Informed Consent for Whitening

Procedures: Teeth-whitening systems employ a hydrogen- or carbamide peroxide-based whitening gel. Whitening can be accomplished through an in-office process or a take-home process.

The whitener for the in-office process comes prepackaged as two individual components that are mixed at the time of application. The procedure usually takes between one to two hours from the start to finish depending on beginning tooth color. Each whitening session is broken down into individual applications of whitener, with the duration of each application being 15 minutes.

The take-home process involves taking impressions of your teeth, which we use to make custom whitening trays. You will return to our office to have the trays fitted and be given instructions on how to add the gel to the trays. Typical wear of the trays is for 2 weeks; what time per day is dependent on which product is chosen for you.

Variations in the Results: Treatment results may vary or regress depending on the patient and a variety of circumstances. The achievement of a certain shade is unpredictable and cannot be guaranteed. Whitening treatments are not intended to lighten artificial teeth, caps, crowns, veneers, or composites, and teeth with multiple coloration, bands, splotches, or spots may need multiple treatments or may not whiten at all.

Relapse: After treatment, it is natural for teeth to regress to a somewhat darker shade. This progression tends to be gradual but can be accelerated if teeth are exposed to various staining agents. The results are not permanent, and secondary, repeat, or take-home treatments may be needed to maintain the lightest tooth shade achieved after treatment. Refraining from consuming any dark-colored substances that could discolor your teeth for the first 48 hours after treatment is recommended. Some examples of dark substances are coffee, teas, colored sodas, all tobacco, mustard, ketchup, red wine, soy sauce, berries, and red sauces.

Risks: In-office and take-home whitening treatments are considered safe but are not without risks. The most common side effect is sensitivity, which will subside over time and can be managed with desensitizing toothpaste. Please discuss any specific concerns you may have with the dentist.

Consequences of Not Performing These Procedures: None.

Every reasonable effort will be made to ensure that your whitening is completed properly, although it is not possible to guarantee perfect results. By signing below, you acknowledge that you have received adequate information about the proposed procedures, that you understand this information, and that all of your questions have been fully answered. You also give permission for photographs or other information derived from your treatment to be used in clinical and economic research, practice marketing, and patient-education activities and materials, provided that your identity is not reasonably discernible.