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Consent for Early Treatment

The following information is provided to people who will be starting early orthodontic treatment in our practice.

Early treatment or Phase I treatment is tailored to address a specific area (or a variety of areas) of concern. It is more than likely that further comprehensive treatment will be required at a later stage (when more growth and development is complete and/or all the adult teeth are present).

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 appliance: lost, broken or bent appliances disrupt the treatment plan. If an appliance is not working as designed, delay and unwanted tooth movement may occur.
• 4. Regularly scheduled appointments: appliances 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.

Risks and Inconveniences

Like other orthodontic treatments, the use of the appliance prescribed may involve some of the risks outlined below:

• 1. Failure to wear the appliances for the required number of hours per day, not using the products as directed by your Orthodontist, missing appointments, and atypically shaped teeth can lengthen the treatment time and affect the ability to achieve the desired results; If an appliance is not working as designed, unwanted tooth movement may occur;
• 2. Bands may be bonded to one or more teeth during the course of treatment:
• 3. Enamel fractures rarely occur during orthodontic treatment. 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;
• 4. Dental tenderness may be experienced after adjustments;
• 5. Due to the changing nature of the mouth and the eruption of the teeth, there may come a point when appliance will not fit. If required, a new appliance can be made for which there may be a charge;
• 6. Gums, cheeks and lips may be scratched or irritated;
• 7. Tooth decay, periodontal disease, inflammation of the gums or permanent markings (e.g. decalcification) may occur if patients consume foods or beverages containing sugar, do not brush and floss their teeth properly or do not use proper oral hygiene and preventative maintenance;
• 8. The appliance may temporarily affect speech and may result in a lisp, although any speech impediment should disappear within one or two weeks;
• 9. Health of the bone and gums which support the teeth may be impaired or aggravated;
• 10. A tooth that has been previously traumatised, or significantly restored may be aggravated. In rare instances the useful life of the tooth may be reduced, the tooth may require additional dental treatment such as endodontic and/or additional restorative work and the tooth may be lost;
• 11. Existing dental restorations (e.g. crowns) may become dislodged and require re-cementation or in some instances, replacement;
• 12. Unexpected tooth eruption and growth changes during treatment affects overall outcomes. We monitor this and can change treatment plans. Very occasionally the result may be compromised by this;
• 13. General medical conditions and use of medications can affect orthodontic treatment;
• 14. Product breakage has a higher probability in cases with multiple missing teeth;
• 15. Orthodontic appliances or parts thereof may be accidentally swallowed or aspirated;
• 16. In rare instances, problems may also occur in the jaw joint, causing pain, headaches or ear problems; and
• 17. 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.

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 understand that my ongoing appointments will be carried out by the registered Orthodontist and/or the auxiliary team under the direction of the Orthodontist who is responsible for my clinical care outcomes.

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 laboratory making the appliance 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.