Successful orthodontic treatment is a partnership between the doctor, the team, and the patient.

The Practice is dedicated to achieving the best possible outcome, and an informed and cooperative patient can help bring about positive treatment results. The patient and/or the patient’s responsible party/authorized representative should be aware that, along with the benefits of a healthy smile, orthodontic treatment also presents limitations and potential risks.

Although these risks are typically not serious enough to forgo treatment, the patient and/or the patient’s responsible party/authorized representative should always consider alternatives, which can include prosthetic solutions or limited treatment options, and should discuss all options with the Practice prior to beginning the treatment process.

RISKS AND LIMITATIONS OF ORTHODONTIC TREATMENT

Tooth Decay, Stains, Decalcification, and Unexpected Tooth Eruption: Poor oral hygiene causes gum inflammation, decalcification (white scars on the teeth), and decay. Additionally, inflamed gum tissue slows tooth movement and prolongs treatment. Patients should brush after every meal (at least three times a day), floss once a day, minimize sugar intake (especially soda) while in treatment, and maintain regular appointments and cleanings with their primary dentist. Additionally, erupting teeth can become impacted or ankylosed (fused to the bone and un-removable), and may require treatment changes or possible tooth extraction. The Practice will monitor the patient’s bone growth, including tooth formation and eruption.

Routine Dental Visits: The American Dental Association and the Practice recommend that patients continue to see their regular dentist for checkups and cleanings at a minimum every six months or as otherwise recommended by the patient’s primary dentist.

Speech: Certain treatments or products, such as Invisalign® products, can temporarily affect speech or result in a lisp. However, such speech impediments should be temporary.

Care of Appliances: A lost, broken, or bent appliance will disrupt treatment and may result in unwanted tooth movement. The patient and/or the patient’s responsible party/authorized representative should notify the Practice immediately if an appliance becomes lost or damaged.

Auxiliary Appliances: The patient may be asked to wear elastics (rubber bands) or other auxiliaries during treatment to enhance tooth movement. Treatment will not proceed as planned if such auxiliary appliances are not worn as instructed.

Correct Use of Appliances: Appliances are designed to deliver forces in a specific manner, and if they are not worn as instructed, treatment will not proceed as planned.

Injury from Orthodontic Appliances: Although orthodontic appliances are designed for maximum strength, injuries may still occur, and orthodontic appliances and/or their parts could be accidentally swallowed or aspirated. The patient and/or the patient’s responsible party/authorized representative should immediately report any injury to the Practice.

Wisdom Teeth: Tooth alignment can change as third molars (wisdom teeth) erupt. Consistently wearing retainers can help minimize these effects; however, the Practice will monitor the patient’s tooth alignment to determine if, or when, tooth extraction becomes necessary.

Occlusal/Enamel Adjustment: Enomeloplasty or “manicuring” the teeth by altering their shape or otherwise removing enamel may be necessary to prevent relapse or to produce the best functional and esthetic results.”

Unexpected Growth Changes: Facial structure and tooth eruption can be unpredictable and may affect the jaw relationship if they occur disproportionately. Changes following treatment may require further attention or possible surgery.

Inflammation or Recession of the Soft Tissues: Orthodontic appliances can irritate soft tissue in the mouth; however, this usually heals fairly quickly. Lack of proper oral hygiene may cause gum tissue inflammation or other severe reactions that could require referral to a periodontal specialist.

Pain or Discomfort in the Jaw Joint: Pain or discomfort, including clicking or popping sensations, may occur in or around the jaw joint and could require evaluation or treatment by another doctor or healthcare professional. The Practice should be immediately informed if this arises.

Enamel Fractures: Fracture lines and undetected defects can appear in tooth enamel when placing, adjusting, or removing an appliance. They might also occur when brackets are bitten at the wrong angle, enamel is weakened by decay, or if teeth grind or rub against the appliance. Restoration may be necessary in these cases.

Existing Dental Restorations: Existing dental restorations (such as crowns) may dislodge and require re-cementation or, in some instances, replacement. Treatment may not be effective for the movement of dental implants.

Allergies: It may become necessary to medically manage symptoms if the patient is allergic to treatment materials. Although uncommon, this could result in re-evaluation of the treatment plan or discontinuation of treatment altogether.

General Health Problems: Bone, blood, and endocrine disorders can affect treatment, as can many prescription and non-prescription drugs. Treatment may cause a temporary increase in salivation or mouth dryness, and certain medications can increase this effect. The patient and/or the patient’s responsible party/authorized representative should consult with the Practice prior to beginning treatment.

Smoking: Smoking increases the risk of gum disease. It also delays tooth movement and may lead to tooth loss if a compromised periodontal condition exists during treatment. It is recommended that patients quit smoking prior to treatment.

Periodontal Disease: Periodontal (gum and bone) disease is most often caused by poor oral hygiene and could result in treatment ending prematurely if the resulting problems cannot be controlled.

Root Resorption: Unerupted teeth or orthodontic forces affecting tissue surrounding tooth root, can lead to resorption (root damage). Resorption may require a referral for exposure if it is severe. Significant damage can also cause permanent tooth loss; however, this is unpredictable and rare, and progressive radiographs will be taken to monitor root position.

