Informed consent

Informed consent indicates your awareness of the positive as well as the possible negative aspects of orthodontic treatment. In the majority of cases, orthodontic treatment is an elective procedure. Treatment plan options may include extractions (removal of teeth), prosthodontic restoration, jaw surgery or even no treatment at all. Treatment of your teeth, like treatment of any other body part, has inherent risks and limitations. These risks are seldom serious enough to contraindicate treatment, but they should be considered in making the decision to undergo orthodontic treatment.

Perfection is always our goal: Dr. Maplethorp and Siu use their knowledge, training, skill and experience (an additional 2-3 years of graduate orthodontic specialty training beyond dental school are required before one can be called an orthodontist) to achieve excellent function that is also aesthetically pleasing. Orthodontic treatment usually proceeds as planned, and we do everything possible to achieve the best results for every patient. However, we cannot guarantee that you will be completely satisfied with your results, nor can all complications or consequences be anticipated. The success of treatment depends on the patient’s growth pattern, genetics, and co-operation in keeping appointments, maintaining good oral hygiene, avoiding loose or broken appliances and following the orthodontist’s instructions carefully.

Length of Treatment: The length of treatment depends on a number of factors including the severity of the malocclusion, the patient’s growth and the degree of patient cooperation. The actual treatment time is usually close to the estimated treatment time, but treatment may be lengthened in cases where there is unanticipated growth, unresolved habits affecting the dentofacial structures (such as a tongue thrust), periodontal or other dental problems, or if patient cooperation is not adequate. Changes in the original treatment plan may become necessary. If treatment takes longer than the original time estimate (particularly due to non compliance), additional fees may be assessed.

Patient Cooperation: Poor cooperation, poor oral hygiene, broken appliances and missed appointments will prolong treatment time, negatively affect the quality of the result and put the patient at higher risk for root resorption, cavities, gum disease and other problems. In some cases, it may be necessary to terminate treatment prior to completion to prevent further negative side effects.

General Health Problems: General health problems such as bone, blood or endocrine disorders and many prescription (including bisphosphonates) and non-prescription drugs can affect your orthodontic treatment. It is imperative that you inform us of medications you are on and any changes in your general health status.

Use of Tobacco Products: Smoking or chewing tobacco has been shown to increase the risk of gum disease and interferes with healing after oral surgery. Tobacco users are also more prone to oral cancer, gum recession, and delayed tooth movement during orthodontic treatment. If you use tobacco, you must carefully consider the possibility of a compromised orthodontic result.

Oral Health/Oral Hygiene: All dental work must be completed prior to starting orthodontic treatment. While undergoing orthodontic treatment, excellent (not just good) oral hygiene is essential!!! Poor brushing and flossing while undergoing orthodontic treatment may result in cavities, demineralization of the enamel (decalcification or “white spots”), discoloured teeth and gum disease. It is important to brush the teeth and gums after each meal, floss at least once a day and minimize sugar consumption during treatment. In addition to avoid enamel erosion, consumption of acidic drinks should also be minimized. Orthodontic visits are not a substitute for regular dental cleanings and check-ups. Routine visits to your dentist for cleanings and topical fluoride treatments are recommended every six months at a minimum while in treatment.

Periodontal Disease: Periodontal (gum and bone) disease can develop or worsen during orthodontic treatment as a result of many factors, however it is most commonly caused by lack of adequate oral hygiene. You must have your general dentist, or if indicated, a periodontist, monitor your periodontal health during orthodontic treatment every three to six months. In some cases, due to lack of adequate tissue thickness the tissue will recede. Should recession occur, the need for selected periodontal procedures such as gum grafting may arise. Grafting may be recommended at the beginning, during or after orthodontic treatment. Although rare, should periodontal disease become uncontrollable, orthodontic treatment may be ended prematurely.

Discomfort: The mouth is very sensitive so you can expect an adjustment period and initial discomfort. Non-prescription pain medication such as Advil or Tylenol can be used if necessary. Cold sores, canker sores, and irritations or injury to the mouth are possible while wearing braces. Loose or broken wires and bands can scratch or irritate your cheeks, gums, or lips. We will give you soft wax or braces covers to cover problem areas until the tissue heals.

Allergic Reactions: Allergic reactions to dental materials or medications are rare, but should they occur, this may require a change in treatment plan, ending treatment prematurely or rarely medical management.

Disproportionate Growth and Habits: Growth patterns causing insufficient or undesirable growth can affect our ability to achieve and/or maintain the desired results. Disproportionate or asymmetric growth can cause facial changes and the need for additional treatment, including jaw surgery. Uncorrected habits such as finger or thumb sucking, tongue thrusting or similar pressure habits will also negatively influence treatment time and the final result.

Root Resorption: In some cases, during orthodontic treatment the ends of the roots may blunt or become shorter (called root resorption). Although there are some known predictive factors, the exact cause of root resorption in unclear. .Under healthy circumstances, the shortened roots do not cause a problem for the patient. However, in severe cases and where gum disease occurs (even later in life), root resorption could reduce the longevity of the affected teeth. If resorption is detected during orthodontic treatment, we may recommend a pause in treatment or, in more severe cases, ending treatment prematurely.

