Printable Consent Form

COSMETIC DENTAL TREATMENT

Cosmetic dental treatment includes procedures such as porcelain veneers, composite bonding, contouring, and other treatments aimed at improving the appearance of your teeth and smile (color, shape, size, alignment, and overall aesthetics).

DESCRIPTION OF TREATMENT

Depending on the treatment, teeth may be prepared (enamel reduction for veneers), impressions or scans taken, and custom restorations fabricated. Treatment may involve one or multiple visits. Digital previews or mock-ups may be used to plan the result.

BENEFITS

• Improved tooth color, shape, size, alignment, and overall smile appearance
• Can correct chips, gaps, stains, short teeth, and mild crowding or rotation
• Durable, natural-looking results with proper care
• Boost in self-confidence and social/professional interactions

RISKS AND POSSIBLE COMPLICATIONS

• Irreversible removal of natural tooth enamel (especially with veneers)
• Tooth sensitivity (temporary or occasionally long-term)
• Chipping, cracking, or debonding of the cosmetic restoration
• Color mismatch or shade changes over time (coffee, tea, wine, tobacco, aging)
• Gum inflammation or recession around the restorations
• Need for replacement of restorations over time (typically 7-15+ years)
• Bite or TMJ discomfort if the new shapes alter the bite significantly
• Risk of future root canal treatment on prepared teeth
• Aesthetic limitations - perfect symmetry or "Hollywood" results are not always achievable

Cosmetic dentistry is both an art and a science. While we strive for excellent results, individual healing, tooth structure, and patient factors influence the final outcome. No specific aesthetic result is guaranteed.

ALTERNATIVES

• Orthodontic treatment (clear aligners or braces) for alignment issues
• Whitening only (for color improvement without changing shape)
• No treatment / acceptance of current appearance

PATIENT ACKNOWLEDGEMENT

• I understand that cosmetic procedures (especially veneers) are largely irreversible.
• I have been shown and approve the proposed appearance via photos, models, or digital preview (when applicable).
• I understand that final results depend on many factors and that minor adjustments may be needed.
• I agree to follow all care instructions and attend maintenance visits.

PATIENT / GUARDIAN ACKNOWLEDGEMENT AND CONSENT

I have read (or had read to me) and understand this consent form. I have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction. I understand the risks, benefits, and alternatives of the proposed treatment. I voluntarily consent to the treatment described above.