Pros and Cons or Informed Consent For Braces
The following information is provided to patients
who will be starting orthodontic treatment in our office. While recognizing
the benefits of teeth that function well and have a pleasing appearance,
a patient should be aware that orthodontic treatment, like any other treatment
of the human body, has inherent risks and limitations. The response of
a living system cannot be predicted perfectly. If a patient decides not
to proceed with treatment, then the state of the dentition (teeth) can
be expected to continue on its present path. Any unwanted changes that
are occurring can be expected to continue, but the rate of these changes
are very unpredictable. In general, dental change tends to be very slow,
but as much as we would like to, we cannot tell a patient exactly what
might happen if they decide not to proceed with our recommendations. A
patient must balance the risks of non treatment against the risks of treatment.
In our opinion, the risks of treatment are not enough to rule against proceeding;
nevertheless, a patient should consider them carefully before they make
a final decision. Please note that it is not possible to list every circumstance,
so the following list is necessarily incomplete.
THE PATIENT'S RESPONSIBILITIES
Orthodontic treatment will not be completely successful unless a patient
complies with the directions given by us. Many treatment forces are applied
by our patient outside of the office. A patient needs to fulfill their
responsibilities because the patient's effort = their treatment result.It's
just that simple! Typically these responsibilities will include:
Correct use of the appliance: orthodontic appliances are designed to deliver
forces in a very specific manner. If the appliance is not worn as requested,
the treatment will not proceed as planned.
Meticulous oral hygiene: A thorough brushing several
times each day, complete flossing once each day
and daily application of a fluoride mouth rinse
Care of the appliance: lost, broken, or bent appliances disrupt the treatment
plan. Unwanted tooth movement may occur if the appliance is not working
Regularly scheduled appointments: Appliances must be adjusted periodically
and treatment progress must be monitored carefully. Missed or rescheduled
appointments prolong treatment inevitably. Some appointments will be during
work or school hours.
Routine dental visits: An orthodontic patient should continue to see their
family dentist for regular cavity check-ups, teeth cleaning, sealants
and fluoride varnish applications and periodontal
evaluations based on their risk
The bacteria present in plaque (the white, sticky material that is constantly
forming on tooth surfaces) release acids that draws the calcium and phosphorous
out of the outer surface of the tooth. This will damage a patient's tooth
surfaces if the plaque is not removed several times each day by thorough
brushing, flossing and rinsing. This damage includes tooth decay and permanent
white decalcification markings. The bacteria
that live in plaque thrive on refined carbohydrates (sugar!). While a patient
is undergoing orthodontic treatment, they should minimize the amount and
frequency of sugar in their diet. These same problems can occur without
orthodontic treatment, but the risk
is greater to an individual wearing braces.
INFLAMMATION OF THE SOFT TISSUES
The wires, brackets, or band attachments can
sometimes irritate the lips, cheeks, or gum tissue. These soft tissue irritations
usually heal quickly. The wax that we give our patients can help cushion
these irritations while they are healing. If the irritation is persistent
a patient should contact us immediately so that we can solve the problem.
Poor oral hygiene during orthodontic tooth movement can accelerate deterioration
of the periodontal tissues (gums and underlying bone). Severe tissue
reactions may require us to refer a patient to a periodontal (gum) specialist
or discontinue orthodontic treatment.
TREATMENT GOALS AND TREATMENT COMPLETION
We have tried to establish realistic and achievable goals for treatment.
We know that patients share our desire to produce the best result that
is possible. As we begin treatment, we believe that we will be able to
achieve those goals. Nevertheless, unforeseen factors such as atypical
tooth formation and disproportionate jaw growth may interfere with our
intentions. These biological processes are beyond the orthodontist's control.
As treatment proceeds we will keep a patient fully informed as to treatment
progress. If our original goals become unreachable, we will discuss the
alternatives with a patient.
Although we give a patient an estimate of their treatment time, we do not
know exactly how long their treatment will take. Individuals vary
considerably in their response to orthodontic forces, so treatment time
may be more or less than our estimate. It is our general intention to have
the treatment move along in a fashion that is consistent with tissue health,
minimal discomfort, and long term stability.
PAIN OR DISCOMFORT IN THE JOINT OF THE JAW
Pain, discomfort, clicking or popping noises may occur in or near the joint
of the jaw at any time, including during orthodontic treatment. Just as
with any joint discomfort, the possible causes vary widely. It is important
that we be told about jaw joint problems so that we can deal with them
LOSS OF TOOTH VITALITY
It is possible for the nerve of a tooth to die during orthodontic treatment,
especially if a tooth was previously injured, bumped, or impacted. It is
helpful in our monitoring the health of each tooth for a patient to tell
us about any previous injury or stress to the tooth. Sometimes seemingly
minor bumps can result in nerve damage that is unknown to a patient. Such
previous injuries cannot always be detected during the orthodontic diagnostic
process. Root canal treatment may be recommended if such a problem occurs.
Extraction is necessary occasionally, though not usually.
