Teeth Whitening
Teeth Whitening is designed to lighten the color of your teeth. When done properly, the whitening will not harm your teeth or gums. Significant lightning can be achieved in the vast majority of cases, but the results cannot be guaranteed. Teeth whitening, like any other treatment, has some inherent risks and limitations. These are seldom serious enough to discourage you from having your teeth whitening but should be considered in making a decision to have the treatment. Multiple sessions may be required based on the severity of the skin condition.
Risks- Although it is impossible to list every potential risk and complication, these are some known risks. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to initial treatment, as well as provide any necessary updates at all future treatment sessions. I do understand that any hormone imbalance present within my anatomical system can alter the treatment. Please review the following carefully. It is important that you answer all questions honestly and to the best of your ability and knowledge. Failure to do so can result in unsatisfactory results and/or injury.
Whitening will not change the color of fillings, crowns, dentures, veneers, or any other material (restorations) that is not enamel. If after bleaching a color difference results between your teeth and other restorations, these restorations may have to be replaced to match your new enamel color.
Do not attempt to bleach crowns, veneers, or any other restoration, as this will not work and possibly damage them. Bleaching is only indicated for enamel.
Whitening is not recommended for patients that are pregnant, trying to get pregnant or breastfeeding.
Whitening will likely not be successful if tartar buildup exists in your mouth. A cleaning is recommended to remove these deposits prior to bleaching.
If you suffer from periodontal disease (bone loss around your teeth), and roots of your teeth are exposed, you’ll notice that these are darker than your enamel. Whitening will not change the color of your roots, only of enamel. It is likely that these areas may be more sensitive when exposed to whitening material.
If you have tetracycline staining in your teeth, it is likely that you may need power bleaching for best results.
Tooth Sensitivity: During whitening, some patients experience transient sensitivity. This sensitivity is usually mild if your teeth are not normally sensitive.
Gum Irritation: This is the result of using the trays for too many hours when you first start whitening. During the teeth whitening session the gums may bleach and turn white it can possibly cause sensitivity during and after the treatment. It’s caused by salivating, use sensodyne to help the sensitivity
Effect on Fillings: Be aware that tooth colored filling will not whiten, and mismatched shading may happen. Same thing applies to any other restoration in your mouth (crowns, veneers, dentures, inlays, onlays, etc.). You may need to replace these restorations so that they will match your newly whitened teeth. Completion of Treatment.
Level of Lightening: There is no reliable way to predict how light your teeth will whiten. Type of staining, tooth anatomy and periodontal/carious condition vary from person to person, thus affecting bleaching results.
Relapse: Following the completion of whitening, pigment found in food and drinks will re-stain your teeth after some time. This is commonly called ‘bleaching relapse’. With home whitening, you may choose to wear your trays once every few months to keep relapse from occurring.
Allergic Reaction- Additionally, since this procedure increases the sensitivity of topical substances, it can cause you to be hypersensitive to products used. I do understand sensitivity can occur.
Infection- Viral, bacterial, and fungal infections can occur anytime the integrity of the is compromised.
Lack of permanent results- I understand it may take multiple treatments to obtain optimal results.I understand I may not experience complete clearance, and that it may take multiple treatments. Some conditions may not respond at all and, in rare cases, may become worse. There is a possibility of a poor result from any cosmetic procedure. It is important that your expectations be realistic and understand the procedure has its limitations. Additional procedures may be necessary to achieve desired effect. No Refunds or Returns Due to the nature of the services and products provided, Foreverbyashh LLC and Ashley Holdings LLC, including their employees, independent contractors, subsidiaries, and affiliates (collectively, “Foreverbyash”) does not issue refunds for used or unused services and does not accept any product returns.
Contraindications- Although it is impossible to list every potential risk and complication, the following are recognized as known contraindications. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to initial treatment, as well as provide any necessary updates at all future treatment sessions. If you have any of the conditions listed below, you should bring it to the attention of your esthetician PRIOR to signing this consent form.
Crowns
FIllings
Enamel
Veneers
Pregnant
Breastfeeding
Periodontal disease
Tetracycline
If you have any of the listed conditions below we will need a doctor’s note prior to receiving any services.
Any Autoimmune disease
Blood pressure medication
Cancer
Chemotherapy / radiation
Psoriasis
Serious Medical Condition
Cannot perform any services if you’ve been on accutane in the past 1 year.
Post Care
Avoid acidic foods (can cause sensitivity
Avoid extreme temperatures (hot/cold)
Avoid eating (2 hours after)
Anything that can stain the teeth (wine, soy sauce, berries, coffee, coke, dark drinks etc)
Stay hydrated to avoid sensitivity.
