Phase 1 Orthodontic Treatment Consent Form

About Phase 1 Treatment

Phase 1 orthodontic treatment is early treatment carried out in children, usually while some baby teeth are still present. The aim is to guide jaw growth, improve bite development, create space for permanent teeth, and reduce the need for more complex treatment later.

At Ellenbrook Orthodontics, Phase 1 treatment may involve:

• Twin Block appliances
• Rapid Maxillary Expanders
• Partial braces
• One-arch braces
• Facemasks (reverse pull headgear)
• Space maintainers
• Fixed appliances
• Removable appliances

Phase 1 treatment is of limited duration. If treatment needs to extend beyond the expected timeframe due to poor cooperation (e.g. not wearing appliances as instructed) or biological factors beyond our control, additional fees may apply.

Importantly, Phase 1 treatment does not guarantee that Phase 2 (comprehensive) orthodontic treatment will not be required. In many cases Phase 2 is still needed to fully correct bite and alignment, especially if:

• Growth is unfavourable
• The malocclusion is severe
• Additional orthodontic problems develop later

ASO FORM information

Orthodontic Treatment

Orthodontic treatment promotes a healthy smile, healthier teeth and gums and a better bite for normal chewing. Orthodontic treatment depends for much of its success on the understanding and co-operation of the patient. This form covers the usual material risks associated with orthodontic treatment. Other factors may also be described by your orthodontist. You may ask your orthodontist to explain anything you do not understand. While recognising the benefits of healthy teeth and a pleasing smile, you should also be aware that orthodontic treatment has limitations and potential risks and there may be alternative treatment options. You should clarify what is expected of you as a patient, or as the parent of a young patient, to achieve excellent results. Keep in mind that with orthodontic treatment, like other healing arts, results cannot be guaranteed. The unknown factor in any orthodontic correction is the response of the patient to the orthodontic treatment. Should you have any questions, please ask.

Benefits

Orthodontics plays an important role in improving overall oral health and achieving balance and harmony between the face and teeth for a healthy smile, which may enhance one’s self esteem. Properly aligned teeth and a correct bite promote optimal chewing function and make brushing easier, potentially reducing risk of decay and gum disease. Correctly aligned teeth are less likely to experience abnormal wear. Because of the individual conditions present and the limitations of treatment imposed by nature, each specific benefit may not be attainable for every patient.

Risks

All forms of medical and dental treatment, including orthodontics, have some risks and limitations. Fortunately, in orthodontics complications are rare and are usually of a minor consequence if they do occur. Nevertheless, all risks should be considered when making the decision to undergo orthodontic treatment. The principal risks in orthodontic treatment are:

1. Oral Hygiene

Orthodontic appliances do not cause tooth decay. Gum disease, tooth decay and permanent markings (decalcification) on the teeth can occur if orthodontic patients eat sugary food and drinks or do not brush their teeth frequently or properly. These same problems can occur without orthodontic treatment, but the risk is greater to an individual wearing orthodontic appliances. It is imperative that extra care be taken with oral hygiene during orthodontic treatment.

2. Enamel or Restoration Damage

Minor tooth surface cracks (known as enamel crazing) or, in rare cases, enamel fractures may occur during orthodontics. Damage to the enamel of a tooth or to a restoration (crown, bonding, veneer, etc.) is possible when orthodontic appliances are removed. If the enamel is weaker, the depth of this damage can be deeper and may need restoration. This problem may be more likely when aesthetic (clear or tooth coloured) appliances have been selected. Healthy enamel is less likely to have damage. Your dentist can help if needed.

3. Speech

Speech can be affected for a short time after appliances are placed. This is more common when there is less room for the tongue. Speech may improve with practice.

4. Relapse

Teeth may tend to change their positions after treatment. The long term, faithful wearing of retainers should reduce this tendency. Teeth can, however, move any time, whether or not they have had orthodontic treatment. This is especially true during the late teen period when active growth of the facial bones is coming to an end. The most vulnerable teeth are those at the front. Throughout life the bite can change adversely from various causes such as eruption of wisdom teeth, growth or maturational changes, mouth breathing, playing of musical instruments and other oral habits. Very occasionally tooth movements will be severe enough to merit a further course of treatment to ensure a satisfactory result.

5. Periodontal Health

The health of the bone and gums which support the teeth may be affected by orthodontic tooth movement if periodontal disease already exists, and in some rare cases where periodontal disease does not appear to exist. Orthodontic treatment may lessen the risk of tooth loss or gum infection due to misalignment of the teeth or jaws. Inflammation of the gums and loss of supporting bone can occur if bacterial plaque is not removed daily with good oral hygiene.

