Dental Consent Form
- This Dental Consent Form is to be read in conjunction with our terms and conditions and forms part of the contract between you and Diamond Whites Aligners Limited (we, us, our) in respect of our home orthodontics aligners services. The definitions in our terms and conditions are used here unless otherwise stated.
- We recommend you read the below carefully before your telephone appointment with a Registered Dentist. During your telephone appointment a Registered Dentist will talk you through the treatment, including the risks and you will be given an opportunity to ask any questions before giving consent to treatment. Please note that the treatment cannot go ahead until you have had the telephone appointment and then returned this Dental Consent Form.
About Invisible Aligners
- Invisible Aligners are an orthodontic treatment in which the patient wears a series of clear, removable aligners that gradually move the teeth to improve the aesthetic appearance of your smile.
[a] The aligners are clear, so people may not even notice you wearing them.
[b] There are no cuts or abrasions from wires or brackets, so clear aligners are more comfortable than traditional braces.
[c] The aligners are removable, allowing you to eat, drink, brush and floss with freedom.
- Although the benefits generally outweigh the potential risks, all factors should be considered before making the decision to wear aligners.
- We will appoint a Registered Dentist who will work with you to design a safe and effective orthodontic result. While recognising the benefits that patients can achieve using our invisible aligners you should also be aware that, as with all cosmetic treatment has limitations and risks.
- If you choose to undergo clear aligner therapy, we will manufacture aligners customised for your teeth based on the Registered Dentist's prescription.
- Your aligners will arrive labelled in number order as well as on the aligner. It is important that this order is followed, as failure to do so will affect the results.
- You are responsible for managing your care and wearing the aligners in accordance with their instructions.
- Whilst we will act as a provider of your clear aligners and monitor your movements, this is not an alternative to maintaining a regular check-up and treatment regime with your own local dentist and/or hygienist. It is your responsibility to maintain good oral hygiene throughout the course of the treatment being provided.
- Clear aligners may carry some of the potential risks described below:
- Treatment time may exceed estimates. Poor compliance to the recommended instructions, wearing aligners less than 22 hours per day for 1 week minimum, losing aligners, excessive bone growth, poor oral hygiene and broken aligners, can not only lengthen treatment time, but increase the cost, and affect the quality of the end results.
- Unusually shaped teeth can also extend treatment time and affect results. For instance, short clinical crowns can cause problems with aligner retention and slow or prevent teeth movement.
- If proper oral hygiene and preventative maintenance are not maintained, you may experience tooth decay, periodontal disease, permanent markings on the teeth, or inflammation of the gums may occur.
- Sores and irritation of the gums, cheeks, tongue and lips are possible but rarely occur due to wearing aligners.
- When you first start wearing your aligners, they may temporarily affect your speech. Most patients quickly adapt to wearing aligners.
- While wearing aligners it is completely normal to experience a temporary dryness of the mouth or increase in salivation. Certain medications can also cause this.
- Any medications you may be taking and your overall medical condition can affect your aligners journey.
- In cases of overcrowding, IPR (Interproximal reduction), may be required to create the space needed to allow your teeth to move. This is not part of your aligner treatment and if needed we would advise you if necessary and this would need to be done by your local dentist at an additional cost to you. It is a simple treatment that reduces the thickness of a tooth’s enamel.
- You experience tooth sensitivity and tenderness of the mouth during your treatment.
- Though extremely uncommon, allergic reactions to the material used during treatment could occur. If you believe you are experiencing an adverse reaction, please contact your Treatment Coordinator immediately.
- Jaw problems may not be solved by wearing aligners. There sole purpose is to align your teeth. If there is excessive crowding or severe, pre-existing jaw issues, oral surgery may be your option. This is not included in the aligner treatment. All risks of oral surgery, such as those associated with anaesthesia and proper healing, must be considered with your own local provider before treatment.
- Bone and gums, both of which support the teeth, can be aggravated by wearing aligners. Though rare, if this were to happen such teeth may require additional dental treatment such as endodontic treatment or other restorative treatment, the useful life of the teeth may be shortened, or the teeth may be lost completely. The cost of this will be your responsibility.
