the Zoom Lamp emits visible LED light and all materials used in the isolation process, when
properly used as directed, will block any exposures of soft tissues to this light.
it is recommended that those currently treated for a serious illness or disorder (e.g. immune
compromised, AIDS, etc) should consult a medical doctor before use.
Zoom treatment is not recommended for pregnant or lactating women.
I understand that the results of my Zoom Treatment cannot be guaranteed.
I understand that in-office whitening treatments are considered generally safe by most dental
professionals. I understand that although my dentist has been trained in the proper use of the Zoom
whitening system, the treatment is not without risk.
I understand that some of the potential complications of this treatment include, but are not limited to:
Tooth Sensitivity/Pain – During the first 24 hours after Zoom treatment, some patients can experience
some tooth sensitivity or pain. This is normal and is usually mild, but it can be worse in susceptible
individuals. Normally, tooth sensitivity or pain following a Zoom treatment subsides within 24 hours,
but in rare cases can persist for longer periods of time in susceptible individuals. People with existing
sensitivity, recession exposing root surfaces, exposed dentin, untreated caries, cracked teeth,
abfractions , oral tissue injury, open cavities, leaking fillings, or other dental conditions that cause
sensitivity or allow higher penetration of the gel into the tooth may find that those condition increase
or prolong tooth sensitivity or pain after Zoom treatment.
Gum/Lip/Cheek Inflammation/Burn – Improper isolation during the whitening procedure may cause or
result in (i) inflammation of your gums, lips or cheek margins due to exposure of a small area of those
tissues to the whitening gel or the LED light, or (ii) a chemical burn due to whitening gel coming in
contact with soft tissue. The inflammation or burn is usually temporary and will subside in a few days,
but may persist longer and may result in significant pain or discomfort, depending on the degree to
which the soft tissues were exposed to the gel or LED light.
Dry/Chapped Lips – The Zoom treatment involves three, 15-minute sessions during which the mouth is
kept open continuously for the entire treatment by a plastic retractor which covers the lips. This could
result in dryness or chapping of the lips or cheek margins, which can be treated by application of lip
balm, petroleum jelly or Vitamin E oil.
Cavities or Leaking Fillings – Most dental whitening is indicated for the outside of the teeth, except for
patients who have already undergone a root canal procedure. If any open cavities or fillings that are
leaking and allowing gel to penetrate the tooth are present, significant pain could result. I understand
that if my teeth have these conditions, I should have my cavities filled or my fillings redone before
undergoing the Zoom treatment.
Cervical Abrasion/Erosion – These are conditions which affect the roots of the teeth when the gums
recede and they are characterized by grooves, notches and/or depressions, that appear darker than the
rest of the teeth, where the teeth meet the gums. These areas appear darker because they lack the
enamel that covers the rest of the teeth. Even if these areas are not currently sensitive, they can allow
the whitening gel to penetrate the teeth, causing sensitivity. I understand that if cervical abrasion/
erosion exists on my teeth, these areas will be covered with dental dam prior to my Zoom treatment.
Relapse – After the Zoom treatment, it is natural for the teeth that underwent the Zoom treatment to
regress somewhat in their shading after treatment. This is natural and should be very gradual, but it can
be accelerated by exposing the teeth to various staining agents. Treatment usually involves wearing a
take-home tray or repeating the Zoom treatment. I understand that the results of the Zoom treatment
are not intended to be permanent and secondary, repeat or take-home treatments may be needed for
me to maintain the tooth shade I desire for my teeth.
The safety, efficacy, potential complications and risks of Zoom treatment can be explained to me by my
dentist and I understand that more information on this will be provided to me upon my request. Since it
is impossible to state every complication that may occur as a result of Zoom treatment, the list of
complications in this form is incomplete.
The basic procedures of Zoom treatment and the advantages and disadvantages, risks and known
possible complications of alternative treatments have been explained to me by my dentist and my
dentist has answered all my questions to my satisfaction.
By signing this document in the space provided I indicate that I have read this informed consent (or it
has been read to me), I fully understand the entire document and the possible risks, complications and
benefits that can result from the Zoom treatment, and that I give my permission for the Zoom treatment
to be performed on me.