Teeth Whitening Informed Consent Form
1. Teeth whitening is designed to lighten the color of your teeth. Significant whitening can be achieved in the vast majority of cases, but the results cannot be guaranteed. When done properly, the whitening will not harm your teeth or gums. However, like any other treatment, it has some inherent risks and limitations. These are rarely serious enough to discourage you from having your teeth whitened, but should be considered when deciding to have the treatment.
2. Candidates for Teeth Whitening:
Almost anyone is a candidate for teeth whitening. However, people with dark yellow or yellow brown teeth tend to whiten better than people with gray or bluish gray teeth. Multi-colored teeth, especially if due to tetracycline, do not whiten very well. Teeth with many fillings, cavities, chips, etc., are usually best treated by bonding, porcelain veneers or porcelain crowns. Any current restoration you have, such as, fillings, porcelain crowns, onlays and inlays cannot be whitened.
3. Office Whitening:
This process can usually be done in one visit. The appointment takes approximately 15-30 minutes. The advantage of in office whitening include our doing all the work for you and in less total time than you would spend whitening your teeth at home. The disadvantages include the normal inconveniences of any dental treatment, such as having to come to our office to have the procedure done and having to keep your mouth open for the duration of the appointment.
4. Home Whitening:
This process, which can be done anywhere and anytime, involves wearing a custom made whitening tray filled with a mild whitening agent for optimal results. Insert trays into the mouth. Remove any excess gel that leaks onto the gum line. Leave on mouth for 30 minutes. For the best results, we recommend to use up for 7 days and each time for 30 minutes. The advantages of home whitening include performing the treatment when it is convenient for you. The disadvantage of home whitening is that the success of the treatment is dependent on your commitment to wearing the whitening tray consistently for the prescribed period.
5. Your Responsibilities:
Wearing your whitening tray if you choose home whitening, it will only be effective if you conscientiously wear the tray for the prescribed time for one to three weeks.
If you experience any severe discomfort or other problems, discontinue the whitening and contact us immediately. Most sensitivity is usually transient and disappears after one to several days.
I have read the information provided and understand the whitening procedure. Dr. Tao and/or her staffs have explained this procedure to me, and all my questions, if any, were answered. I consent to this treatment.