Removal and Retainer Consent Form

I UNDERSTAND THAT I HAVE THE FOLLOWING RESPONSIBILITIES:
• Wear my removable retainers 22 hours a day (including sleeping) for the first two months followed by “night-time for a life-time” wear. [Phase I patients must wear retainers at night (10 hours/day) until instructed otherwise]
• Retainers may feel awkard at first and make speaking clearly a little difficult. You will learn to speak normally with your retainers after a few days.
• Remove your retainers when eating or brushing
• Place your retainers in the case when eating. NEVER put them in a napkin or a pocket.
• Remember that vacations and summer camps will change your normal routine - these are high risk times for losing or not wearing your retainers properly.
• Keep retainers away from pets - they love to chew on them.
• Do not wear your retainers during contact sports, instead wear a mouth guard.
• Do not attempt to remove "hands free" with tongue or cheek pressure as this can distort the retainers

CLEANING YOUR RETAINERS
• Brush visible debris from your retainers twice a day when you are brushing your teeth using liquid soap
• Never use hot or boiling water as it can warp or melt the retainers.
• Soak your retainers in RetainerBrite cleaner or a 1:1 mixture of white vinegar:water solution for 20 minutes.

LOST OR BROKEN RETAINERS
Your retainers are made using only the best possible material. If a retainer is lost or damaged, call our office immediately to schedule an appointment. There will be a laboratory charge per replacement retainer. Like eye glasses and other personal items, it is possible for retainers to wear over time. Replacing a worn-out retainer is a wise investment in retaining your smile and the long term stability of your teeth.

If further treatment is required due to unexpected growth or noncompliant retainer wear, additional charges will be applied.

PLEASE MAKE SURE TO BRING YOUR RETAINERS TO ALL YOUR FOLLOW UP VISITS!

I understand the above information. I have had an opportunity to ask any questions and I have had those questions adequately answered.