, Consent for a Tooth Whitening


Medway Smile – Consent Form

    Consent for a Tooth Whitening

    Tooth whitening is a dental procedure during which a peroxide solution is used to permanently change the colour of the teeth. The intended benefits of the procedure include returning the teeth back to the shade they may have been in youth or sometimes even lighter.

    As with all medical procedures there are risks and potential complications which you must be aware of before you can give your consent to proceed..

    Expected complications
    • Most people experience some increased sensitivity to cold stimuli while undergoing this process.
    • Your teeth will continue to naturally age and darken following this procedure meaning most people will choose to top up the result in the future.

    Common risks and complications
    • The extent to which your teeth will whiten cannot always be accurately predicted. The effect can be greater for some people than others.
    • Only tooth material will whiten so some fillings and crowns may look out of place afterwards meaning some people chose to then have those replaced.

    Rare risks and complications
    • Allergic reaction to something used during the procedure.

    By signing below I acknowledge that this procedure has been explained to me and I have had time to ask questions, consider my options and am happy to proceed. I am also aware that I have the right to seek a second opinion from another dentist at any time.


    Sign:

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