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Patient Acknowledgment of Receipt of Dental Materials Fact Sheet I acknowledge I have patient name received from a copy of the dentist or dental office name Dental Materials Fact Sheet dated October 2001. Patient Signature Date SAMPLE The following document is the Dental Board of California s Dental Materials Fact Sheet. Information on this fact sheet is intended to encourage discussion between the patient and dentist regarding the selection of dental materials best suited for the patient s dental needs. The Department of Consumer Affairs has no position with respect to the language of this Dental Material Fact Sheet and its linkage to the DCA web site does not constitute an endorsement of the content of this document The Dental Board of California Adopted by the Board on October 17 2001 As required by Chapter 801 Statutes of 1992 the Dental Board of California has prepared this fact sheet to summarize information on the most frequently used restorative dental materials. It is not inte....

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This guide provides a step-by-step approach to completing the Dental Materials Fact Sheet online. It is designed to assist users in accurately filling out the form while ensuring all critical components are addressed.

Follow the steps to complete the Dental Materials Fact Sheet.

  1. Click the ‘Get Form’ button to access the Dental Materials Fact Sheet and open it for editing.
  2. In the first field, enter the name of the patient who acknowledges receipt of the fact sheet. Ensure that the name is spelled correctly to avoid any discrepancies.
  3. In the second field, input the name of the dentist or the dental office providing the fact sheet. This details who the information is coming from.
  4. Locate the date field and enter the current date to indicate when the acknowledgment is being made.
  5. Ensure all entered information is accurate. Review the form to confirm that there are no omissions or errors.
  6. The patient should then sign the form in the designated signature area. This signature indicates that they acknowledge receipt of the Dental Materials Fact Sheet.
  7. After completing the form, you can save changes, download a copy for your records, print the form, or share it as needed.

Complete your Dental Materials Fact Sheet online today for efficient management of your dental documentation.

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Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, and materials called composite resin fillings.

What do l do with the DMFS? Senate Bill 134, signed by the governor in October, requires that beginning January 1, 2002, each dentist is provide a copy of the DMFS to any patient prior to commencing any dental restorative work. This requirement applies to new patients and patients of record.

Gold fillings last the longest, anywhere from 15 to 30 years. Silver amalgam fillings can last from 10 to 15 years before they need to be replaced. Composite resin fillings don't last as long. You may need to replace them every five to seven years.

Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, and materials called composite resin fillings.

Amalgam fillings are relatively inexpensive and resistant. However, due to their silver color, they are more noticeable than resin-based composite fillings and aren't usually used in visible areas, such as the front teeth. Amalgam fillings are strong. They can withstand the forces of chewing.

Composite fillings are an attractive option because they can be closely matched to the color of your teeth. However, composite fillings are more expensive than silver amalgam fillings and are not as durable. Ceramic fillings are made of porcelain and are a very aesthetically pleasing option that is also very durable.

While composite fillings are not as strong as amalgam ones, they are still quite strong and can last for many years. Many composite fillings last at least 5 years. There are many instances in which they can last up to 10 years or more.

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