Patient Information - Tooth Whitening

You have requested your teeth to be “whitened” and, to achieve this, your dentist will recommend the most appropriate whitening system available. The whitening gel contains carbamide peroxide 10% or 20% which are accredited by the American Dental Association for tooth whitening. The chemical formula diffuses into the tooth surfaces and enables the free oxygen radicals to break down the dark pigmented amino acids, peptides, polypeptides, proteins and glycoproteins in the surfaces of your teeth. These largely arise from tea coffee or other pigmented substances in your diet.

Contra indications for using this system include sensitivity to glycerine or glycols, pregnancy or lactating. Dentine sensitivity is sometimes experienced and a side effect may be the appearance of whiter areas on your tooth where previous decalcification has occurred. You will be aware that UK legislation does not warrant the use of 10% peroxide for cosmetic purposes. However, the majority of European countries and the North American dental associations have accreditation for this product for use as specified by dental surgeons.

Your custom-made whitening trays have been designed to provide a half millimetre space between your tooth surface and the tray for the gel to sit in. I recommend using the trays with gel for up to two hours per night for 14 days at which point we will review the progress of the whitening. Please adhere to the following protocol for your “nightly routine”:

1. Brush your teeth thoroughly with fluoride toothpaste.
2. Rinse the trays under cold water and shake dry.
3. Squeeze a drop of whitening gel into each tooth space of the clear tray.
4. Place the trays into your mouth and leave for two hours.
5. Remove the trays after the period of treatment and rinse your mouth before brushing gently with your normal toothpaste.
6. Rinse both trays under cold water and gently brush the excess gel away with your toothbrush. These trays can be stored either in the plastic container provided or in a glass of cold water. NB: Do not rinse the trays under hot water as they may distort.
7. Following whitening, your teeth will be susceptible to additional staining from wine, tea, tobacco and fruit juices. However, this can be minimised by using the “whitening” toothpaste that is available from the practice or supermarket.
8. I will arrange an inspection after your course of whitening treatment where we can assess your teeth.

While every attempt has been made to inform you of the extent of whitening that may be anticipated, everybody’s teeth do vary and the degree of whitening may not always be achieved. Some teeth will not respond to this whitening procedure and crowns and veneers likewise will not be affected. Photographs at the beginning of treatment with a reference colour are used to provide a starting point for colour comparison after the course of tooth whitening. If you experience any difficulties during the treatment, I would recommend that you contact the practice and explain the nature of the problem. I recommend using a fluoride toothpaste subsequent to the whitening procedure to prevent future sensitivity and to seal the surface of your enamel and dentine against future staining.

I, the patient ________________________________ have requested and accept the prescription of this item for the purposes of whitening my teeth to benefit my smile.