Tooth whitening forms
These four documents have been provided courtesy of
Dr Linda Greenwal BDS MGDS MSC MRD RCS FFGDP for the use of CODE members
Patient Information on Home Whitening Treatment
Your dentist has given you a whitening kit to take home with you together with your whitening
trays. It is essential that you fol ow the instructions given by your dentist and the manufacturers’ instructions in wearing the trays and applying the whitening agent.
How long should I wear the trays for?
This depends on the amount of lightening that you desire and the original shade of the teeth. If your teeth are quite dark or very yel ow/ grey/ tetracycline stained it wil take longer to bleach the teeth.
If you are not experiencing any sensitivity you may wear the trays for at least 1 – 2 hours and even sleep with the trays in your mouth. It is very important to remove al the excess material around the
gums or the palate prior to sleeping with the trays. The darker your teeth, the longer they wil take to get lighter. Tetracycline stained teeth can take from 6 months to one year to reach the desired colour. Some teeth can whiten after one month.
If you cannot wear the trays for a few days because of your hectic schedule, it does not matter. Whiten your teeth according to your own schedule. Some people put the trays in after dinner and
wear them for the first hour while watching TV or doing the dishes. Then if everything is fine they replenish the trays and sleep with them in the mouth.
What do I do if I have any sensitivity?
Sensitivity of teeth is the most common side ef ect of home whitening. In fact many patients suf er from sensitive teeth anyway. This occurs usual y around the necks of the teeth where the gums have
receded. If you are experiencing any sensitivity you should stop whitening your teeth for 3-4 days. If the teeth become ultra sensitive you can place a sensitive toothpaste into the whitening trays for an
hour a day. Alternatively you can rub the sensitising toothpaste into the gum margins with your finger 5 times per day for a few days. If you are at al concerned, please cal your dentist.
What happens if the teeth do not whiten evenly?
If the teeth have white spots on them before whitening, these spots wil appear whiter during the
first few days, however the contrast between the spots and the rest of the tooth wil be less and eventual y they wil not be noticeable. Sometimes the dentist can perform a special procedure cal ed
microabrasion for you where the white spots can be more permanently removed. Ask your dentist about the procedure if you are concerned about this.
You may notice new white spots occurring on the teeth while you are undertaking the whitening
treatment. These white spots were already present on the teeth before whitening. As the teeth become lighter they become more visible. Do not worry. As the whole tooth becomes lighter these
spots wil fade. You may notice these white spots immediately after a whitening session or in the morning if you have been wearing the trays for the whole night.
Some teeth may appear banded with lighter/whiter areas, this is because these bandings are original y present on the tooth but when the tooth was dark these bandings were not obvious. As the tooth
becomes lighter, the lighter parts of the tooth wil lighten first fol owed by the darker banded area. After a week or so these should no longer be noticeable.
M 335A - Tooth Whitening Forms, Version 1, Page 1 of 6
How will my teeth feel?
Normal y the teeth feel very clean after the whitening procedure. The whitening materials also have an indirect ef ect on the gums of improving their health. This is how the technique was invented as it
was first used to treat the gum irritation caused by orthodontic treatment. What about my smile?
Your smile wil appear brighter as a bonus. It is very rare, but sometimes the teeth do n ot lighten at
al . If this happens and you are wearing the whitening trays as recommended, you may need to try a dif erent whitening product or a slightly higher concentration of the whitening material. The dentist
can do a few “power whitening sessions” for you while you relax in the chair. Discuss this with your dentist.
If you have white fil ings in the front teeth that match the existing shade of your teeth before
whitening your teeth, they may not match the teeth afterwards. This is because your teeth can
lighten, but the fil ings do not lighten. When the desired colour has been achieved, the dentist can replace these fil ings with a lighter shade of fil ing material to match the new shade of your teeth.
Normal y the dentist wil wait a week before changing the fil ings. How long does the whitening last? Will I have to whiten my teeth again?
Normal y the new white colour of your teeth keeps quite wel . The ef ect is dependent on what has
caused the teeth to discolour in the first place. If you drink cof ee, red wine, cola drinks the ef ect may darken slightly. Some patients have a top up treatment after 3-4 years. Some patients do not
need to. The dentist wil normal y ask you to return your trays after the desired shade of lightening has been achieved. This is to ensure that you do not over whiten your teeth.
Does whitening harm the teeth or gums?
Safety studies have shown that whitening teeth using the dentist prescribed home whitening
technique is perfectly safe on the teeth, cheeks, gum and tissue of the mouth. Whitening the teeth with the dentist prescribed kits is equivalent to drinking one soda drink. The whitening material has a
neutral ph. There are problems with the whitening kits that are purchased over the counter. Although they are inexpensive, they normal y contain an acid rinse, which can damage the teeth or thin down the
enamel of the teeth. This acid rinse can be extremely harmful to the teeth. It is not advisable to whiten your teeth if you smoke. It is best to stop smoking for at least 3 weeks before commencing the whitening procedure. Smoking causes the teeth to darken anyway and the
The technique of whitening is not for everybody. There are some situations where whitening teeth is
contraindicated such as where the front teeth are already crowned or where there are very large fil ings on the front teeth or where the teeth are already excessively worn and there is tooth surface
loss. The most ideal situation is where the teeth are healthy and strong but have become more discoloured with age.
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Home Whitening Instruction and Consent Form
We are planning to whiten your teeth using carbamide peroxide solution. Please read the fol owing instructions careful y.
The active ingredient is carbamide peroxide in a glycerine base. If you know of any al ergy
or are aware of an adverse reaction to this ingredient, please do not proceed with this treatment.
As with any treatment there are benefits and risks. 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. Research indicates that using peroxide to whiten teeth is safe. There is new research indicating the safety for use on the soft tissues
(gums, cheek, tongue, throat). The long-term ef ects are as yet unknown. Although the extent of the risk is unknown, acceptance of treatment means acceptance of risk.
The amount of whitening varies with the individual. Most patients achieve a change within
2 - 5 weeks. Reduce the consumption of tea, cof ee, red wine, berries and curries during or after treatment for at least 1 month. Please use the toothpaste supplied with the kit to clean
It is advisable not to smoke during the course of whitening treatment and for at least 5 - 8 weeks afterwards.
You may notice slight sensitivity after a few days of treatment. If this should occur refrain from using the whitening treatment for 3 - 4 days.
Do not use the whitening treatment if you are pregnant. There have been no adverse
reactions, but long-term clinical ef ects are unknown.
Wear the trays overnight or for two hours during the day
After the desired amount of tooth whitening has been achieved, you wil be requested to return the whitening trays to your dentist. It may be necessary to do a top-up treatment in
18 - 24 months depending on the amount of staining and your diet.
I have read the above information and agree to return for examination in days after treatment
begins and at any recommended time afterwards. I have read and received a copy of this information sheet. I
consent to treatment and assume the risks described above. I consent to photographs being taken. I understand that they may be used for documentation and for il ustration of my treatment.
Patient's Signature: _____________________________
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