Tooth Sensitivity Management After Whitening
Report and manage your tooth sensitivity following a whitening procedure. Your responses will help tailor advice and support.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Whitening Procedure
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How soon after whitening did you notice sensitivity?
*
Immediately after the procedure
Within a few hours
Next day
More than a day later
Rate the severity of your tooth sensitivity
*
1
2
3
4
5
6
7
8
9
10
Which of the following triggers your sensitivity? (Select all that apply)
*
Cold foods or drinks
Hot foods or drinks
Sweet foods
Sour foods
Brushing teeth
Breathing cold air
Other
How long does the sensitivity typically last?
*
A few minutes
A few hours
All day
Several days
Have you experienced tooth sensitivity before whitening?
*
Yes, frequently
Yes, occasionally
No, never
Current strategies you are using to manage sensitivity (select all that apply)
Using sensitivity toothpaste
Avoiding triggers
Taking pain relief medication
Using fluoride rinses
No management strategies
Other
How much does tooth sensitivity impact your daily life?
*
No impact
1
2
3
4
5
6
7
8
9
Severe impact
10
1 is No impact, 10 is Severe impact
Additional comments or questions
Submit
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