Patient information and declaration of consent

Despite all care taken on our part, dental and/or orthodontic treatments come with certain risks. Complications may arise that, in some circumstances, necessitate additional dental/medical and/or orthodontic treatment measures.

The following general information applies to all treatments offered by bestsmile:

• Daily oral hygiene needs to be practised regularly and thoroughly in accordance with the instructions from your bestsmile dentist. Without further instruction, regular dental hygiene usually includes brushing your teeth three times per day (morning, noon and night) and using other oral hygiene products such as floss and/or mouthwash.
• Patients must attend their treatment and check-up appointments and reschedule them as soon as possible if they can’t make it.
• Any instructions from your bestsmile dentist must be followed precisely and diligently.
• Please inform your bestsmile dentist about any medications you are taking, your general physical condition, any complications that arise and any other information that could be relevant to your treatment.

Information and risks for Aligner treatment

The following information and risks apply to treatments involving Aligners. Depending on how the patient’s individual treatment plan is set up, the following procedures may need to be performed: placement of attachments and/or other treatment aids (e.g. bite ramps, buttons, elastics) and/or space-creating measures such as stripping/slicing.

Aligner, Teens Aligner, Night Aligner, Finaliser, Retainer Splint or Retainer package

• The Aligners should be worn for at least 22 hours per day. For Night Aligners, the minimum wear time is 8 to 10 hours per night.
• Pressure is exerted on the teeth in order to change their position. This can often cause temporary pain or discomfort. In rare cases, it may be necessary to treat the pain or carry out other treatments.
• Wearing an Aligner can impair speech and enunciation. This is usually short-term but can, in some rare cases, occur over a longer period of time.
• Wearing an Aligner can increase saliva or lead to oral dryness. The use of certain medications may influence and/or intensify this effect, depending on the individual. Please inform your bestsmile dentist about the medications you are taking.
• Your actual treatment time may exceed what was estimated by your bestsmile dentist. The following factors in particular can lengthen your treatment time: not enough daily wear time (22 hours for normal Aligners and 8 to 10 hours per night for Night Aligners), not showing up for treatments and check-up appointments, not practising good oral hygiene and wearing damaged Aligners. Having unusually shaped teeth can also extend the required treatment time. For instance, short clinical crowns can cause problems with Aligner retention and slow down or prevent the movement of the teeth.
• Night Aligner treatment can be turned into regular Aligner treatment by your dentist at any time. Please inform your bestsmile dentist if you notice a lack of progress with your Night Aligner treatment.
• The simulated end result is a purely visual simulation. Achieving this result heavily depends on individual factors such as sticking to the required daily wear time, showing up to your treatment and check-up appointments and practising good oral hygiene as well as the position of your teeth and the spacing between them, among other factors.
• The following problems can occur if your oral hygiene is poor: cavities, periodontitis, decalcification (permanent marks on the teeth) and inflammation of the gums. In individual cases, there can be erosion of the tooth enamel, which involves a possible but unlikely loss of the tooth.
• Wearing an Aligner can, in some cases, cause injuries and rubbing on the inside of the mouth (gums, cheeks, tongue, lips). Please get in touch with your bestsmile practice or dentist if this is the case.
• To enable the teeth to shift and/or if you experience crowding (teeth that overlap each other in parts), it can be necessary to perform an interproximal enamel reduction so that there is sufficient space.
• Taking certain medications and/or your general physical condition can cause individual variations in the Aligner treatment. Please inform your bestsmile dentist about the medications you are taking and about your general physical condition.
• Allergic reactions* to the Aligner material are not known and are very unlikely to occur but cannot be ruled out.*
• During your Aligner treatment, especially at the beginning or when switching to a new tray, you may experience increased sensitivity in your teeth and mucous membranes.
• In isolated cases, particularly those involving severe pre-existing dental disease, wearing an Aligner can severely impair the condition of the patient’s teeth, including the death or loss of a tooth, which would necessitate further treatment to maintain the dentition.
• Wearing an Aligner can impair the quality of existing fillings, crowns and bridges. They may become loose and need to be re-cemented into place or, in isolated cases, replaced entirely. Please contact your bestsmile dentist before exchanging or re-affixing any fillings, crowns or bridges, as these changes can influence the fit of your Aligner.
• While root resorptions (degradation or loss of enamel around the root area) can occur in the natural untreated dentition, they are mostly a common side effect of orthodontic treatment. Sometimes, the body can repair root resorptions itself, but bigger defects can remain after treatment. Most root resorptions are so small that they are undetectable in panoramic X-ray images and are never noticeable or result in any damage. Only around 20% of patients show very small changes in their X-rays, and here, they rarely become clinically relevant. Tooth loss due to root resorption is reported very rarely in the literature. However, it is theoretically possible and, therefore, cannot be ruled out.
• Your Aligners may break. Aligners are more likely to break when several teeth are missing, and there is a tooth gap. If your Aligner breaks, please inform your bestsmile dentist immediately so that they can organise a replacement.
• Since Aligners are worn in the mouth, they can be fully or partially swallowed or inhaled. To reduce the risk of swallowing or inhaling your Aligner, be sure to have it checked regularly. Broken or otherwise damaged Aligners may not be worn. Please get in touch with your bestsmile practice or dentist if this is the case.
• In rare cases, wearing an Aligner can cause problems in the jaw joint that cause and/or worsen joint pain, headaches, ear problems, tinnitus or other symptoms. Inform your bestsmile dentist immediately if any symptoms of this kind arise.
• The usual risks of ionising radiation apply to X-rays of your oral cavity and surrounding structures (e.g. orthopantomogram or cephalometric X-ray).

