Download Simply Smile Consent Form

PATIENT CONSENT
Dentist:
Practice:
As with any medical or dental procedure, certain risks and complications may arise as a result of
orthodontic treatment. The review that follows is not meant to be alarmist. The objective is to
provide you with sufficient information for you to make an informed decision regarding treatment.
With your Simply Smile braces we are aiming to straighten your front teeth. You may have other
orthodontic issues which we are not attempting to correct. These may include problems such as
the way your teeth bite together (crossbites and molar relationships), the prominence of your
upper front teeth (overjet), problems with your jaw joint (TMD), midline discrepancies and the
profile of your face. A specialist orthodontist may offer full correction of all of your orthodontic
problems but usually this type of treatment can take 2 years or longer.
Dental Hygiene We will instruct you how to clean your teeth, gums, brackets and wires and advise you on
products that will help you maintain a clean, healthy mouth. If dental hygiene is compromised
then your gums might swell and bleed and this will delay your treatment. Indeed we may have to
suspend or stop your treatment if you do not maintain your dental hygiene. Patients who neglect
adequate cleaning and have a high sugar diet might find that the enamel around the brackets
becomes permanently stained with white spots.
If we have arranged for you to have a professional cleaning appointment during your treatment it
is important that you do attend for this.
Hard sticky foods Those who eat hard and sticky food can suffer from the brace breaking. Frequent breakages can
result in a longer treatment time and may compromise the final result.
Appointments Please do keep the appointments that we have made for you. Missed appointments can result in
treatment taking longer. Should you need to reschedule your appointments please let us know 48
hours in advance so that we can offer your slot to another patient.
We will need to see you after the braces come off your teeth, these appointments are very
important as we will monitor how your bite is settling and whether we need to make adjustments to
your retainers.
If you plan to move to another area during the treatment period it is advisable to complete your
treatment with our practice.
Soreness After the braces are put on, the teeth may be sore, usually for 2 -4 weeks. Tablets which you
usually take for aches & pains or headaches, eg ibuprofen or paracetamol may be taken to relieve
this. If the soreness makes eating even soft foods difficult then please ring for an appointment so
we can make any necessary adjustments. If the insides of your lips are sore, the wax can be used
as a cushion over the brace until the lips get used to it.
Jaw Joint Very rarely, patients develop stiffness or clicking of the jaw joint, this is usually transient as the jaw
adapts to the new bite. Tablets which you usually take for aches & pains or headaches, eg ibuprofen
or paracetamol may be taken to relieve this.
Injury to the Tooth Nerve Occasionally the movement of the teeth with any orthodontic appliance can result in 1 - 2 mm of
resorption (shortening) of the root tips. This does not involve any discomfort and does not usually
jeopardise the teeth. Very rarely, individual teeth or groups of teeth can suffer marked root
shortening which may prejudice their long term retention or result in the death of the tooth’s nerve
and necessitating root canal therapy.
Retention Teeth have the tendency to rebound to their original positions after orthodontic treatment. Very
severe problems have a higher tendency to relapse and the most common type being with twisted
teeth. Retainers will be placed immediately to minimise relapse.
Teeth also move with age, similar to skin, they tend to wrinkle/crowd over the years. We therefore
recommend that your retainer is for life. This way you teeth will look fantastic over the years to
come. Very rarely the retainer may need replacing Making space If your teeth are crowded, we may need to make space by polishing some of the enamel between
your teeth. Sometimes your teeth may be so crowded that we might need to extract a lower incisor
to relieve the crowding.
Tooth shapes - Misshapen and abnormally long teeth will be reshaped as part of the treatment. On occasion we
may need to bond composite onto the edges of the front teeth to improve their appearance.
Main Treatment Objectives I understand that the main objective of my orthodontic treatment is to align my front teeth for
cosmetic reasons. My bite and the relationship of my back teeth will not be changed dramatically. A
few months may be required for the bite to settle and become comfortable after treatment.
I fully understand that the course of treatment being offered may not result in complete orthodontic
correction.
I understand that the dentist providing this treatment is a general dentist practitioner and not a
Specialist Orthodontist.
Patient:
Patient Signature:
Date: