[口腔医学]全口义齿及活动义齿知情同意书 [复制链接]

INFORMED CONSENT FOR COMPLETE DENTURE PROSTHETICS AND/OR
REMOVABLE PARTIAL DENTURE PROSTHETICS
（全口义齿及活动义齿知情同意书）
     The purpose of this document is to inform you of what to expect during removable
prosthodontic treatment along with the benefits and potential risks or problems that may
be encountered before, during or after treatment.
     Please read this document carefully and make note of any questions you may wish to
discuss with us. You will be asked to sign a copy of this document before treatment
begins.
1. The purpose of a removable prosthesis is to replace missing teeth with dentures
that can be removed from the mouth. The 3 major categories of removable
prosthetics are:
a.) Removable complete dentures (supported by gum and bone tissue).
b.) Removable partial dentures (supported by gum and bone tissue as well as teeth).
c.) Overdentures (supported by gum and bone tissue as well as tooth roots or implants).
2. Removable prosthetics are generally chosen as a tooth replacement option over
implants over non-removable prosthetics for financial or anatomical limitations.
In other words, removable prosthetics are generally as a less than ideal option.
3. Removable- This is self explanatory, but it is important to know that your teeth
are removable and should be removed for cleaning and at night unless otherwise
recommended. This allows the gum and bone tissue to “breathe” and takes
pressure off of the bone, especially during sleep when most people put
extraordinary force on their teeth.
4. Chewing efficiency- It is well documented that with increasing tooth loss, there is
a corresponding decrease in chewing efficiency. This means that with your new
dentures, you may not be able to eat the foods you have been able to eat in the
past. With time, most people accommodate and are able to eat most foods,
however, corn-on-the-cob, lettuce and steak are examples of foods that may be
difficult to eat. As specialists, we are able to provide you with techniques and
materials that can maximize denture chewing efficiency. Chewing efficiency can
also be enhanced by utilizing dental implants.
5. Future bone loss- Long term studies show that when teeth are lost, the bone that
once supported those teeth will be lost. This bone loss will continue over time,
with a majority of the initial bone loss occurring within the first year of tooth loss
and a gradual continuation of bone loss throughout life. This is especially true in
the lower jaw where bone loss occurs 4 times as rapidly as the upper jaw. This
bone loss makes wearing dentures a problem that can get worse as years pass.
As specialists, we utilize impression making techniques that place denture
pressure in the areas of the mouth that are best suited to bear the stress load of a
denture and minimize bone loss. Placing dental implants will also minimize if not
eliminate this bone loss. Dental implants require an adequate quantity and quality
of bone for long term success and it is advantageous to place implants sooner
than later to avoid the need for bone grafting.
6. Thermal discrimination- Because the acrylic base portion of a removable
prosthesis may cover gum tissue that was not covered before, it is important to
know that you may not be able to feel hot and cold as you once could. Some
patients are disappointed that coffee, soup, ice cream and other items has lost its
appeal because they can no longer feel the temperature of these items.
7. Stereognosis- This refers to the ability to feel the shape of food and objects in
the mouth. Items such as ice cubes, hard candy, etc… have a recognizable size
and shape. Because dentures cover much of the gum tissue and their associated
mechano-receptors, the ability to recognize the shapes of objects in the mouth
will be diminished.
8 Proprioception- This refers to your ability to know where your teeth and jaws are
in 3 dimensional space. When teeth or implants are present, the neuromuscular
system is able to know when the teeth are about to hit each other. This is why
when you are about to bite into something overly hard or potentially damaging,
your brain tells your jaw to be careful and slow down or stop. When the teeth are
lost, so is the ligament that regulates this safety feature. Therefore, sometimes
while wearing dentures, the first sense you are about to bite into something hard
or hit your teeth is when you actually have already made contact. Placing
implants will regenerate a significant amount of the lost proprioceptive
mechanism.
9. Taste- Taste buds are located on the tongue which is not covered by removable
dentures. Contrary to popular belief, there are no taste buds on the palate.
However, acrylic resin and metal denture bases, can affect the taste of food,
especially if they are not properly cleaned.
10. Retention and Stability- Stability is the ability of a denture to remain stable during
function. Retention is the ability of a denture to resist dislodgement. The stability
and retention of a denture is dependant upon many factors including: quantity
and distribution of gum and bone tissue, the quantity and quality of saliva,
muscular coordination of the patient, the fit of the tissue surface of the denture as
well as the fit of the polished or outer surface of the denture. Many times, teeth
placed in violation of the lip or tongue will be dislodged because of the action of
the muscles. Training in muscle control and speaking may be necessary to reach
the full retentive and stability potential of your dentures. In addition, bone loss
will influence the fit of the denture. As discussed in #5 above, the continuation of
bone loss will make retention and stability more difficult with time and relines may
be necessary. Dental implants substantially increase retention and stability not
only primarily due to the physical retention of the denture, but secondarily
because of the benefit of minimal bone loss.
