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Sacramento Natural Dentistry

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NTI Informed Consent

Kindly initial each item as you read and understand it. Please feel free to ask us if you have any questions.
* Wear the appliance(s) continuously (except when eating) for the first four weeks (if you have one for sleeping and one for waking). Sleeping use may continue indefinitely, while daytime use will eventually be tapered off to, at most, stressful occasions.
* Never wear an NTI appliance while eating. (Doing so may be painful and possibly damaging to the opposing teeth). Discontinue all gum chewing even when not wearing the NTI. Your dentist may also ask you to avoid chewing hard or rubbery foods for some time. Note: use your container when you take out your NTI and don’t wrap it in a napkin. Lost appliances have a replacement fee.
* Avoid sleeping on your stomach. Sleeping on your stomach forces your head to be turned to the side, which may allow significant muscle strain.

NTI use should temporarily be discontinued (and adjusted by your doctor):
* if it is uncomfortable, too tight or binding, too loose (can be removed with your tongue or lips), or damaged.
* if, when wearing the NTI, your back teeth or canine (eye) teeth can somehow touch each other in various jaw positions, or if you notice an obvious notch or "divot" where your opposing teeth contact the device.
* if you notice that your teeth are no longer coming together as they did prior to NTI use. This is an indication that your jaw is re-aligning. Although this is usually a good sign and occurs as symptoms have resolved (or are resolving), the improving alignment of the jaw may be undesirable without some type of modifications to the teeth. Otherwise, you may continue to have jaw pain, headache or damaged teeth.

I understand that:
* The NTI suppresses muscle dysfunctions and is not an orthodontic appliance which can move teeth. Daily chewing (without wearing the NTI) will maintain each tooth's original position. Those familiar with any type of removable custom mouthpiece realize that a mouthpiece may fit poorly if it has not been worn for an extended period. This is due to the constant slight adjustments teeth make to the forces around them.
* Pre-existing jaw joint noises may not necessarily be indicative of disease or damage, but may also be the body’s way of adapting to irritated muscles or injury. The NTI may allow the degree of "loudness" to decrease or resolve completely. Or sounds could increase. Your dentist will recommend diagnostic tests for specific jaw joint disorders.
* Complete resolution of your symptoms may not occur immediately. Sometimes these bad habits put up a fight (while you’re asleep and are unaware)! Typically, the jaw's range of motion improves. Symptoms may change over time and must be reported to your dentist. Sometimes we modify the device as the condition adapts and attempts to "defeat" the NTI.
* Reducing jaw muscle tension may allow the jaw joints to achieve their most natural, relaxed position (if they weren’t in that position to begin with) and allow the jaw to close in its best and most natural path, which may be different from what the patient originally started with. This is considered a “diagnostic event”, and while it is not a common occurrence, it presents as symptoms are relieved, demonstrating that your jaw-joints had not been in their ideal positions. There is no test to determine in advance if the jaw-joints are in their ideal positions.
* One example of an improvement in jaw relationship results in the farthest back molars contacting before the other teeth do, while the front incisors may not contact as well as they did before (or in rare cases, may not be able to touch each other at all). In this event, your dentist may recommend modifying your teeth to achieve the most efficient closure (or "bite"). This may be done by varying therapeutic combinations which may include re-shaping the teeth, adding to them by fillings or caps, moving them by orthodontics (braces), or surgery.
* Part of the historical "Standard of Care" in dentistry for jaw related conditions had been to provide a "full coverage" mouthpiece. These appliances cover all of the upper or lower teeth and are intended to deflect, absorb, or modify the forces generated by muscle clenching or tooth grinding. Unfortunately, these appliances can also allow for the intensity of bad habits to increase, by simply providing a more efficient surface to bite on. The NTI appliance is specifically designed to suppress muscle bad habits.
* Clean the appliance thoroughly with cool, not hot, water, and brush with regular toothpaste. Do not put it in the dishwasher or microwave! Once in a while you may have to soak it for a half hour in diluted white vinegar if crusty deposits are starting to develop. Soak, then brush. Note: the plastic portion of the NTI will often change color with time. This should not affect the function of the appliance.
* Keep the appliance away from pets. They love to chew on them too.
* I have read and discussed all the points raised in this advisory and have had all my questions answered to my satisfaction.

(Your digital signature (full name) is as legally binding as a physical signature.)