Stripping/slicing

• The reduction of tooth enamel can lead to hypersensitivity of the teeth, increased predisposition to cavities and increased plaque formation, which can, in rare cases, necessitate further dental treatment.
• Narrowing of the interradicular space can cause increased susceptibility to periodontal diseases, which can, in rare cases, necessitate further dental treatment.

Attachments and other treatment aids (e.g. bite ramps, buttons, elastics)

Attachments and other treatment aids can lead to temporary misalignment when biting down.

• When removing a treatment aid that has been applied to the tooth (e.g. attachments or buttons), some healthy tooth enamel may also be removed in rare cases.
• Since attachments and other treatment aids are attached to the teeth/placed in the mouth, patients may accidentally swallow or inhale them, either fully or partially. Please get in touch with your bestsmile practice or dentist if this is the case.

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Information and risks for treatment with ceramic dental restorations

The following information and risks apply to ceramic dental restorations such as veneers, inlays, onlays and bridges as well as full and partial crowns (also hereinafter referred to as ‘ceramic(s)’).

• Treatment with ceramic requires the permanent removal of a thin layer of enamel, which is an irreversible procedure that can involve pain or discomfort (usually temporary). In rare cases, it may be necessary to treat the pain or carry out other treatments.
• The procedure for removing the thin layer of enamel and applying the final ceramic is usually performed under local anaesthesia (see information on local anaesthesia below).
• Your teeth can be especially sensitive to cold and heat while wearing temporary ceramics and in the first few weeks following the placement of the final ceramics. In rare cases, additional dental treatment such as endodontological interventions (e.g. root canal) may be necessary.
• Ceramic restorations can, in isolated cases, become detached or break, which would necessitate additional treatment such as dental procedures and/or the placement of new ceramics.
• Since ceramics are worn in the mouth, they can be fully or partially swallowed or inhaled. To reduce the risk of swallowing or inhaling, be sure to have the conditions of your ceramic components checked regularly. Broken or otherwise damaged restorations need to be inspected by a dentist immediately. Please get in touch with your bestsmile practice or dentist if this is the case.
• Wearing ceramics can impair speech and enunciation. This is usually short-term but can, in some rare cases, occur over a longer period of time.
• Wearing ceramics can, in some cases, cause injuries and rubbing on the inside of the mouth (gums, cheeks, tongue, lips). Please get in touch with your bestsmile practice or dentist if this is the case.
• The following problems can occur if your oral hygiene isn’t good enough, particularly in the area where the ceramic is attached: cavities, periodontitis, decalcification (permanent marks on the tooth) and inflammation of the gums. In individual cases, there can be erosion of the tooth enamel, which involves a possible but unlikely loss of the tooth.
• In isolated cases, particularly those involving severe pre-existing dental disease, having ceramics can severely impair the health of the patient’s teeth, which would necessitate further treatment to maintain the dentition.
• The usual risks of ionising radiation apply to X-rays of your oral cavity and surrounding structures (e.g. orthopantomogram or cephalometric X-ray).

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Information and risks for additional products and services

Whitening (bleaching)

• Having your teeth bleached (whitened) can make them temporarily (or, in rare cases, permanently) sensitive to warm, cold and sour food and beverages.
• For internal bleaching (inside of a hollow tooth), there is the risk that your tooth will fracture during the bleaching process. This means that the hollow, unstable tooth can break, and there is a risk of (root) resorption (degradation and/or dissolution of the tooth root or enamel), especially if the root canal filling is insufficiently sealed.
• Each round of bleaching makes the enamel slightly thinner and more porous. The roughened surface of the tooth makes it easier for bacteria and acids to attack enamel directly after a bleaching session.

Finishing

• Contouring and shaping can temporarily (or in some cases permanently) increase the sensitivity of the teeth as a result of removing some enamel, making additional treatment necessary.
• The material used is not as resistant as a tooth. When biting or chewing hard food, the material can break and/or naturally wear out.

Laser gum and frenulum correction

• Laser gum corrections are usually low-pain procedures. However, afterwards, you may experience temporary light pain that typically resolves itself, or that can be successfully treated with conventional pain medication. The necessity of additional dental/medical treatments cannot be entirely ruled out.
• The use of dental lasers can cause injuries to the mucous membranes, tongue, teeth (or any dental superstructures) and, more rarely, to bone tissue. In rare cases, these injuries can leave infected tissue behind or cause the tissue to die off, which would necessitate further medical treatment.
• The complications and risks for gum and frenulum correction with a laser are minimal. Your bestsmile dentist will thoroughly inform and advise you about the treatment.