Loss of Tooth Vitality: Previous tooth, face, or jaw injuries are not always detectable, and injured teeth can turn dark or become non-vital during treatment. Braces do not cause this; however, if extreme cases arise, the problem may require tooth extraction or root canal treatment.

Temporary Anchorage Devices: Temporary anchorage devices (such as metal screws or plates) may be used during treatment and carry specific risks. Screws can loosen, break, or get swallowed and require removal, relocation, or replacement. Surgery may be necessary in some cases. Damage to roots or nerves can occur, including perforation of the maxillary sinus. Devices can also cause inflammation or infection to the surrounding tissue, or soft tissue may grow over the device. This could require removing the device, surgically excising the tissue, and/or the use of antibiotics, antimicrobial rinses, or other treatments recommended by the Practice. Applying or removing a device may also require the use of local anesthetics, which also carry risk. The patient and/or the patient’s responsible party/authorized representative should advise the Practice of any past difficulties with dental anesthetics before the device is applied.

Soft Tissue Laser: Lasers may be used to remove excessive soft tissue surrounding teeth to help facilitate or expedite treatment. Discomfort and sensitivity may be experienced during healing. In rare circumstances, additional dental and/or medical treatment might be necessary.

Orthognathic Surgery: Orthodontic treatment prior to orthognathic surgery often only aligns the teeth within the individual dental arches. Therefore, patients discontinuing orthodontic treatment without completing the planned surgical procedures may have a malocclusion that is worse than when they began treatment.

Patient Responsibilities: Treatment will not succeed completely unless the patient complies with the Practice’s instructions, including but not limited to those set forth in this Informed Consent.

Results of Treatment: Orthodontic treatment usually proceeds as planned, and the Practice intends to do everything possible to achieve the best results for every patient. However, the Practice cannot guarantee complete satisfaction with results, nor can all complications or consequences be anticipated or overcome. The success of treatment depends on the patient and/or the patient’s responsible party/authorized representative’s cooperation and compliance with keeping appointments, maintaining good oral hygiene, avoiding loose/lost/broken appliances, and following the Practice’s instructions.

Stability of the Result: Teeth and jaw structures constantly change, and tooth positions may not perfectly stabilize even after treatment. Wearing a retainer can help minimize these effects; however, teeth will slowly change position, and some problems may reoccur if a retainer is not worn as the Practice instructs.

Limited Aligner Treatment: Limited treatment may be recommended by the Practice to treat cases that have a minimal amount of correction needed (e.g., treatment limited to the social teeth). This treatment option may not include bite correction or other comprehensive changes. Limited aligner treatment may not fully correct and/or treat all orthodontic needs, and the Practice may recommend further comprehensive treatment at an additional cost. The patient and/or the patient’s responsible party/authorized representative should discuss with the Practice to ensure a full understanding of the benefits and risks of this limited treatment option.

Additional Treatment: Growth changes, periodontal inflammation, gingival recession, and tooth or jaw discomfort can be unpredictable. The Practice will consult with the patient and/or the patient’s responsible party/authorized representative if further treatment and associated fees are required.

X-ray and Records Consent: I hereby consent to the making of diagnostic records, including x-rays, before, during, and following orthodontic treatment provided by the doctor(s) and their team (where appropriate) for orthodontic treatment prescribed by the doctor(s) for the below individual. I have been informed of, and fully understand, the risks associated with the treatment.

Whitening Treatment: Whitening treatment may be offered or recommended by the Practice at the patient’s discretion. There may be risk associated with whitening treatment, including but not limited to, tooth sensitivity which is normal and is usually mild, but it can be worse in susceptible individuals. Usually, tooth sensitivity or pain following a whitening treatment subsides after a few days but it may persist for longer periods of time in susceptible individuals. People with existing sensitivity, recession, exposed dentin, exposed root surfaces and large wear facets, damaged or missing enamel, cracked teeth, cavities, leaking fillings or other dental conditions that cause sensitivity or allow penetration of the gel into the tooth may find that those conditions increase or prolong tooth sensitivity or pain after whitening treatment. Whitening treatment results may vary or regress due to a variety of circumstances. Teeth with multiple colorations, bands, splotches or spots due to tetracycline use or fluorosis do not whiten as well and may need, multiple treatments or may not whiten at all. Results of my whitening treatment cannot be guaranteed. Whitening treatment results are not intended to be permanent. Repeated take-home treatments may be needed to maintain the achieved tooth shade. After whitening treatment, any foods or liquids that could discolor teeth should be avoided such as coffee, teas, soda, tobacco, products, red wine, and red sauces. Whitening is not recommended for patients who do not have all permanent teeth or pregnant/lactating women.

---

By signing below, I hereby acknowledge and agree that I have been informed of, read and fully understand the above risks associated with the orthodontic treatment, and have had the opportunity to ask questions of my doctor(s) and the Practice team. I also understand that there may be additional risks that occur less frequently than those presented above, and that actual results of treatment may differ from anticipated results.