Informed Consent — Removable Prosthodontics

Risks and limitations:
I understand that dentures are not natural teeth and may not function like natural teeth. Becoming accustomed to wearing, functioning, and speaking with dentures takes time, effort, and commitment on behalf of the patient. 1 accept and understand that denture treatment results are subjective and as such the outcome of my treatment plan may not completely meet my expectations. I understand that the final opportunity to make changes to my new denture will be during the "wax try-in" visit.

Dentures may, at times, feel loose or become loose due to changes in the supporting structures of the jaw(s) and/or remaining teeth. I accept and understand that if gum tissue shrinkage occurs, the denture (partial or full) could become difficult to wear, and could require the aid of denture adhesive in order to fit more securely.

Many times immediate dentures cannot be tried-in prior to final fabrication which means that the appearance of the teeth cannot be evaluated until the time of insertion. 1 accept that in such instances a new denture may be required if the esthetics of the immediate denture are deemed not acceptable. The cost of this procedure is not included in the initial denture fee.

I accept and understand that dentures (full or partial) made within six (6) months of dental extractions may become loose due to the healing process, and may require relining at an additional cost.

  • Looseness of Dentures
  • Difficulty wearing denture
  • Food particles slipping under denture
  • Soreness of gum tissue
  • Shrinkage of gum and bones
  • Use of denture adhesive
  • Breakage or wear of denture
  • Need for reline, readjustment or replacement (additional cost)
  • Change in speech or appearance

By signing this form, I acknowledge that I have had an adequate opportunity to ask questions about this treatment plan and treatment options and the risks have explained to me.

Witness:
Date:
Signed: