New Patient Consent Form

    General Dentist

    Clinical Photographs

    Clinical photographs will be stored in your clinical notes and viewed by you, staff at Moira Wong Orthodontics for clinical/treatment planning purposes and a clinical referral recipient

    I have received an explanation of the reasons why Moira Wong Orthodontics wishes to take photographs of my face, mouth, and teeth. The photographs might be used for:

    Clinical purposes relating to my treatment and kept with my confidential dental records.
    For demonstrating clinical techniques at scientific lectures or in papers published in scientific journals.
    To send to me and, if permission granted, my referring dentist on completion of treatment as a record of my Orthodontic journey.

    I agree and consent to all the above selected clinical photographs being taken and used as described and stored in accordance with current data protection legislation. When used for any purpose not directly related to my care, the photographs will be made anonymous by obliterating the eye area of the photographs so that I cannot be personally identified when they are used in lectures or publications. If for whatever reason, the photograph cannot be modified to protect my identity, Moira Wong Orthodontics will contact me to explain the reasons and seek my consent for the use of the photographs. I understand that the photographs will not be used in these circumstances unless my consent is obtained.

    X-rays

    Following a clinical examination, the clinician may take X-rays to diagnose disease, check for unerupted teeth, and for orthodontic treatment planning. This is part of a comprehensive examination, but X-Rays will only be taken when there is a clinical need (justification) and comply with IRMER guidelines (2006). All X-rays will be reported on, and relevant clinical findings will be recorded in the notes. X-rays will be taken by either the clinician or her nurse, who has full training. We use equipment that has the lowest radiation output.

    Risks associated with use of X-rays

    X-rays are a form of electromagnetic radiation, just like light waves and radio waves. Because X-rays have higher energy than light waves, they can pass through the body. Just like other forms of high-energy radiation, X-rays have a very small risk of causing damage to cells in the body, which in turn can increase the risk of developing cancer. This increase in risk associated with each X-ray procedure is extremely low but does slowly increase with the increasing number of X-rays tests you have. This is the same principle as the way in which increased exposure to the sun increases skin cancer risk.

    Benefits of using X-rays

    The overriding concern of your dentist is to ensure that when radiation is used, the benefits from making the right diagnosis and consequently giving you the right treatment outweigh any small risk involved. Your clinician uses X-rays to look for decay that is not evident on clinical examination, to detect disease, and to check for missing/additional teeth and possible problems with unerupted teeth. The radiation dose is also kept as low as possible without detracting from the information the examination can provide. To put it in perspective, a large X-ray of all of your teeth and jaws (called an OPG/OPT) has an approximate equivalent dose to a flight to Spain.