- We do not recommend you get aligners if you have baby teeth, implants, crowns, bridges or fillings. Existing dental restorations, such as crowns, veneers, bridges or fillings may be affected by wearing aligners. They may become dislodged and require re-cementation or in some instances, replacement. Before any dental restorations are replaced or added, consult your assigned Registered Dentist, as they can affect the way your aligners fit if your aligners have already been manufactured. If new aligners are needed this will be at an additional cost to you.
- If you have wisdom teeth problems you should consult your local dentist for treatment before proceeding and let your Treatment Coordinator know.
- Root resorption (shortening) can occur during any type of orthodontic treatment, including clear aligners. Shortened roots are of no disadvantage under healthy conditions. In rare cases, root resorption can result in loss of teeth.
- In cases of severe crowding or multiple missing teeth, it is more likely that the aligner may break. We do not recommend aligners for severe crowding. We will be able to assess this in our video consultations and receipt of your impressions.
- Although rare, customers could experience joint pain, discomfort, headaches or ear problems. Contact your Treatment Coordinator if this happens and they can direct you to our dental team.
- Accidental swallowing of the aligner may occur
- 3D Visuals provided are a simulation of what is possible & predicted. In some cases customers may achieve great results but slight differences to the plan
- A visual may show improvement in midline issues however this cannot be guaranteed and should not be the relied on.
- On some cases, a “black triangle” of missing gingival tissue may be visible below the interproximal contact when teeth are aligned after being overlapped for an extended period of time. This is due to the shape of your existing teeth and this is out of our control.
- Results may relapse if a retainer is not worn after the aligner treatment. You can purchase the Diamond Retainer from our site.
Failing to scan with the provided scan box will impact any smile guarantee.
If your teeth do not match your 3D Visual, subject to meeting the criteria we will provide further refinement aligners free of charge. Diamond Whites must be informed in under 30 days from date of the last scan. Failing this there will be a fee of £250.00.
If you have not been regularly scanning and following the Dentists instruction there will be a charge of £250.00.
Should Diamond Whites be informed about unhappy results over 90 days after last scan, a fee of £500.00 will be required.
If you purchase a retainer at the start of your treatment and require further refinements under our smile guarantee, you will receive a replacement retainer free of charge.
If a retainer is purchased during your treatment or at the end, we are not able to provide this free of charge and there will be a 50% charge on the retail price.
INFORMED CONSENT AND AGREEMENT
By purchasing Our Aligners you are acknowledging the following:
I have had a telephone appointment with a Registered Dentists to discuss the treatment and I have read and understand the information within this document, outlaying the considerations and risks of clear aligners. I have been informed and have been given the opportunity to discuss this form and its contents, and to have been given the opportunity to discuss any questions I may have.
I agree to follow the plan exactly as prescribed and as provided to me, and I understand that any questions, concerns or complaints I have regarding my treatment must be communicated to the assigned Registered Dentist or us as soon as they arise. I have been asked to make a choice about my treatment, and I hereby consent to order clear aligners manufactured as planned, and I will comply with the recommended wearing of the aligners and all instructions.
I acknowledge that none of Diamond White Teeth Whitening Limited, your employees, representatives, successors, assigns, or co-ordinators, have, can, or will make any promises or guarantees as to the success of my treatment or give any assurances of any kind concerning any particular result of my treatment.
I confirm that:
- I am aged 18 years and over.
- I reviewed and signed the Dental Declaration Form.
- I understand that Diamond Whites Aligners Limited cannot correct severe orthodontic conditions, the shape and thickness of my teeth or my bite. This is purely a cosmetic/aesthetic procedure.
- I understand that for the treatment to be successful, I have to wear the aligners for a minimum of 22 hours a day for a minimum of 7 days a week. Failure to do so will affect my results.
- All pictures that I am required to submit are mine and pictures will be shared with the Diamond Whites Aligners Limited dental team to create my treatment plan.
- Should I be unhappy with my results, I should inform Diamond Whites within 14 days of completion.
- I understand that the treatment time of 6 months is an average and that my treatment time can take less or more time than this.
- I can confirm that failure to upload weekly scans when requested via Dental Monitoring may result in my smile guarantee being void.
- I understand that it is advised that I purchase the Diamond Retainer after my aligners course has finished to maintain my smile.