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Consent for Braces Treatment

The following information is provided to people who will be starting orthodontic treatment in our practice. While recognising the benefits of teeth that function well and have a pleasing appearance, you should be aware that orthodontic treatment, like any treatment of the human body, has inherent risks and limitations.

The Patient's Responsibilities

Orthodontic treatment will not be successful if you do not comply with the directions given by your Orthodontist. Typically, these responsibilities include:

• 1. Meticulous oral hygiene: thorough brushing at least three times a day.
• 2. Correct use of the appliance and patient co-operation: orthodontic appliances are designed to deliver forces in a very specific manner. If the appliances are not worn as requested, the treatment will not proceed as planned.
• 3. Care of the braces: brackets off or bent wires disrupt the treatment plan and can delay treatment. Having brackets off repeatedly may incur fees.
• 4. Regularly scheduled appointments: braces must be adjusted periodically, and treatment progress must be monitored carefully. Missed or rescheduled appointments inevitably prolong treatment.
• 5. Routine dental visits: you must continue to see your dentist for regular checkups - at least every 6 months.

Tooth Decay/Stains/Decalcification

The bacteria present in plaque (the white sticky material that forms on the tooth surface) will damage the teeth if not removed by thorough brushing at least 3 times a day. Bacteria thrive on sugar: limit the amount you eat. This will lessen the potential for tooth decay, staining and decalcification (permanent markings on the teeth). It is imperative during orthodontic treatment that extra care be taken with oral hygiene and tooth brushing.

Dental Care during Orthodontic Treatment

Please ensure that any necessary fillings and scaling/cleaning are completed by your Dentist/Hygienist before commencing orthodontic treatment. It is your responsibility to continue to see your General Dentist every 6-12 months throughout orthodontic treatment for examinations and any necessary general dental treatment. Any dental treatment including extractions are not included in your orthodontic treatment fee.

Root Shortening

In some patients, the length of the roots of the teeth may be shortened during orthodontic treatment. Some patients may be prone to this happening, some are not. It is nearly impossible to predict susceptibility. Usually this shortening does not have significant consequences, but on very rare occasions it may become a threat to the longevity of the teeth involved. Progress x-rays will be taken to evaluate the status of the roots.

Extractions

It may be necessary to have permanent teeth extracted as part of treatment. This is usually because the jaw is not large enough to hold all the teeth. The space created by their loss will allow the remaining teeth to be straightened. Usually the extractions are carried out by your own dentist, but in certain cases you may need to be referred to the hospital or a Specialist. As part of your treatment, we will advise you if extractions are required.

Treatment Time & Suspension of Treatment

The total time required to complete treatment may exceed the estimate. Poor co-operation in wearing the appliance the required hours per day, poor oral hygiene, broken appliances and missed appointments can lengthen the treatment time and affect the quality of the results. As a last resort, in cases of poor cooperation, the treatment may be suspended. In such cases, orthodontic fees will be payable up to the time of termination of treatment. In these circumstances, it is likely that the result will be a compromise.

Retention

Once the orthodontic appliances are removed, the retention phase of treatment begins. This requires wearing long term retainers as directed by your orthodontist. During the retention phase of treatment, regular retainer checks over a 12-month period is included in your contract fee. After this time, an annual review is recommended and is charged on a per visit basis. Retainers are guaranteed for 12 months and will be repaired or replaced free of charge within this time if damage occurs through normal use. There will be a charge made for replacement retainers if they are lost or broken due to poor care.

Relapse

Teeth may have a tendency to change their positions after treatment. The faithful wearing of retainers should reduce this tendency. Teeth can however, move at any time, whether or not they have had orthodontic treatment. This is especially true during the late teen period when active growth of the lower jaw is coming to an end. The most vulnerable teeth are those at the front. Occasionally tooth movements will be severe enough to merit a further course of treatment to ensure a satisfactory result. If significant relapse occurs due to poor wear of retainers, any additional treatment to resolve this will be charged for.