Temporomandibular Disorder (TMD): Problems may occur in the jaw joints area, (the temporomandibular joints (TMJ)), causing pain, headaches and/or ear problems. Many factors can affect the health of the jaw joints, including past trauma (blows to the head or face), degenerative changes (such as arthritis), hereditary tendency to jaw joint problems, excessive tooth grinding or clenching, poorly balanced bite, and many medical conditions. Jaw joint problems may occur with or without orthodontic treatment. Any signs of jaw joint dysfunction, including pain, jaw popping or difficulty opening or closing, should be promptly reported to our office or your dental office. Treatment by other medical or dental specialists may be necessary.

Extractions: Some cases will require the removal of deciduous (baby) teeth or permanent teeth. There are additional risks associated with the removal of teeth which you should discuss with your family dentist or oral surgeon prior to the procedure.

Headgear: If headgear is recommended, instructions must be followed carefully. Always release the elastic forces before removing the headgear. To prevent accidents or injury, headgear should not be worn during sports or rough play and should not be hung around the neck. In the event of injury, especially an eye injury, however minor, immediate medical help should be sought.

Temporary Anchorage Devices (TADs): Your treatment may include the use of a temporary anchorage device(s) (i.e. metal screw or plate attached to the bone). It is possible that a screw(s) could become loose requiring its removal and possible relocation or replacement with a larger screw. If the TAD cannot be stabilized an alternate treatment plan may be necessary. The tissues around the TAD can become inflamed, infected, or grow over the TAD, especially with poor oral hygiene, which could require removal of the TAD, surgical excision of the tissue and/or the use of antibiotics or antimicrobial rinses. Although rare, a TAD could break upon insertion, removal or during use. If this occurs, the broken piece may be left in your mouth or surgically removed. Although rare, it is possible to damage the root of a tooth, a nerve, or to perforate the maxillary sinus during TAD placement. Usually these problems are not significant; however, additional dental or medical treatment may be necessary. Local anaesthetic may be used when these devices are inserted or removed.  It is important to advise the doctor if you have had any past difficulties with dental anaesthetics. If any of the above mentioned complications occur, a referral to your family dentist or another dental or a medical specialist may be necessary. Fees for these external services are not included in the cost for orthodontic treatment.

Orthognathic Surgery: Some patients have significant skeletal disharmonies which require orthodontic treatment in conjunction with orthognathic (dentofacial) surgery. There are additional risks associated with this surgery which you should discuss with your surgeon prior to beginning orthodontic treatment. Please be aware that orthodontic treatment prior to orthognathic surgery often only aligns the teeth within the individual dental arches. Therefore, patients discontinuing orthodontic treatment without completing the planned surgical procedures may have a bite that is worse than before they began treatment!

Mouth Guards: Patients should wear a mouth guard for any sporting activities where it is possible to sustain injury to the mouth or teeth.

Unusual Occurrences: Activities or foods which could damage, loosen or dislodge orthodontic appliances need to be avoided. Loosened or damaged orthodontic appliances (including lower retainers) can be inhaled, swallowed or could cause other damage to the patient. You should inform us of any unusual symptoms or of any loose or broken appliances as soon as they are noticed. Damage to the enamel of a tooth or to a restoration (crown, bonding, veneer, etc.) is possible when orthodontic appliances are removed. This problem may be more likely when aesthetic (clear or tooth coloured) appliances have been selected. If damage to a tooth or restoration occurs, repair of the involved tooth/teeth by your dentist may be necessary. Independent from orthodontic treatment, an abscess or dental cyst while rare, may occur during treatment, especially when there is a history of dental trauma or a deep filling where the nerve of the tooth may have been damaged. In some cases, root canal treatment may be necessary. In severe cases, the tooth or teeth may be lost.

Impacted, Ankylosed, Unerupted Teeth: Teeth may become impacted (trapped below the bone or gums), ankylosed (fused to the bone) or just fail to grow in. Oftentimes, these conditions occur for no apparent reason and generally cannot be anticipated. Treatment of these conditions depends on the particular circumstance and the overall importance of the involved tooth, and may require extraction, surgical exposure, surgical transplantation or prosthetic replacement.

Reshaping of Teeth: You can expect minimal imperfections in the way your teeth meet following the end of treatment. An occlusal equilibration procedure may be necessary, which is a method used to fine-tune the occlusion. It may also be necessary to remove a small amount of enamel in between the teeth, thereby “flattening” surfaces in order to reduce the possibility of relapse, improve the bite or improve the appearance of the teeth.

Non-Ideal Results: Non- ideal results may occur with inadequate cooperation with headgear wear and elastics wear. In addition, the wide variation in the size and shape of the teeth, missing teeth, etc., may mean that achievement of an ideal result (for example, complete closure of a space) may not be possible. Restorative dental treatment, such as aesthetic bonding, crowns or bridges or periodontal therapy, may be indicated. You are encouraged to ask us and family dentist about adjunctive care.

Relapse (Post-Treatment Movement): Completed orthodontic treatment does not guarantee perfectly straight teeth for the rest of your life. Retainers will be required. Rotations and crowding of the lower front teeth is the most common area for relapse. Recurrent space in extraction sites or space reopening between the top front teeth is also possible. For this reason, it is important for you to carefully follow instructions regarding retainer wear.