New Patient Success Agreement - Braces

 Below is a list of ideas and recommendations to aid you in the success of your orthodontic treatment. Good luck, I know you will be great!

 
 HOME CARE KIT: This is a complete kit full of lots of dental hygiene items. In it you will find instructions, a toothbrush, GUM soft picks, and wax to help you with your home care.
 BRUSH YOUR TEETH 3 TIMES A DAY: Brushing your teeth three (3) times a day or each time you eat is sure to keep your smile bright and healthy. Keep your toothbrush handy by putting the travel one from your kit in your purse, locker, backpack, suitcase. etc.
 PROXY BRUSH & GUM SOFT PICKS: Sometimes it’s hard to get all of the nooks and crannies clean when you wear braces. The Proxy Brush can help because it is able to clean those hard to reach places, and the GUM soft picks will simplify flossing as well.
 FOOD LIST: Did you know there are certain foods you should avoid when wearing braces? On the next page is a list of some of those items. Please post this list on your refrigerator and your braces will thank you!
 WAX: If you have a wire that is poking, scratching, or rubbing your cheeks or lips, put some wax on it. Simply soften the wax between your fingers and place it over the area that is bothering you. This will keep you comfortable until you get a chance to come into the office. Should you run out of the wax before you can come in to see us, major drug stores usually carry orthodontic wax and you can always ask us for more the next time you’re here.
 ACHINESS: There may be a dull, achy sensation after getting your braces on as well as after each adjustment appointment. You can take Motrin or Ibuprofen, or whatever you normally take for a headache or muscle aches to relieve this discomfort. Dr. Benton and Dr. Barry prefer Motrin or Ibuprofen.
 BREAKAGE: NOTIFY THE OFFICE! Accident happen; if you break a brace, band, or wire, please call the office immediately. We will schedule an appointment to repair your braces because we want to keep your treatment on track.
 EMERGENCY: If you experience extreme pain, swelling, or have an injury, please contact our office immediately!
 APPOINTMENTS: Dr. Benton and Dr. Barry will request appointments at specific intervals to keep your treatment progressing toward your bright new smile. It is important to keep each appointment. However, if you must cancel an appointment, please call our office ASAP and we will reschedule the appointment. Please note that excessive cancellations can prolong your orthodontic treatment, so make it a priority to keep all your appointments.
 BUSINESS CARD: Our business card if your lifeline to our office. Please keep in a safe place so you can easily find our phone number in case you have questions or an emergency.
 SPECIAL APPLIANCE INSTRUCTIONS
LIST SPECIAL APPLIANCE INSTRUCTIONS: PATIENT PROGRAMS
LIST PATIENT PROGRAMS:

Patient's Signature:​​​​
Assistant's: Signature:
Date: