction of the malocclusion.
TM Joint Symptoms: There may already be damage to the jaw joints before treatment has started, even if symptoms were not initially present. Changing the bite can aggravate these damaged joints, resulting in pains to the head, jaws, and face.
More Orthodontics Due to Maturation: Growth may continue after the completion of active orthodontic treatment, disrupting the final treatment occlusion. In severe cases, retreatment may be necessary to re-establish the correct bite after growth is completed. In class lll malocclusions, the severity can be such that surgery to the jaws may be required to correct the bite.
Open Contacts after Orthodontics: Spaces between the teeth must be made to fit the orthodontic bands. After treatment, almost all these spaces close either spontaneously or by the orthodontic retainer. In some cases, spaces open and in other cases the spaces fail to close. The usual treatment is to place a filling or crown to keep food from packing between the teeth.
Surgery: Surgery may be a part of your treatment, including, but not limited to tooth extraction, gingival grafting, corticectomy, and orthognathic (jaw) surgery. The usual risks associated with dental surgery include excessive bleeding, loss of flaps with exposed bone and delayed healing, damage to teeth, nerve damage, and loss of tooth valley.
Change In Treatment: Although the best effort has been made to make the most complete diagnosis and the most accurate treatment decision, it is possible that changes in the treatment plan may be required during treatment to reach the listed treatment goals. If consent is not given for the recommended treatment, even if not included in this initial treatment plan, the dentist cannot be held responsible to reach the listed treatment goals.
Non-Specialist: The doctor is not a specialist in orthodontics, although he has a special interest in this part of the profession. The complexity of the case has been carefully considered before accepting the case for treatment. The patient/parent has been offered the referral to a specialist, and requests the treatment from this dentist instead, understanding the training to be less than the specialist.
The goals, limitations, and treatment alternatives, and risks have been presented to me, and I request treatment as suggested. Photographs and x-rays may be used for professional journal publications, seminars, websites, and other professional uses.
Contract
Dr Robert Wakefield agrees to provide orthodontic care for . Treatment is expected to take 12-18months, with appointment intervals ranging from 4-8weeks.
The above orthodontic fee does NOT include fees for the following:
- Tooth Cleaning
- X-rays taken during orthodontic treatment
- Bridges
- Crowns
- Dental Fillings
- Possible bonding of veneers after orthodontics
- Fiberotomy
- Corticotomy
- Gingival Grafts
- Cosmetic gingivectomy
- Ceramic brackets
- Implants
It is expected that the patient will maintain their orthodontic appliances during the treatment time. In the event of breakage or loss of an appliance, an extra fee will be charged for its repair or replacement. These may include:
- Functional Appliance
- Headgear and/or facebow
- Orthodontic Brackets
- Archwires
- Retainers
If the patient moves out of the area before the orthodontic treatment is completed, a determination of the fee for services rendered to date will be made. This amount will be the sum of the initial banding fee plus the number of treatment visits made to the practice at the rate determined in the above calculation. The financing arrangement does not in any way determine the fee for services at any one time during the treatment period.
The fee determined by this agreement will be due upon transfer. If the fee is not paid, then the initial records and the transfer letter will not be sent to the subsequent treating doctor without the payment in advance for the duplication of the records plus for the transfer letter. It is understood that changing treating dentists almost always results in longer treatment time and higher overall fees for the treatment.