Several types of written information are given to patients. Below is an example of the information provided regarding disclosure of problems related to orthodontic treatment.
Information About Orthodontics Treatment
Regulations of the AUB Medical Center include that the parent or adult patient give informed consent. Informed consent indicates your awareness of the negative as well as the positive aspects of orthodontic treatment. In other words, informed consent includes your understanding of the diagnosis, nature and purpose of proposed treatments, risks and consequences, treatment alternatives, and possible prognosis if there is no treatment. Here are examples of these negative possibilities:
- Problems related to diet and oral hygiene:
- In the presence of poor hygiene, the enamel of some teeth can be affected by wearing orthodontic bands or bonded attachments, resulting in decalcification or scarring of the enamel. The signs of these effects include white or soft areas of the enamel, and at times cavities. These effects can be minimized by the careful brushing of braces and teeth as directed and the avoidance of sweet products, including candy, chocolate, taffy, caramel, and chewing gum- all of which can enhance enamel dissolution.
- Poor hygiene can also lead to accumulation of calculus, inflammation of the gums, and eventually to periodontal disease that jeopardizes the health of the gingiva and bone surrounding the tooth/teeth, and consequently the longevity of these teeth. The presence of braces on the teeth renders brushing and flossing more difficult. Proper brushing would require additional time. We recommend brushing after every meal, imperatively before bed, and the use of waterpick and mouthwash rinses after brushing.
- In infrequent instances, the patient presents at the onset or during treatment or at the conclusion of treatment some problems with the joint of the lower jaw. These problems include “clicking” or pain in the joint upon opening or closing of the jaws. These symptoms can also be present in individuals who are not undergoing orthodontic treatment, who may even have a good occlusion with completely well aligned teeth. There is no scientific evidence that problems of the so-called “temporo-mandibular joint”, known as “temporomandibular dysfunction”, are related to orthodontic treatment. Furthermore, there is increasingly more scientific evidence that the occlusion of teeth is not associated with the onset and maintenance of temporomandibular dysfunction.
- A small percentage of non-orthodontic patients show evidence of root resorption (decrease in size of root surface or root length, or changes in shape) of some teeth. The incidence of root resorption increases amongst patients undergoing orthodontic treatment. In the great majority of orthodontic patients the resorption does not jeopardize the health, function, longevity, or appearance of the affected tooth or teeth. In very few patients, root resorption of over one third the length of the root can occur. This rare decrease in root size can cause a dental problem requiring other dental procedures, and in extreme cases, can result in tooth loss. It must be remembered that this unusual decrease can occur in individuals who have never been treated by an orthodontist.
- On rare occasions, the nerve of a tooth can undergo regression and may become non-vital as a consequence of pressure of orthodontic appliances or trauma to the tooth such as blows, falls, or being hit by an object.
- Teeth shift during the lifetime of an individual regardless of orthodontic treatment. After removal of braces, changes in the position of teeth can occur. This irregularity tends to affect the front teeth more than others, particularly if, at the onset of treatment, these teeth are extremely crowded. The wear of a retainer is required to maintain the teeth at the position reached at the end of a successful orthodontic treatment. The patient must follow the instructions regarding time and manner of wear of retainers. It is not unusual to recommend partial wear of retainers throughout life.
Even though informed consent is a legal requirement of the AUB Medical Center we assure parents and adult patients that we endeavor to avoid all negative possibilities of orthodontic treatment.