Dentures/Partial Dentures Consent Form

I UNDERSTAND THAT REMOVABLE PROSTHETIC APPLIANCES (PARTIAL DENTURES and FULL ARTIFICIAL DENTURES) include risks and possible failures associated with  such dental treatment. I agree to assume those risks and possible failures associated with, but not limited to, the following: (even though the utmost care and diligence is  exercised in preparation for, and fabrication of, prosthetic appliances, there is the  possibility of failure with patients not adapting to them):

1. Failure of full dentures: there are many variables which may contribute to this  possibility, such as: (1) gum tissues which cannot bear the pressures placed upon them  resulting in excessive tenderness and sore spots; (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 interfering with success.

2. Failure of partial dentures: Many variables may contribute to unsuccessful utilizing of  partial dentures (removable bridges). The variables may include those problems related  to failure of full dentures, in addition to: (1) 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. 

3. Breakage: Due to the types of materials which are necessary in the construction of  these appliances, breakage may occur even though the materials used were not  defective. Factors which may contribute to breakage are: (1) chewing on foods or  objects which are excessively hard; (2) 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 (1)  and (2); or the dentures having being dropped or damaged previously. The above may  also cause extensive denture tooth wear or chipping. 

4. Loose Dentures: Full dentures normally become looser when there are changes in the  supporting gum tissues. Dentures themselves do not change unless subjected to  extreme heat or dryness. When dentures become “loose”, relining the dentures may be  necessary. Normally, it is necessary to charge for relining dentures. Partial dentures  become loose for the listed reasons in addition to clasps or other attachments loosening.  Sometimes dentures feel loose for other reasons (see paragraph 1). 

5. Allergies to dental materials: Very infrequently, the oral tissues may exhibit allergic  symptoms to the materials used in the construction of either partial dentures or full  dentures, over which we have no control.

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

7. It is the patient’s responsibility to seek attention when problems occur and do not  lessen in a reasonable amount of time; also, to be examined regularly to evaluate  the dentures, condition of the gums, and the patient’s oral health.

INFORMED CONSENT: I have been given the opportunity to ask any questions  regarding the nature and purpose of artificial dentures have been given alternative  treatment options including dental implants 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 authorize my Dentist to render the dental treatment  necessary or advisable to my dental condition(s), including administering and prescribing  all anesthetics and/or medications, making of photographs and radiographs, and any  treatment deemed needed.



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