Extractions

• Extractions are carried out using local anaesthesia (see information on local anaesthesia below).
• Since extractions take place in the mouth, the tooth in question can accidentally be fully or partially swallowed or inhaled.
• Bleeding may take place during and/or after the extraction. This is usually easy to treat, but complications can arise if the patient has a predisposition to blood clotting (blood clotting disorder) or if they have been taking anticoagulants.
• In rare cases, extractions can cause infections that impair healing and/or cause pain in the area that was treated. In these cases, treatment with antibiotics cannot be ruled out.
• In rare cases, the tooth may break during the extraction, making it necessary to perform an operation to remove the remaining tooth. In individual cases, non-irritating pieces of the root will be left intact if removing them could damage anatomical structures such as nerves.
• It may be necessary to open up the maxillary cavity since the roots of the teeth in the upper jaw are often separated from the maxillary cavity by only a thin bone.
• There is a risk of jaw breakage when removing certain teeth or implants that are unfavourably situated in the lower jaw, which would require further dental/medical treatment.

Local anaesthetic (e.g. for ceramic dental restorations and extractions)

• The needle or cannula tip can injure mucous membranes, the tongue and, in rare cases, bone tissue. Injuries of this kind are usually harmless and either heal on their own or can be treated easily. In rare cases, however, infection or death of the injured tissue may occur.
• The needle or cannula tip can injure blood vessels, causing bleeding and haematoma (internal bleeding in the tissue). Usually, injuries of this kind do not require any treatment and heal on their own. Haematoma and more severe bleeding that requires treatment primarily occur in patients who have blood clotting disorders or who take anticoagulants. Please inform your bestsmile dentist about the medications you are taking.
• Injecting local anaesthesia can, in very rare cases, cause nerve damage, for instance, in the lower jaw or tongue. In these cases, numbness to the tongue and lips or disruption to one’s sense of taste may occur, either for a longer period of time or, in rare cases, even permanently.
• Infections may occur at the injection site. Infections of this kind usually resolve on their own or can be easily treated with antibiotics. In cases of infection or haematoma, patients often experience difficulty opening their mouths, but this usually dissipates within a few days. In rare cases, this difficulty persists and sometimes requires additional dental/medical treatment.
• As is the case with every kind of injection, the possibility of bacteria entering the bloodstream and causing sepsis or organ inflammation (e.g. to the inner cardiac tissue) cannot be ruled out. Complications of this kind rarely happen for dental procedures but cannot be ruled out entirely.
• The injection of local anaesthetic can lead to circulatory reactions (e.g. blood pressure changes, heart palpitations, sweating), including short-term circulatory failure with temporary loss of consciousness.
• Allergies or hypersensitivities (e.g. to anaesthetic or other medications, disinfectant, latex) can cause intolerance reactions. Minor allergic reactions may manifest as temporary swelling, itching, sneezing, rashes, dizziness and/or vomiting, et cetera. Stronger allergic reactions can cause acute circulatory shock that would require hospitalisation. In extremely rare cases, severe and sometimes permanent damage can occur (e.g. organ failure, brain damage, paralysis).
• In very rare cases, the anaesthetic can accidentally enter the bloodstream and cause cramps, loss of consciousness and life-threatening disruption to the heart, circulatory system and lungs. Should this situation occur, emergency medical care would be required.

Important information about local anaesthetic

• Because of the residual effects of the anaesthetic, your reaction time and ability to drive can be impaired for a period of time, even if you don’t notice it yourself.
• As long as the local anaesthetic is active, patients may bite their cheeks or tongue while chewing. This is why you should not eat or consume hot beverages until the anaesthetic has completely worn off.
• Please notify your bestsmile dentist immediately if you experience severe pain, intense swelling, fever or persistent bleeding following your procedure.

Wire retainer

• Wire retainers can sometimes break. With a broken retainer, patients run the risk of injuring their oral cavity or swallowing or inhaling broken parts. Please get in touch with your bestsmile practice or dentist if this is the case.
• In rare cases, patients may experience sensitivity to the materials used in the retainer, necessitating its removal.
• The fixed wire retainer depends on individual factors (e.g. swallowing pattern, tooth position, space and material compatibility) and is not always possible, particularly in the upper jaw. Even with a fixed wire retainer, it may be necessary to additionally secure it via a splint, depending on the influence of the above-mentioned factors.

Night Guard

• The Night Guard can be damaged or broken due to nocturnal grinding. In rare cases, patients may experience sensitivity to the materials used in the Night Guard, making it necessary to stop using it.
• In rare cases, wearing the Night Guard can lead to problems in the jaw joint that cause and/or worsen joint pain, headaches, ear problems, tinnitus or other symptoms. Inform your bestsmile dentist immediately if any symptoms of this kind arise.

Other general risks of dental treatment

• Medical devices may be swallowed and inhaled (aspiration). In case of aspiration accompanied by symptoms such as gagging, difficulty breathing, or in case of swallowing sharp, pointed and long objects whose diameter exceeds 2.5 cm, immediately go to the nearest medical emergency unit.