Unexpected Growth Changes

Growth of the facial structures and eruption of the teeth can sometimes take unexpected turns. Average growth of a child may not continue to be average. If growth becomes disproportionate, the jaw relationships can be affected. Insufficient, excessive or asymmetrical changes in the growth of the jaws may limit our ability to achieve the desired result. If this occurs, original treatment objectives may not be met and a change in treatment plan may be required. Growth changes that occur after orthodontic treatment may alter the quality of treatment results and may require further orthodontic treatment. In some cases of atypical growth, the bite may change so much that jaw surgery is required to achieve the best possible result.

Periodontal Health

The health of the bone and gums which support the teeth may be affected by orthodontic tooth movement if a condition already exists, and in some rare cases where a condition does not appear to exist. In general, orthodontic treatment lessens the possibility of tooth loss or gum infection due to misalignment of the teeth or jaws. Inflammation of the gums and loss of supporting bone can occur if bacterial plaque is not removed daily with good oral hygiene.

Pain or Discomfort in the Jaw Joint

Pain, discomfort, clicking or popping noises may occur in or near the joint of the jaw (TMJ) at any time, including during orthodontic treatment. Some patients are susceptible to TMJ problems and some are not. Just as with any joint discomfort, the possible causes vary widely. It is important that we are informed of any jaw joint problems so that we can deal with them promptly. Discomfort in the TMJs can last for a few days to several weeks or longer.

Unexpected Tooth Eruption Problems

Sometimes when a tooth is erupting, it will not follow the usual and expected direction of eruption. The tooth may not be able to reach its normal position and will become impacted. Usually it is possible to solve these impactions - but not always. If the impaction is extreme and the tooth becomes tightly bound to its surrounding bone, it may not be possible to move that tooth at all. We will be carefully monitoring the teeth as they erupt, to catch such a problem. If a tooth does become impacted, a change in treatment plan may be necessary.

Loss of Tooth Vitality

If a tooth was previously injured, bumped, impacted or had a large filling, it is possible that the nerve of the tooth may die during orthodontic treatment. It is helpful for you to tell us of any previous injury or stress to the teeth. Sometimes such injuries are unknown to the patient. Such previous injuries cannot always be detected during the diagnostic process. Root canal treatment and treatment to restore the colour of the tooth may be recommended if such a problem occurs. Extraction is occasionally, though not usually, necessary.

Micro-Implants

If during the treatment Micro-Implants or temporary anchorage devices are considered desirable, then these will be discussed with you. It is not always possible to assess the certain need or otherwise for these at the start of treatment. If needed, these implants will be placed by a Specialist. There are additional fees for Micro-Implants. Should Micro-Implants fail they will need to be replaced generally at reduced or no cost. At the completion of orthodontic treatment any Micro-Implants used are removed.

Enamel Fractures

Tooth enamel is a crystalline structure - and like other crystals it can have undetected defects and fracture lines within it. As a result, even with extreme care being taken, enamel can fracture during placement or removal of the appliances. Such fractures may also occur if a band or bracket is bitten on at just the wrong angle or if the enamel has been weakened by decay or dental restorations. The enamel may also be damaged by rubbing against a part of the appliance. Tooth colored ceramic brackets are abrasive to enamel. Be sure to report immediately if any tooth is hitting against a ceramic bracket.

Injury from Appliances

Appliances are designed to have maximum amount of strength and a minimum amount of injury potential. Nevertheless, accidents can occur. It is very important to follow our instructions. Any injuries should be reported to us immediately. Injuries can occur during rough play or contact sports. Patients are warned not to wear certain appliances such as headgear during these times. The gums, cheeks or lips may be scratched or irritated by newly placed appliances, by loose or broken appliances or by blows to the mouth. You should inform us of any unusual symptoms or broken or loose appliances.

