Consent Form
Richter Retainer Patient Agreement
Please review the requirements and guidelines before ordering the Richter Retainer
Retainer Wear
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Once given the Richter Retainer it is recommended to wear 24/7 for 3 months removing only to eat and brush. After the 3 month period nighttime wear is recommended indefinitely.
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If the retainers are not worn as suggested teeth will likely relapse, requiring additional treatment at an additional cost.
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Any fit or discomfort issues should be reported to your orthodontist immediately to prevent any potential relapse.
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The Richter Retainer is the final retainer. No additional retainers are required, such as an Essix retainer that covers the teeth. Please allow 9-12 months for the back teeth to settle in.
Follow up Richter Retainer Appointments
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A 3 month retainer check is recommended after the delivery of the Richter Retainer. This will allow the orthodontist to check the progress of settling of the posterior teeth.
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Please bring all retainers to future appointments.
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If you need to be seen sooner please call the office to schedule an appointment.
How to clean your retainers
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It is important to brush and floss your teeth twice a day to prevent stains and cavities. Staining of the retainer may occur due to poor oral hygiene.
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When you take your retainers out in the morning, make sure you rinse them with COLD water and brush them with a soft toothbrush and soap. Do this 1-2 times a day.
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Antibacterial and dish soap work best.
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Do not use toothpaste on your retainers. It will cause them to look foggy and wear down faster.
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To freshen and deep clean the retainer(s) you can purchase Retainer Brite from Amazon or a gentle retainer cleaner from the store. Use as directed from the directions on the box.
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You can do this up to 2-3 times a week.
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Denture cleaner is not recommended for cleaning the Richter Retainer as it can wear down the retainer and cause wear and tear.
Retainer DOs and DONTs
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DON’T eat or drink anything with your retainers in. WATER IS OKAY.
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DON’T boil, microwave, or soak your retainers in anything except what’s suggested for retainer products. This will permanently deform them and require replacements.
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DO keep your retainer away from dogs. DOGS LOVE TO CHEW THEM UP!
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DO keep your retainers in the case provided. Never wrap in a napkin, etc.
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DO remove them by starting in the back, don’t start in the front THAT’S HOW THEY CRACK.
Financial
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If your retainers get thrown away, lost, stepped on, your dog eats them, etc., it will cost $_____ PER ARCH to replace.
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If you notice wear and tear due to natural causes, please contact your orthodontic office to get your retainer evaluated.
Patient Consent
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I have read, understand, and agree to the instructions and policies stated above.
Print Name: ______________________________________
Sign Name: ______________________________________
Date: ___________/_____________/____________