Full Artificial Dentures And/Or Partial Dentures

Consent For

FULL ARTIFICIAL DENTURES AND/OR PARTIAL DENTURES

REMOVABLE PROSTHETIC APPLIANCES (PARTIAL DENTURES and FULL ARTIFICIALDENTURES), like most medical/dental treatments, haverisks and possibilities of failure associated with treatment. Even though your dentist will take care in seeing that a satisfactory result is achieved, the patient must understand the risks and possible reasons for failure and the patient must accept these risks prior to moving forward with the process. Risks include [but are not limited to]:

I .Failure of full dentures: Dentures are false teeth designed to replace failed teeth. They are not as effective as healthy teeth. At best, dentures may be only 15% as effective at chewing as healthy teeth. They do not feel like normal teeth, and many patients never acclimate to wearing normal dentures. There are many variables which may contribute to thepossibility of failure, such as: (I) gum tissues which cannot bear the pressures placed upon them resulting in excessive tenderness and sore spots which may not resolve; (2) jaw ridges which may not provide adequate support and/or retention; (3) musculature in the tongue, floor of the mouth , cheeks, etc., which may not adapt to and be able to accommodate the artificial appliances; (4) excessive gagging reflexes; (5) excessive saliva or excessive dryness of mouth; (6) general psychological and/or physical problems may interferewith success; (6) Some patients cannot achieve a satisfactory esthetic result due to circumstances beyond the control of the dentist.

2.Failure of partial dentures: Many variables may contribute to unsuccessful partial dentures (removable bridges). The variables may include those problems related to failure of full dentures, in addition to: (I) natural teeth to which partial dentures are anchored (called abutment teeth) may become tender, sore, and/or mobile; (2) abutment teeth may decay or erode around the clasps or attachments; (3) tissues supporting the abutment teeth may fail. When these things occur, the necessary treatment to remedy the failure is the full responsibility of the patient.

3.Breakage or discoloration: Due to the types of materials which arc necessary in the construction of these appliances, breakage or discoloration may occur even though the materials used were not defective. Factors which may contribute to breakage are: (I) chewing on foods or objects which are excessively hard; (2) normal gum tissue shrinkage which causes excessive pressures to be exerted unevenly on the dentures; (3) cracks which may be unnoticeable and which occurred previously from causes such as those mentioned in (I) and (2); or the dentures having been dropped or damaged previously. The above may also cause extensive denture tooth wear or chipping. Repairs may be possible, but in some instances a full remake of the denture must occur at full cost to the patient.

4.Loose dentures: Full dentures normallybecome loosewhen there are changes in the supporting gum tissues. Gum tissues change regularly, and changes can be more extreme due to illness, weight gain/loss, medications, or during the first two years after tooth removal. Dentures themselves do not change unless subjected to extreme heat or dryness. When dentures become "loose", relining or remaking the dentures may be necessary. There is a feefor relining dentures and the fit is not subject to any warranty or guarantee. Partial dentures become loose forthe listed reasons in addition to clasps or other attachments loosening. Sometimes dentures feel loose for other reasons (Seeparagraph 1) and cannot be reasonably repaired or improved in any way.

5.Allergies to denture materials: Infrequently, the oral tissues may exhibit allergic symptoms to the materials used in construction of either partial dentures or full dentures over which we have no control. While this is not common, when this does occur it may prevent the use of dentures or require different treatments and materials.

6.Failure of supporting teeth and/or soft tissues. Natural teeth supporting partials may fail due to decay; excessive trauma; gum tissue or bony tissue problems. This may necessitate extraction or repair. The supporting soft tissues may fail due to many problems including poor dental or general health.

7.It is the patient's responsibility to seekattention when problems occur and do not improve in a reasonable amount of time; also, it is recommended that patients maintain a checkup schedule at 6 month or yearly intervals to allow your dentist to evaluate the dentures, condition of the gums, and the patient's oral health.

8.Metal Frame Partial Dentures: May require modification of tooth shape (via drilling) to allow for sufficient room for metal. This can, in rare circumstances, cause sensitivity. Metal clasps should be expected to be visible when smiling.

9.Cosmetics: While dentures often look very nice, there are limitations to the cosmetic results obtainable with dentures. Most premium quality (non-temporary) dentures include a tryin visit where the dentist allows the patient to view the dentures in wax prior to completion. It is the patients obligation to approve the look, color, bite, and other reasonable qualities at that time. Once the tryin has been agreed upon by the patient and the dentist, any changes to the final result will incur a full remake of the dentures at a full fee.

10.Nearly all dentures require adjustments due to sore spots, discomfort, bite acclimation, or other reasons. During the first three months you have your dentures, your dentist includes these visits as part of the treatment. A few patients require no adjustments, most patients require 2-3 adjustments, and a few patients may require extensive adjustments. This is a normal part of dentures. After three months, there will be a fee for subsequent adjustment visits.

11.All dentures are expected to require replacement in the future. There is no guarantee of the denture longevity. Like tires on a car, each person will get a different life expectancy out of their dentures.

INFORMED CONSENT: I have been given the opportunity to ask any questions regarding the nature and purpose of artificial dentures and have received answers to my satisfaction. I do voluntarily assume any and all possible problems and risks, including risk of substantial harm, if any, which may be associated with any phase of this treatment in hopes of obtaining the desired potential results, which may or may not be achieved. No guarantees or promises have been made to me concerning the results relating to my ability to utilize artificial dentures successfully nor to their longevity. The fee(s) for this service have been explained to me and are satisfactory. By signing this form, I freely give my consent to allow and authorize CarolinasDentist to render the dental treatment necessary or advisable to my dental condition(s) ,including administering and prescribing all anesthetics and/or medications.

Patient's name (please print)Signature of patient, legal guardian or authorized representative

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