Other Risks and Inconveniences

The use of appliances for orthodontic treatments may involve some of the risks outlined below:

• 1. Existing dental restorations (e.g. crowns) may become dislodged and require re-cementation or in some instances, replacement;
• 2. Short clinical crowns can pose appliance retention issues and inhibit tooth movement;
• 3. Teeth may require interproximal recontouring or slenderising in order to create space to allow tooth movement to occur;
• 4. Extractions or oral surgery may be necessary to correct crowding or severe jaw imbalances that are present prior to orthodontic treatment. If so, risks associated with anaesthesia and proper healing must be taken into account prior to treatment;
• 5. Dental tenderness may be experienced after adjustments;
• 6. General medical conditions and use of medications can affect orthodontic treatment;
• 7. Product breakage has a higher probability in cases with multiple missing teeth;
• 8. Orthodontic appliances or parts thereof may be accidentally swallowed or aspirated; and
• 9. Allergic reactions may occur.

Success of Treatment

We intend to do everything possible to provide the very best treatment result. It is our professional opinion that the treatment will be beneficial. However, because of individual conditions and the limitations of treatment imposed by nature, each specific treatment goal may not be attainable for every patient.

Additional Treatment

Unforeseen circumstances, such as growth changes or gum disease, may cause us to recommend a form of treatment not previously discussed. If this occurs, we will explain the reasons for a change in treatment plan. First phase treatment is often provided in the mixed dentition i.e. when both primary and adult teeth are in place. It is likely that further orthodontic treatment will be required when all the adult teeth have erupted. We will monitor the eruption of the teeth along with the growth and development of the jaws and make recommendations for further treatment as required.

Fee Summary

The fees, as outlined in your consultation, include all charges for treatment and appliances agreed upon, except for:

• 1. Charges for lost or broken appliances, frequently missed appointments, and any unusual procedures that were not considered in the original treatment plan.
• 2. Charges for treatment outside this practice that are normally completed by a general dentist or another specialist.
• 3. Charges for retainer checks or adjustments after 12 months of complimentary follow-up care.

Consent

I have been given adequate time to read and have read the preceding information describing orthodontic treatment. I understand the benefits, risks and inconveniences associated with treatment. I have been sufficiently informed and have had the opportunity to ask questions and discuss the concerns about orthodontic treatment with my Orthodontist from whom I intend to receive treatment. I understand that I should only use the treatment products after consultation and prescription from a qualified Orthodontist, and I hereby consent to orthodontic treatment that has been prescribed by my Orthodontist.

I understand and give consent for treatment to be provided by registered Orthodontic Specialists, registered Orthodontic Auxiliaries and Orthodontic Auxiliaries in an accredited training program.

I consent to Eden Orthodontics collecting and keeping information about my health for the purpose of making sure I receive appropriate care and treatment, and for the associated administrative tasks. I agree to provide this information voluntarily. I understand and agree to my health information being stored overseas and I have been notified of this arrangement. I am entitled to request access to correction of my health information.

I authorise my Orthodontist to release my medical records, including, but not limited to, radiographs (xrays), scans, reports, charts, medical history, photographs, findings, plaster models or impressions of teeth, prescriptions, diagnosis, medical testing, test results, billing and other treatment records in my Orthodontist’s possession (“Medical Records” ) (i) to other licensed dentists or orthodontists and organisations employing licensed dentists and orthodontists for the purposes of investigating and reviewing my medical history and to the Braces provider as it pertains to orthodontic treatment (ii) educational and research purposes.

I acknowledge that use of my Medical Records is without compensation and that I will not nor shall anyone on my behalf have any right of approval, claim of compensation, or seek or obtain legal, equitable or monetary damages or remedies arising out of any use such that comply with the terms of this Consent. A photostatic copy of this consent shall be considered as effective and valid as an original. I have read, understand and agree to the terms set forth in this consent as indicated by my signature below.