Occlusal Guard Consent

A consent form for an occlusal guard. The patient confirms the dentist explained the pros and cons of the guard, that it may reduce the effects of grinding, and that it is prescribed as a short-term preventive option. It notes that continued grinding can lead to broken or lost teeth, and the patient agrees to wear the device as prescribed, accepting that not doing so can cause further damage.

Have the patient sign it when the guard is ordered or delivered. The dentist or assistant reviews the wear instructions at the same time, and the signed copy goes into the chart. The form also records that no guarantee was given about the outcome.