1. The active ingredient in teeth whitening is carbemide 1. It is advisable to abstain from smoking during treatment peroxide in a glycerine base. If you know of any allergy and also to reduce staining foods such as tea, coffee, red or adverse reaction to either ingredients please do not 2. Brush your teeth before and after bleaching. Brush the 2. Bleaching can only be done in a healthy mouth. Fillings trays with your normal toothbrush and tooth paste. Apply and crowns do not bleach and may need to be replaced the gel as you have been shown; wipe away any excess that comes out with a tissue. Wear the trays for at least 2 hours/day. You may also wear the trays over night.
3. The amount of colour change is difficult to predict.
3. If sensitivity occurs contact the surgery immediately. We 4. Bleaching can usually be carried out on a patient with can give you special desensitizing agents and appropriate advice. Do not bleach your teeth if you are pregnant. There care needs to be taken and desensitising agents applied. have been no reports of adverse reactions, but long term Bleaching may cause sensitivity which can normally be controlled. Cases of permanent sensitivity are extremely rare.
4. Once treatment is completed keep the trays in a save place; they can be used for top up maintenance.
5. The bleach does not change the colour right next to the gum very much.
6. Some causes of discoloration are more difficult to bleach 1. We usually do at home bleaching as it is easier to for example tetracycline staining usually takes 6 months. control the colour change and any sensitivity.
Color stability varies; you may want a top up of one week at home bleaching once a year.
2. Impressions of the teeth are taken so that a laboratory can make up bleaching trays- these are a bit like a gum 7. As with any treatment there are benefits and risks. The shield in which the bleach is placed and worn by the benefit is that teeth can be whitened fairly quickly in a simple manner. The risk involves the continued use of the peroxide solution for an extended period of time such as a 3. A shade match for the teeth is taken so we can monitor few years. Research indicates that using peroxide to bleach any changes. The bleaching trays are worn in the evenings teeth is safe. There is new research indicating the safety for or over night by the patient. Treatment time varies usually use on the soft tissues (gingivae, cheek, tongue, and throat). takes from a few days to a few weeks and occasionally a The long- term effects are as yet unknown. Although the extent of the risk is unknown, acceptance of treatment means acceptance of risk.
t. 01702 544 275 f. 01702 546 568 e. help@oakdentalgroup.co.uk www.oakdentalgroup.co.uka. Oak Dental Group, 9 West Street, The Square, Rochford, SS5 1BE I have read the above information and agree to return for examination after the treatment begins and at any recommended time afterwards. I have read and received a copy of this information sheet. I consent to the treatment and accept the risks described above.
I consent to photographs being taken. I understand that they may be used for documentation and for illustration of my treatment.
t. 01702 544 275 f. 01702 546 568 e. help@oakdentalgroup.co.uk www.oakdentalgroup.co.uka. Oak Dental Group, 9 West Street, The Square, Rochford, SS5 1BE

Source: http://www.oakdentalgroup.co.uk/rochford/patient-area/downloads/consent-forms/1943-whitening-Consent%20Form.pdf

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