Home Whitening Consent

Important information and terms and conditions applicable to your home whitening procedure

1. Background

We provide this information to give you an insight into professional teeth whitening with the Opalescence home whitening system. The safety of the procedure is high, but as with all professional health care procedures, there are limitations and risks. Absolute success is variable and cannot be guaranteed.

2. Candidates for Professional Teeth Whitening

Your dentist determines the suitability of your teeth for treatment through consultation and examination. If your teeth are not suitable for whitening, they will discuss their findings with you along with other possible treatment options as appropriate. Your whitening program may be undertaken by another oral healthcare professional under the direction of your dentist.

3. Expectations Upon Completion of the Procedure

Significant whitening may be achieved in many cases, but there is no definitive way to predict how white your teeth will become. The level of whiteness varies greatly between individuals. If you have questions, ask your registered oral health care professional before starting the procedure.

4. The Bleaching Process

Home whitening systems use removable custom-made trays similar to soft mouth guards and a milder whitening agent then that used for “in surgery” whitening. It is important that you follow the instructions provided in your home whitening kit. Trays may be worn daily for a few hours or as instructed by your dentist. It is essential that you do not eat/drink or smoke whilst the trays are in place. Avoidance of food and drinks that stain your teeth during the whitening process is also important as they may stain your teeth. The use of tobacco products or vaping is discouraged.

5. Maintenance

Teeth naturally become darker with age and over time. Day to day staining due to eating, drinking, and/or smoking may cause a regression of the shade of your teeth following a whitening procedure. To help keep your teeth at their lightest, ask your registered oral healthcare professional about which home maintenance products and processes are suitable for you.

6. Potential Risks/Problems

All forms of health treatment have some associated risks and limitations. Complications in professional teeth whitening are generally infrequent and minor in nature. Please read the information below before signing this consent form.

6.1 Tooth sensitivity

During the whitening process, some patients may experience tooth sensitivity. If your teeth are normally sensitive, please inform your registered oral healthcare professional before treatment. They may offer advice on the use of additional products to manage sensitivity.

6.2 Gum and Soft Tissue Irritation

Temporary inflammation of the gums and other soft tissues can occur if the whitening gel comes in to contact with these tissues. Careful insertion of the trays and correct loading of the whitening agent/gel will reduce this. This process will be demonstrated to you. If the discomfort persists after 24 hours, please contact our dental practice on 02 67663975.

6.3 Tooth coloured fillings, composite veneers/bonding, porcelain crowns/veneers/implants

Tooth coloured fillings, composite veneers/bonding, porcelain crowns/veneers/implants etc. will not whiten along with your natural teeth. Dental restorations that show when you smile, may need to be replaced at extra cost if they become more noticeable. Discuss this with your dentist prior to starting the whitening process for advice about the treatment options available to you.

6.4 Enamel defects/discoloration

Enamel defects/discoloration may become more noticeable during the whitening process and require additional treatment at my own cost.

7. Your Treatment Responsibilities

Please take the time to carefully read all written instructions provided and listen carefully to the directions given at your appointment. If you do not understand anything or have questions, please ask your registered oral healthcare professional.

Authorisation and Release

The information I have provided is accurate and complete to the best of my knowledge. I certify that I have thoroughly read and understand the above and I have had all questions answered to my satisfaction. I hereby authorise my registered oral healthcare professional to perform the whitening procedure on me.