11. Speech- The tongue, palate and teeth are generally responsible for the
pronunciation of words. Removable dentures cover areas of the jaws and palate
that are not normally covered. At first, your tongue will not be used to the
additional bulk of acrylic or metal required for a strong prosthesis. Most patients
will adapt to the new prosthesis within 2 weeks. Some may require additional
time as well as working with a speech pathologist. Usually, simply reading or
singing out loud for several days is enough training to allow the mouth to
accommodate to the new teeth.
12. Appearance- Properly fitting dentures should look extremely natural. Tooth
position can be determined by a number of different phonetic (because tooth
position is responsible for ‘f’and ‘v’ sounds) and aesthetic guidelines. Your input
as the patient will be extremely important in the selection of color, shape, size
and position of the denture teeth. Contouring of the pink base portion of the
denture can also assist in creating natural lip and facial support. However, it is
important to know that when teeth and facial skeletal bone are lost, so is some of
the facial muscle tone. This may result in the “loosing my lip” syndrome. This
means that despite all of our best efforts, it may appear that your lip has turned
under.
13. Maintenance and follow-up- If you do not have any teeth and have complete
dentures, we would like to see you 1 time per year for an office visit. This will
allow a thorough evaluation of your hard and soft tissues as well as a complete
oral cancer screening. It allows for an evaluation of fit of your dentures and the
possibility of the need for a re-line. Your bite can also be evaluated and the
degree of wear on the denture teeth can be assessed.
14. Relines, Repairs, New teeth and New dentures- In time, you will lose bone under
your denture as discussed in #5 above. This will cause your denture to feel
loose. A reline is a procedure that can re-fit your existing denture by re-surfacing
the inside to fill in where bone has been lost. Relines are usually recommended
every 5 years and sooner if teeth were recently extracted.
From time to time, a denture tooth may chip or crack. If this happens, please call
our office and bring your denture in so that tooth in question may be repaired or
replaced. This may require an outside laboratory and therefore, you may be
without the denture for the day.
When cleaning your denture over a sink, please place a towel in the sink or fill the
sink bowl with water, as it is not uncommon to drop a denture in the sink and
fracture the teeth or the denture. Dogs and other pets enjoy all types of dental
appliances, so please keep them away from your dentures.
Denture will wear flat after a number of years and it may be necessary to replace
these teeth with new teeth. If your denture fits well, it may be as simple as
replacing the teeth with new denture teeth. This may require you to be without
the teeth for several days.
As no dental appliance will last forever, it may be necessary to make a new set of
dentures. It has been my experience that every 10-12 years is normal and a
good time to consider replacing dentures with new ones.
Dentures that are made properly can have a wonderful outcome. However, it is
important to realize that they are a prosthetic replacement of your own teeth. Much like
someone with a hip replacement or artificial leg, you will likely never be the same as you
were when you had your own teeth. For that reason, as a marathon runner would not
begin running right after a hip replacement, you should not expect to function at peak
level with your new dentures immediately. With time, you will adjust to your new
dentures and function adequately. However, implants are considered the best way to
function and feel as though you had your own teeth again.
DENTURE TRY-IN APPROVAL
A critical step in the denture process is the tooth try-in appointment. The goal of this
specific appointment is to gain your approval of a trial setup of the denture. The teeth
will be arranged in pink wax, however, the teeth themselves will be the actual teeth that
will be in the definitive denture. We will not proceed with processing the definitive
denture until you have given us your written approval to do so. Once the denture has
been processed, any changes will cost
In order to provide you with the most cosmetic denture possible, we request the
following:
1. 3 pictures from a magazine that represent the look you desire. Please cut them
out and bring them to your next appointment.
2. In addition, we would like you to bring a picture of yourself at a time in your life
that you liked your smile. This picture should show your teeth in a smiling pose.
This can be a formal portrait or a casual snap shot. We will scan this photograph
and place it in your record and return the original photograph to you. Please
bring this photograph to your next appointment.
3. We also request you bring a spouse, significant other or someone in your life that
you value their opinion. At times, patients have given their enthusiastic approval
only to have their spouse disappointed. If you decline this option, we will ask for
a signed refusal.
4. If necessary, 3 try-in visits are included in the complete denture service.
Additional try-in appointments may have additional fees.
I have been given the opportunity to read this document and ask questions.
I give my approval to allow Dr. Chasolen to process my denture. I approve of the color,
shape, size and arrangement of teeth. I have been given the opportunity to see a
photograph of my try-in. I understand that any changes made to the denture after
processing will carry additional charges. Re-processing fees may exceed $1000.
Patient:______________________________________ Date:_____________
(signed)