complete denture consent form

 
 











Complete Dentures Informed Consent


Dentures are teeth substitutes and only have limited chewing efficiency (25%) compared to that of the real teeth.  Dentures are supported by areas of the mouth, which were not designed to carry the chewing loads applied by the dentures. If the gums and bone underneath are not given an 8-hour rest each day, they may resorb rapidly. This may require frequent relines or adjustments of your dentures. Like natural teeth, dentures must be kept clean; if not, they may develop a bad odor or ugly stains. Some individuals are unable to wear conventional dentures and may require the use of special soft liners or implants to supported their dentures. Your dentures will be made of inert acrylic polymers and uses a technique that involves several impressions and fitting sessions. You must agree to be involved in the selection of the shape, size, color and arrangement of the teeth. If you would like your teeth to look like some specific way, bring a photograph of a person who demonstrates this arrangement and color. It is your responsibility to express any concerns before the final dentures are processed. You will see your final denture teeth arranged in wax at the cosmetic try in appointment. If you value the opinion of someone else, bring this person to your cosmetic try in appointment. You must inform the dentist of any desired changes at this appointment.  We can not make major cosmetic changes to the processed dentures after the cosmetic try in appointment.  If you desire any changes after this appointment, you must agree to pay the full fee for new dentures. Once your dentures are processed and delivered, there will be several adjustments to refine the fit to your mouth. The denture fee includes these adjustments for a period of three months and/or up to five appointments. After the three-month period or five denture adjustment appointments, you will be charged for each additional denture related appointments. The doctors and staff at Scident Family Dental Clinic promise to do their best in making you a set of dentures that functions as expected. However, we can not guarantee perfection since “ beauty is in the eye of the beholder “. It is not always possible for a patient and a dentist to fully understand what each other are thinking.

I accept my responsibility, as the future owner of my dentures, to make my desires and opinions regarding my dentures absolutely clear so that my dentist has a good chance of being successful at making me happy. I have had all my questions answered regarding the denture construction procedure and it's potential complications. I understand this consent form and the Scident Family dental Clinic staff have answered all of my questions related to this procedure. I give permission to the dentist to make my dentures.


Patient ( or Guardian ) Signature:


Dental Staff Signature: