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HOME BLEACHING INFORMATION AND INSTRUCTIONS
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INFORMATION                  

  Home bleaching is a relatively simple bleaching procedure by which you, supervised by your dentist, can easily and effectively apply a bleaching solution to your teeth in a custom-made plastic frame to hold the bleach against your teeth.


INFORMED CONSENT

 

Ingredients of this bleaching solution are carbamide peroxide, hydrogen peroxide, glycerin, and trace amounts of fluoride and flavorings.  Do not begin treatment if you are allergic to any of these materials. 

Although peroxide solutions have long been used as a mouth antiseptic, they have only recently been used for home bleaching with professional assistance.  The FDA (Food and Drug Administration) has approved its use as an antiseptic but not as a home bleach.

Dentists have bleached teeth with hydrogen peroxide for about 100 years with no long- term adverse effects to teeth.  Although preliminary results with home bleaching are encouraging, Long-term effects, particularly on enamel, dentin, gums, cheeks, tongue, throat are not yet established.

As with any procedure there are benefits and risks.  The hoped for benefit is whiter teeth.  The risks include, but are not limited to, occasional hot and cold teeth sensitivity, a burning sensation of the gums, soft tissue ulcers, nausea, soreness in the teeth and changes in bite, jaw joint soreness or disorders form the appliance, sore throat from swallowing bleach and facial pain.  These problems occur in less than 10% of patients treated.  Discontinue treatment if any of these symptoms occur.

Dental crowns and fillings usually do not lighten and may be more noticeable after treatment.  In addition, these restorations can occasionally be damaged from bleaching and may need to be replacement.


CONTRAINDICATIONS TO TREATMENT

 

Patients should not smoke tobacco or use other potential carcinogens during treatment.  Bleaching materials may potentiate carcinogenic effects.

Pregnant women or those expecting to be pregnant should not undergo treatment.  Long-term effects of bleaching materials on pregnancy have not been studied.

Patients with root sensitivity may not wish treatment since sensitivity can be aggravated.



EXPECTED RESULTS

 

While there is no guarantee of tooth whitening and the amount of tooth lightening is unpredictable, most teeth lighten 1 to 2 shades on the Vita shade guide.

Average treatment time is 2 to 6 weeks but some results may be seen in 5 days.  more difficult cases require extended treatment times and may result in teeth looking chalky.

Yellow and brown stains usually respond best  (aging, yellowing); gray and blue stains usually improve less (i.e. Tetracycline and Fluorosis).

In some patients, stains relapse when treatment is discontinued.

The exact duration of whitening varies among patients.  With office bleaching, whitening usually lasts from 6 months to a few years when some or all of the original tooth color appears.   Periodic retreatment is generally indicated with office bleaching and should be expected with home bleaching.


PATIENT INSTRUCTIONS

 

Place a few drops of bleaching solution on the inner wall of the bleaching appliance by the teeth to be whitened.   With both hands, carefully place the filled appliance in the mouth.   Expectorate excess solution.  Swallowing bleach, although not harmful, can result in throat irritation.  Wear for the recommended time.

To change the solution, remove the appliance with both hands, rinse your mouth with water, rinse and dry the appliance, and replace the solution.   Brush the appliance inside and out every day.  Clean your teeth as usual.

The more treatments per day the faster the bleaching.  However, this can also increase sensitivity and cause other complications.

Slow Bleach: the safest is to wear the filled appliance 3-4 hours a day, replenishing every 30 to 60 or as indicated by your dentist.  Always use the recommended replenishing time.

Fast Bleach: Maximum wearing time is 8-16 hr/day replenished as directed.  This should only be done under the direction and supervision of your dentist and only after shorter treatment has been ineffective.

Nighttime treatment is an option although day use works faster since there are more changes of bleach.  If this appeals to you, discuss it with your dentist.

Fluoride may be applied to the teeth every day before bedtime.  Some patients say this reduces sensitivity while others say it has no effect.   Discuss this with your dentist.

Discontinue bleaching if the teeth, gums, or bite become uncomfortable.  See your dentist immediately for correction.

Do not wear the appliance while eating.

Your dentist should check your mouth every 1 to 6 weeks to ensure no damage is being done to your teeth, gums, or dental restorations.

Discontinue treatment if any discomfort or problems occur, and see your dentist immediately.

 


SPECIAL INSTRUCTIONS


 

Recommended wearing time: ____ hours     Replenish           solution every  ____ hours

I have read the above and any of my questions and concerns have been answered and explained to me.  I agree to return for examination during treatment as recommended by my dentist.  I also agree to return for periodic oral examinations after treatment is completed.  I have received a copy of this information and instruction sheet.   I understand the directions and risks, and I consent to treatment.

I also consent to photographs being taken.  I understand they will be used for documentation, treatment study, and for educational purposes.

I further understand the first bleaching gel syringe will be provided to me free of charge.  If I desire more bleaching gel for future use, I would need to purchase the new supply.

Patient:  __________________  Doctor: __________________  Date: _________

 

 
       
 
 


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