6. Root Shortening

In some patients, the length of the roots of the teeth may be shortened during orthodontic treatment. It is nearly impossible to predict patient susceptibility to root shortening. Usually, this shortening does not have significant consequences, but on very rare occasions it may compromise the longevity of the teeth involved.

7. Jaw Joints

Occasionally patients may suffer pain or dysfunction in the jaw joints (TMJ). This may present as joint pain, headaches, or ear problems. These problems may occur with or without orthodontic treatment. Any of the above noted symptoms should be reported to the orthodontist. Some patients are susceptible to TMJ problems, and some are not. Numerous studies have shown that the movement of the teeth during orthodontic treatment is unrelated to the onset of TMJ problems. Just as for painful conditions in other joints, discomfort in TMJ can last from a few days to several weeks or longer.

8. Tooth Vitality

Sometimes a tooth may have been traumatised by a previous accident or a tooth may be decayed or have fillings which can cause damage to the nerve of the tooth. Orthodontic tooth movement may aggravate this condition and in rare instances may lead to loss of tooth vitality and discolouration of the tooth requiring root canal treatment and other dental treatment to restore the colour of the tooth.

9. Loose appliances and discomfort

The gums, cheeks or lips may be scratched or irritated by newly placed appliances or by loose or broken appliances or by trauma to the mouth. You will be given instructions on minimising these effects. Very rarely, loose orthodontic appliances may be accidentally swallowed or aspirated. You should inform your orthodontist of any unusual symptoms, or broken or loose appliances, as soon as they are noted. Usual post-adjustment tenderness or sensitivity of 24-48 hours should be expected, although this can vary with each patient and the procedure performed.

10. Atypical Growth

Insufficient excessive or asymmetrical changes in the growth of the jaws may limit the orthodontist’s ability to achieve the desired result. If growth becomes disproportionate during orthodontic management the treatment may be prolonged. Growth changes that occur after orthodontic treatment may alter the quality of treatment results and may require further orthodontic treatment. In some cases of atypical growth, the bite may change so much that oral surgery is required to achieve the best possible result.

11. Headgear

If improperly handled, headgear may cause facial injury. Patients are warned not to wear the appliance during times of boisterous or competitive activity.

12. Treatment Time

The duration of orthodontic treatment can vary depending on factors such as the complexity of the case and patient compliance. Total treatment time may exceed the estimate and delays are more likely with lost or broken appliances, missed appointments, poor cooperation, or unexpected complications.

13. Co-operation

Co-operation throughout treatment is your best guarantee of achieving a pleasing smile and a good bite. It is vital to follow your orthodontist's instructions on all aspects of treatment (i.e. wearing elastics, aligners and retainers for the prescribed amount of time). Without your co-operation, treatment may not be as successful. Your orthodontist may need to consider a change in treatment plan or, in rare situations, stop treatment or accept less than ideal results. Best results will occur when you work well with your orthodontist.

14. Complementary aesthetic dentistry

In some situations, achieving the desired aesthetic outcome may require additional dental procedures, such as cosmetic bonding, crowns, or periodontal therapy, to address specific issues not corrected by orthodontic treatment alone.

15. General Health

General medical problems can affect orthodontic treatment. You should keep your orthodontist informed of any changes to your medical health.

16. Specific Risks

Your orthodontist will discuss your case with you in detail and discuss specific risks.

Release of Patient Information

I authorise Ellenbrook Orthodontics to share relevant information about my/my child’s orthodontic care with other health professionals as appropriate.

Doctor’s Rights

I accept the right of Ellenbrook Orthodontics to discontinue treatment if responsibilities are not met (e.g. poor oral hygiene, repeated breakages, missed appointments, failure to wear appliances as instructed, unacceptable behaviour, or failure to pay accounts).

Privacy Policy

Our practice respects your privacy. Health information is collected and stored securely and used only for your treatment, accounts, and practice administration. Information may be shared with other health professionals if necessary for your care. Your identity will never be disclosed without consent.

You may request access to your records in writing. Access can be refused in limited circumstances (e.g. legal restrictions, unreasonable impact on another’s privacy).

Financial Policies

• Fees cover the expected duration of Phase 1 treatment.
• Additional fees may apply for lost or broken appliances, or if treatment extends significantly beyond the expected time.
• General dental treatment (fillings, extractions, cleans, etc.) is not included.
• Missed appointments may incur charges.
• Accounts must be paid as agreed; extended non-payment may result in discontinuation of treatment.

General Policies

• Regular attendance at orthodontic and dental appointments is required.
• Appliances must be brought to every appointment.
• We reserve the right to discontinue treatment if cooperation is poor.

Consent to Use of Photos for Social Media

Acknowledgement and Consent to Treatment