NTI consent

From: Joel M. Eichen, D.D.S. (joeleichen_at_yahoo.com)
Date: 06/11/04 

Date: Fri, 11 Jun 2004 19:01:22 -0400

This is from a DentalTown dentist.

Any comments?

He offers this for your use

***

Dr. B. writes,

I've been re-working my information and consent forms for the NTI.
Any feedback is appreciated. If you like it, feel free to lift the
copy and use it for yourself...

Wear the appliance for one week, and then return for adjustment and
refinement (This follow-up appointment is very important). The
appliance is primarily worn while sleeping, however, daytime wear may
be required in extreme situations or during stressful times.

Never wear an NTI-TSS appliance while eating (doing so may be painful
and possibly traumatic to the opposing teeth).

Avoid sleeping on your stomach. Sleeping on your stomach forces your
head to be turned to the side, which may allow continued muscle
strain.

Discontinue all gum chewing.

During the first few days of treatment, the jaw joints and muscles may
feel different. Much like you feel “pins & needles” in your leg if
you’ve been sitting on it, the muscle and joint may feel different
when the tension is relieved. Make a note of any concerns and discuss
them during your one week follow-up appointment.

The NTI-TSS should be discontinued until adjusted by Dr. Blanchard if:

If it is uncomfortable, too tight or binding; if it is too loose (you
should not be able to remove the appliance with your lips or tongue);
or if the appliance is damaged.

If when wearing the NTI-TSS, your back teeth or canine teeth can
somehow touch each other in various jaw positions.

I, the patient understand that:

The NTI-TSS suppresses muscle dysfunctions and is not an appliance
that can move teeth. Daily chewing (without wearing the NTI-TSS) will
maintain each tooth’s original position. The appliance may not fit if
not worn for an extended period. This is due to the constant, casual
adaptation of the teeth.

The position of the jaw is influenced by the tension of the muscles.
As the NTI-TSS suppresses muscular tension, the position of the jaw
may change; without extra muscle tension, the jaw will find its most
relaxed, natural position. Some adjustment of the teeth may be
required to allow proper bite in this relaxed jaw position.

Joint noises, may or may not be resolved by treatment with the
NTI-TSS.

Complete resolution may not be immediate. The muscular disorder may
be aggressive in its attempt to maintain itself. Symptoms may change
and evolve as treatment progresses.

Treatment Plan and Fees

The fee for the migraine and tension treatment is $815. This includes
the initial fabrication of the appliance, and a follow up treatment
one week later. Insurance is very unpredictable for this service. It
has been our experience that most dental plans (80% coverage) will pay
about half of the total fee.

The NTI-TSS appliance may need repair and adjustment over time, as you
wear through the appliance, or as symptoms change. The typical
adjustment appointment after the first month of wear is $210.

This appliance will make a dramatic difference in the way you feel,
however, it is understandable if this treatment sounds too good to be
true (I was very skeptical myself when I first heard of it). If, for
whatever reason, you are not happy with the appliance I will buy it
back from you (up to eight weeks following the first appointment).

Date:____________________________

Signature of Patient (or
guardian)___________________________________________________

--------------------------------------------------------------------------
Kirk
Halifax, Canada

"A one that is not cold is scarcely a one at all"
Taken from the property of ones:
"The Oneitude is directly proportional to the colditude of the one"
 
 
Revisions :
 

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