Rebecca Falsafi DDS, MS
3D Orthodontics and Orthopedics for Children and Adults

6161 Transit Rd., Suite 10
East Amherst, NY 14051

Debond and Retainer Consent Form

Consent for Braces Removal
Retainer Instructions and Responsibilities
  • 1. Wear my removable retainers 22 hours a day allowing 2 hours to eat and brush for the first 6 months followed by “night-time for lifetime.”
  • 2. Do not wear my removable retainers during eating to prevent damage.
  • 3. Keep my removable retainer in the proper case when not wearing them.
  • 4. Keep my retainers and retainer case away from all pets.
  • 5. Do not expose my retainer to anything hot, this includes hot water; heat will melt or warp your retainer.
  • 6. Brush retainer with toothpaste and cool water after every meal and before going to bed.
  • 7. I will be given your mold of your teeth, please keep in a safe place in case they are needed in the future.
  • 8. Maintain my scheduled retention appointments as prescribed by my orthodontist.
  • 9. Bring removable retainer to my retention appointments.
  • 10. Clean around my lower lingual bonded retainer.
  • 11. Have my General Dentist evaluate the readiness for wisdom tooth extraction if applicable.
  • 12. Call the office immediately if my retainer breaks or is not fitting properly.
Lost or Broken Retainers