INJURY FROM APPLIANCES
Appliances are designed to have a maximum amount of strength and a minimum
amount of injury potential. Nevertheless, accidents can occur and a patient
can be injured by sharp parts of the appliances. A patient could also be
injured during a routine appointment by one of our sharp instruments. It
is also possible for a patient to swallow or inhale small parts of the
appliance that fall into the back of the throat at any time, including
routine office visits. Everyone working with a patient in the office will
be attentive particularly to preventing accidents. Headgear instructions
must be followed carefully. Improperly handled headgear may cause injury
to the face or eyes, even blindness. Patients are warned not to wear the
headgear during times of horseplay or competitive activity. Always release
the elastic force before removing the headgear from the teeth. Although
our headgear are equipped with a safety system, we urge caution at all
times. Tender teeth should be expected after in office adjustments. The
period of tenderness or sensitivity varies with each patient and the procedure
performed. Typically, post adjustment tenderness may last 24-48 hours.
Abnormal wear of tooth structures is also possible if a patient grinds
their teeth excessively.
UNEXPECTED GROWTH CHANGES
Growth of the facial structures and the teeth can sometimes take unexpected
turns. A child who has grown in average proportions may not continue to
do so. If growth becomes disproportionate, the jaw relationships can be
affected. If this occurs, original treatment objectives may not be met.
UNEXPECTED TOOTH ERUPTION PROBLEMS
Sometimes when a tooth is erupting (growing in), it does not follow the
usual and expected direction of eruption. The tooth may not be able to
reach its normal position and will become impacted or stuck under the bone.
Usually it is possible to solve these impactions, but not always. If the
impaction is extreme and the tooth becomes tightly bound to its surrounding
bone, it may not be possible to move that tooth at all. We will be monitoring
the teeth carefully as they grow in to catch such a problem. If a tooth
does become impacted, a change in the plan of treatment may be necessary.
Tooth enamel is a crystalline structure and like other crystals, it can
have undetected defects and fracture lines within it. As a result, even
when extreme care is taken, enamel can fracture during placement or removal
of the appliances. Such fractures may also occur if a band or bracket is
bitten on at just the wrong angle or if the enamel has been weakened by
decay or dental restorations (fillings). The enamel may also be damaged
by rubbing against a part of the appliance. Tooth colored ceramic brackets
are abrasive to enamel. A patient must be sure to report if any tooth is
bearing against a ceramic bracket.
Sometimes tooth removal or orthognathic(jaw) surgery is necessary in conjunction
with orthodontic treatment, especially to correct crowding or severe jaw
imbalances. We will recommend these procedures only if it improves the
prospects for successful treatment. Risks involved with treatment and anesthesia
should be discussed with the patient's general dentist or oral surgeon
before making a decision to proceed with this procedure.
Tobacco use places orthodontic patients at greater risk of cancer and periodontal
(gum) disease. Tobacco reduces blood flow to the mouth tissues at a time
when good blood flow is needed for tooth movement. We recommend that all
tobacco users enroll in smoking cessation classes given by the American
Cancer Society, the
Intervention Network or the Anne
Arundel Co. Department of Health.
SUCCESS OF THE TREATMENT
We intend to do everything possible to provide the very best treatment
result. However, we cannot guarantee that the proposed treatment will be
successful to a patient's complete satisfaction. Individual patient differences
create the possibility of incomplete or unstable results. Selective retreatment
may be necessary despite the very best of care.
Unforeseen circumstances, such as growth changes or gum
disease may cause us to recommend a form of treatment not previously
discussed. These changes in treatment plan may require additional treatment
in our office or with another specialist. Additional treatment with associated
fees will be discussed with the patient.
Orthodontic forces initiate a cellular response in the supporting tissues
surrounding the roots of the teeth. It is this cellular response that allows
the teeth to move. Sometimes, this response becomes confused resulting
in damage to the ends of the roots of the teeth. Usually this effect is
mild and does not compromise the teeth. However, sometimes this root resorption
can be extensive and may then endanger the teeth if periodontal (bone and
gum) support is lost at some future time. Some patients are prone to this
happening, some are not. Because it is not possible to predict which teeth
might be affected, we may want to take progress x-rays of a patient's teeth
during the treatment process to evaluate whether root resorption is occurring.
STABILITY OF THE FINAL RESULT
The tooth positions achieved at the end of treatment may not be perfectly
stable. The retainers that a patient wears, will enhance the stability
of the final result, but even diligent wear of the retainers may not keep
a patient's teeth exactly as they were at treatment's end. The teeth and
jaw structures are a dynamic system that constantly change throughout one's
lifetime. Orthodontic treatment does not make a patient immune to this
process. Maturational changes that occur after active orthodontic treatment
may alter the quality of the end result. Ongoing wear of the retainers
will minimize changes. If a patient decides to stop wearing their retainers
at some point, their teeth may change. Some of the original problem may
You may schedule an orthodontic
appointment with Dr. William Trepp in his Severna Park, MD office by calling
410.696.4624 or in his Clinton, MD office by calling 301.868.6200.
Written inquiries should be mailed to: 69 Robinson RD, Severna Park, MD
21146, USA or 8918 Woodyard RD, Clinton, MD 20735, USA
Copyright © 1996 - 2013, William J. Trepp, DDS, PA. All rights reserved.
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