INFORMED CONSENT FOR PROFESSIONAL TEETH WHITENING TREATMENT
This information is provided to give you insight into professional teeth whitening. Your cooperation and understanding of this material is necessary as we strive to achieve the best result for you.
Professional tooth whitening is a procedure designed to lighten the colour of your teeth using a hydrogen peroxide mixture. It produces maximum whitening results in the shortest possible time with minimum sensitivity. During the procedure, the whitening gel will be applied to your teeth for three or 10-minute sessions. For the duration of the entire treatment, a plastic check retractor will be placed in your mouth to help keep it open and your gums covered with a barrier to ensure isolation from the hydrogen peroxide gel. Before and after the treatment, the shade of your teeth will be assessed and recorded.
All forms of health treatment, including tooth whitening, have some risks and limitations, Complications that can occur in professional tooth whitening are infrequent and are usually minor in nature.
- Tooth Sensitivity: During the whitening process some may experience tooth sensitivity. This is normal and generally mild if your teeth are not normally sensitive. If your teeth are normally sensitive, please inform us before treatment. Please let us know if you experience any discomfort during or after the procedure so we are able to minimise your discomfort. A mild analgesic will usually be effective in eliminating any discomfort.
- Gum and soft tissue irritation: Whitening may cause inflammation of your gums, lips or cheek margins. This is generally the result of the whitening gel coming into contact with these tissues. Protective materials are placed in the mouth to prevent this, but despite our best efforts, it can still rarely occur. If any irritation does occur, it is generally short in duration and is very milk. Rinsing with warm salty water can relieve it.
Significant whitening can be achieved in many cases, but there is no absolute way to predict how light your teeth will get. Please understand that teeth with multiple colourations, bands, splotches or spots due to tetracycline staining or fluorosis do not whiten as well and may appear more spotted after treatment. These effects are generally short in duration. Professional teeth whitening is not recommended for pregnant or lactating women, children under 16 years of age or any persons having known peroxides allergies.
I understand that my professional whitening treatment cannot be guaranteed.
I understand that after treatment, I will be required to refrain from consuming any chromogenic substances (i.e. tomato sauce, coffee, all tobacco products) for 48 hours.
In signing the consent form I am stating I have read this informed consent and I fully understand it and the possible risks, complications and benefits that can result from the professional teeth whitening system.