Informed Consent Discussion For Denture(S) (Page 3 of 4) in pdf

I understand poor fitting dentures can cause constant irritation over a long period and may

contribute to the development of sores. Failure to wear my denture(s) over a long period of time

may affect the fit of the denture(s). My denture(s) may need to be relined or replaced. If my

denture(s) begin to feel loose or cause pronounced discomfort, I will contact my dentist.

_______

I understand a numb lip may occur from the pressure of the removable denture(s). This problem

requires selective adjustment and in rare cases, a nerve might need surgical repositioning.

I understand that the edge of the denture(s) usually rests on the gumline, which is in an area prone

to gum irritation, infection, or decay. Proper hygiene at home, a healthy diet, and regular

professional cleanings are some preventative measures essential to control these problems.

Consequences if no Treatment is Administered, Not Limited to the Following:

I understand that I can choose to do nothing and my present complaints will continue and may

worsen. Subsequent choices for dentition repair may become more difficult, expensive, or not

feasible.

I understand if I do not replace missing teeth, I risk compromised aesthetics and possible drift of

adjacent and/or opposing teeth into the space(s) with the resultant collapse of the arch integrity.

This could also create or exacerbate a temporomandibular problem.

Treatment Process:

I understand the following timeline represents an estimate of the treatment proposed by my

dentist

It is important that I keep appointments within close succession of the estimated timeline,

or I risk compromising the entire treatment plan.

Exam, shade, mold selection, and impression

Est. date completed: _______

Mouth preparation, surgical adjustment

Est. date completed: _______

Multiple impressions, custom trays

Est. date completed: _______

Try-in wax adjustment

Est. date completed: _______

Adjustment and delivery

Est. date completed: _______

Alternatives to Dentures, Not Limited to the Following:

_______

I understand that depending on the reason I am a candidate for dentures, alternatives may exist,

including the use of dental implants to support the denture. I have asked my dentist about them

and their respective expenses. My questions have been answered to my satisfaction regarding the

procedures and their risks, benefits, and costs.

Alternatives discussed:

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Informed Consent Discussion For Denture(S) Page 3