Patient Forms

Please fill out and return the following forms before your first appointment at our office!

Health History Form

New Patient Form

HIPAA & F,C,S Forms

Your First Visit

Drs. Ford and Derringer and our staff treat our patients like family and strive to get to know everyone individually from their very first appointment. We want you to feel relaxed and at ease to ask questions when you’re in our office. Here’s what you can expect at your consultation.

1
Review your new patient forms and medical history forms
2
Complete your initial exam with x-rays
3
Customize your treatment plan
4
Discuss financial plans, insurance coverage, and payment options
5
Get started on your orthodontic journey!
Financing & Insurance
Affordable Treatment for All

Financing

Please ask us about our financing options, including our in-house preventive care plan. We also recommend the CareCredit and Lending Club financing programs as financing options for your treatment.

Insurance

We are in-network with Dental Care Plus, Delta Premier, Anthem 300, Superior Dental Care, and Cigna. We will also accept all insurance and file for you.

Emergencies
What To Do In An Emergency
If any part of your orthodontia becomes loose or breaks, call our office to make an appointment to come see us. If the band or bracket is still attached to the archwire, leave it just as is and do not try to pull it off or connect any elastics to it. If it is causing any irritation, you can use orthodontic wax to cover it or move it back into place with a pencil eraser, Q-tip, or small pair of tweezers (never your fingers). If the bracket or band comes off completely, make sure you keep it and bring it with you to your next appointment.
Food Caught Between Teeth
This is not an emergency but can be a little uncomfortable for the braces wearing patient. It is easily fixed with a piece of dental floss. Try tying a small knot in the middle of the floss to help remove the food, or use an interproximal brush or toothpick to dislodge food caught between teeth and braces.
Discomfort
It’s normal for a patient to have discomfort for a day or two after braces or retainers are adjusted. But it can make eating uncomfortable. Be assured that the discomfort is both normal and temporary. Encourage soft foods.
Irritation of Lips or Cheeks
Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of non-medicinal relief wax makes an excellent buffer between metal and mouth. Simply pinch off a small piece and roll it into a ball the size of a small pea. Flatten the ball and place it completely over the area of the braces causing irritation. The patient may then eat more comfortably. If the wax is accidentally ingested, it’s not a problem. The wax is harmless. The patient should rinse with warm salt water to help heal mouth sores.
Loose Brackets, Wires or Bands
If the braces have come loose in any way, please notify us so we can determine the appropriate next steps. Brackets are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the center of each tooth. If the bracket is off-center, the brace may be loose. The bracket can become loose if the patient has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play. (Patients, especially those with braces, should wear a protective mouthguard while playing sports.) If the loose bracket has rotated on the wire and is sticking out and the patient cannot immediately come to the orthodontist, do a temporary fix to alleviate discomfort and prevent further damage, but take care to prevent swallowing or another injury. To put the bracket back in place, use sterile tweezers to slide the bracket along the wire until it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the center of the tooth.
Ligatures (Color or Metal Ties) Come Off
Tiny rubber bands or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber ligature should come off, you may be able to put it back in place using sterile tweezers. If a wire ligature comes loose, simply remove it with sterile tweezers. If the wire ligature is sticking out into the lip but is not loose, it may be bent back down with a Q-tip or pencil eraser to eliminate the irritation. Of course, when one ligature pops off or breaks, others may follow. Be sure to examine all ligatures. If you have a missing or broken ligature please notify our office so we can determine the appropriate steps. If a rubber or wire ligature is lost, notify the orthodontist so that they may advise whether the patient should be seen.
Mouth Sores
Some patients are susceptible to episodes of mouth sores. While braces do not cause them, they may be precipitated or exacerbated by an irritation from braces. One or several areas of ulceration of the cheeks, lips or tongue may appear. This is not an emergency, but may be very uncomfortable for the patient. Prompt relief may be achieved by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the ulcerated surface using a cotton swab. Instruct the patient to reapply as needed.
Protruding Wire
Occasionally, the end of a wire will work itself out of place and irritate the patient’s mouth. Use a Q-tip or pencil eraser to push the wire so that it is flat against the tooth. If the wire cannot be moved into a comfortable position, cover it with relief wax. (See Irritation of Lips or Cheeks above for instructions on applying relief wax.) Please make the orthodontist aware of the problem. In a situation where the wire is extremely bothersome and the patient will not be able to see the orthodontist anytime soon, you may, as a last resort, clip the wire. Reduce the possibility of the patient swallowing the snipped piece of wire by using folded tissue or gauze around the area. Use a pair of sharp clippers and snip off the protruding wire. Relief wax may still be necessary to provide comfort to the irritated area.
Piece of Appliance is Swallowed
This is rare, but when it does happen, it can be fairly alarming to the patient. Encourage your patient to remain calm. If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated. If you are able to see the piece, you may carefully attempt to remove it. But do not make the attempt if you could cause harm. If appropriate under the circumstances, examine the patient’s braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above. If you are unable to see the piece and believe it may be have been aspirated, notify our orthodontist immediately so that they can determine the next steps.
Mouth Sores
Some patients are susceptible to episodes of mouth sores. While braces do not cause them, they may be precipitated or exacerbated by an irritation from braces. One or several areas of ulceration of the cheeks, lips or tongue may appear. This is not an emergency, but may be very uncomfortable for the patient. Prompt relief may be achieved by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the ulcerated surface using a cotton swab. Instruct the patient to reapply as needed.
While actual emergencies are rare, if a traumatic event occurs contact any of our offices as soon as possible. In these situations, X-rays are often necessary to determine the extent of the injury or incident and to determine whether or not the orthodontic appliances have been damaged.
FAQ
Frequently Asked Questions
Do I need to see my family dentist while in braces?
Yes, please continue to visit your regular dentist every 6 months for cleanings and check-ups.
Do braces hurt?
Generally, braces do not “hurt.” After certain visits, teeth may be sore for a few days. In these situations, pain medications such as Advil or Tylenol will ease the discomfort. However, after most visits, patients do not feel any soreness at all! We often remind our patients, “It does not have to hurt to work!”
How long will it take to complete treatment?
Treatment time obviously depends on each patient’s individual orthodontic needs. In general, treatment times range from 12-30 months. The “average” time frame a person wears braces is approximately 18-22 months.
Is it too late to have braces if I am already an adult?
A surprising percentage of our patients are adults. In fact, 25 percent of all orthodontic patients are adults. Health, happiness and self-esteem are vitally important to adults. No patient is “too old” to wear braces!
I have crowns and missing teeth, can I wear braces?
Yes. A tooth with a crown will move just like a tooth with a simple filling. When teeth are missing, orthodontic treatment will aid in the alignment of the remaining teeth.