LEGAL MATTERS Document. These additional forms include such topics as missing upper laterals incisors (to open or close space), “pegged-shape” lateral incisors (whether to enlarge), early treatment (Phase I), wisdom teeth (to extract, and when), jaw surgery, extractions, TMD, risks on removal of clear brackets, and so on. In addition, we have removed pictures from the forms for this publication that visually illustrate the topic for each of the nine forms.
Form 1: Root Resorption Form 1-Root Resorption is covered in the AAO Informed Consent document under the same heading, “Root Resorption.” This form provides a little more detail than that found in the AAO document. Form 1 can be used in a number of situations. For instance, if a patient is at a greater risk for root resorption (severe overjet, extended length of treatment, has some pre-existing root resorption, has impacted maxillary canines that may be erupting into the maxillary lateral incisors, etc.), this form may be of particular usefulness.
Form 2: Oral Hygiene Oral Hygiene (Form 2) is to a limited extent covered in the AAO Informed Consent document in the following sections: Decalcification and Dental Caries, Periodontal Disease, and Results of Treatment. It should be mentioned that there is an AAO supplemental informed consent Form for “periodontal disease,” but it is not for oral hygiene. Form 2 is useful in instances where the patient’s attention to, and cooperation with, oral hygiene is questionable, and this could include prior to orthodontic treatment. Importantly, Form 2 covers the situation when the patient is showing signs of decalcification and periodontal disease.
Form 3: Enameloplasty Enameloplasty (Form 3) is not directly addressed in the AAO Informed Consent document. There is a section on Occlusal
Form 1: Orthodontic Root Resorption In some instances during orthodontics, the end of the tooth root can become shorter (resorbs). This is call “orthodontic root resorption.” The extent of the root resorption is variable. Although it is not exactly known what causes root resorption, there are many natural- and unnatural- associated factors such as patient diet, hormones, root length, and structure (hardness of the cementum), original malocclusion, amount of tooth movement, type and extent of orthodontics forces, patient age, patient gender, length of orthodontic treatment, and so on. It takes a considerable amount of root resorption to jeopardize the longevity of a tooth, even for severely resorbed roots. Everyone who has had, or will have, orthodontic treatment runs the risk of root resorption. I hereby acknowledge that the topic and issues of orthodontic root resorption have been explained to me; I have had the opportunity to read this document; and I have had any questions answered. ______________________________________________________________ Patient/Parent/Guardian (Signature)
______________ Date
______________________________________________________________ Orthodontist (Signature)
______________ Date
______________________________________________________________ Witness (Signature)
______________ Date
Form 2: Oral Hygiene •
Cleaning of the teeth and braces is of extreme importance to avoid: decalcification (white marks on the teeth), decay, and periodontal disease (swollen and inflamed gums, gum recession, and alveolar bone loss > loss of some of the surrounding bone surrounding the teeth). • If oral hygiene does not improve, “braces” will have to be removed before orthodontic treatment is completed. • We like to use the term “cleaning” the teeth and brackets rather and “brushing.” A patient can honestly say they “brushed” his/her teeth (spent a few seconds doing this) but not get the teeth “clean.” Cleaning implies that the patient has gotten all the biofilm off of his/her teeth and this would take more than a few seconds, i.e., typically several minutes. To clean the teeth and brackets could involve brushing the teeth/brackets, flossing, “Proxabrush®,” water pick, and so on (one, or more of the listed). What ever it take to clean all surfaces of the teeth and brackets. • Your orthodontist may recommend using a fluoride mouth rinse. • In addition, your orthodontist may have given you a prescription (or the actual fluoride paste) for a fluoride gel. It is important to follow the instructions of its use and to do it daily. • Lastly, there is some evidence that supports what is termed, a “Slurry Rinse.” Before splitting out the toothpaste (fluoridated) after cleaning the teeth, swish it around in the mouth before expectoring. This will aid in applying the maximal concentration of the toothpaste (and fluoride) on the teeth. I (we) have read the above, and have had all questions answered concerning oral hygiene and orthodontics. ______________________________________________________________ Patient/Parent/Guardian (Signature)
_____________ Date
______________________________________________________________ Orthodontist (Signature)
_____________ Date
______________________________________________________________ Witness (Signature)
_____________ Date
Form 3: Enameloplasty When orthodontic appliances (or after the final aligner[s] ) are removed, the orthodontist may want to adjust the edges of the upper and/or lower front teeth to make them even and look better. A very slight amount tooth enamel is removed. This is a very routine procedure in orthodontics. This procedure is called an enameloplasty. The procedure is done with a rotary dental instrument (“dental drill”). I (we) give the orthodontist permission to perform an enameloplasty. ____________________________________________ _____________ Patient/Parent/Guardian (Signature) Date ____________________________________________ Witness (Signature)
94 Orthodontic practice
____________________________________________ _____________ Orthodontist (Signature) Date
_____________ Date
Volume 9 Number 2