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Download Consent for Orthodontic Treatment - Stuart Orton
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Consent for Orthodontic Treatment 12 10/10/00preorth.doc Teeth are moved by gentle pressure using elastic bands or springs attached to brackets and bands glued to teeth or attached to removable plastic appliances. Duration of Treatment. An average course of treatment last about 2 years and may vary from 1 1/2 to 2 years. This depends on the complexity of treatment, delays in attending for adjustment appointments and delays in repairing appliances. Need for Regular Visits. Appliances require regular adjustments at periods of 2 to 6 weeks. Delays to treatment may result if appointments are not attended at the prescribed intervals. Breakage of Appliances is likely to occur. Contact us as soon as possible if this occurs. Delay in repairing appliances may result in prolonged treatment. Appliances are easily lost if not kept in a safe place while not being worn. If your appliance is lost, contact us immediately. A replacement may then be made. The Final Result. Before removing the appliances it is important that you are satisfied with the final result. Be certain that you are satisfied before agreeing to the removal of your appliances. Retention. Teeth tend to return to their original position unless a retainer is worn. At the end of treatment it is necessary to retain the teeth in position otherwise they may move out of alignment. This may be achieved with a hidden wire glued to the teeth or a removable appliance. Maintenance of Retainers. Retainers may wear or break. If not repaired your teeth may move. Contact us immediately if your retainer becomes damaged. Removal of Fixed Appliances After removal of fixed appliances some glue may remain. This may become stained and require removal later. If this occurs, please contact us. Follow-up Appointments To ensure a long lasting result, you should attend for checkups at regular six monthly intervals. The Stages of Treatment. 1. A thorough evaluation. 2. The fitting of bands and brackets or removable appliances. 3. The adjustment of the appliances at appropriate intervals. 4. The final assessment at the completion of treatment. 5. The removal of the appliances and fitting of retainers. 6. Regular six monthly follow-up checkups. 7. Further treatment if any teeth move out of line. Fees are charged on a time basis plus any special materials and laboratory fees. They will vary due to the complexity of treatment, delays in attending for adjustment appointments and delays in repairing appliances. I have been given the opportunity to ask questions about orthodontic treatment. I have read and understood this consent form and have been given a copy to take home Initial ______ Name ( Block Capitals)_______________________________________________ Patient's Signature .................................................................Date............................. Dentist's Signature .................................................................Date............................. Stuart Orton-Jones 33 High Street Harpole Northampton, NN7 4DH England. Tel:- 01604 832399 Fax:- 01604 832867 Mobile:- 07885 349300 Email:- [email protected]
