Consent Form
Richter Retainer Patient Agreement

Please review the requirements and guidelines before ordering the Richter Retainer

Retainer Wear

  • 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.

  • If the retainers are not worn as suggested teeth will likely relapse, requiring additional treatment at an additional cost.

  • Any fit or discomfort issues should be reported to your orthodontist immediately to prevent any potential relapse.

  • 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

  • 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.

  • Please bring all retainers to future appointments.

  • If you need to be seen sooner please call the office to schedule an appointment.

How to clean your retainers

  • 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.

  • 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.

  • Antibacterial and dish soap work best.

  • Do not use toothpaste on your retainers. It will cause them to look foggy and wear down faster.

  • 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.

  • You can do this up to 2-3 times a week.

  • 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

  • DON’T eat or drink anything with your retainers in. WATER IS OKAY.

  • 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.

  • DO keep your retainer away from dogs. DOGS LOVE TO CHEW THEM UP!

  • DO keep your retainers in the case provided. Never wrap in a napkin, etc.

  • DO remove them by starting in the back, don’t start in the front THAT’S HOW THEY CRACK.

Financial

  • If your retainers get thrown away, lost, stepped on, your dog eats them, etc., it will cost $_____ PER ARCH to replace.

  • If you notice wear and tear due to natural causes, please contact your orthodontic office to get your retainer evaluated.

Patient Consent

  • I have read, understand, and agree to the instructions and policies stated above.

Print Name: ______________________________________

Sign Name: ______________________________________

Date: ___________/_____________/____________