CUSTOMER INFORMATION AND CONSENT
Quintessence Whitening is one of the newest, quickest, safest, and most effective over the counter teeth whitening products in the market. Quintessence Whitening is guaranteed to rapidly produce a noticeably brighter and whiter smile for staining caused by coffee, tea, tobacco, and red wine along with some cases of intrinsic staining. Quintessence Whitening is one of the only processes currently available that will give you such dramatic results in a very short time in an easy, convenient process without the prices typically associated with teeth whitening or the pain and sensitivity.
Quintessence Whitening pen can be purchased separately to help maintain and improve teeth whiteness when used regularly and as directed.
WHAT TO EXPECT
Most people with healthy teeth and gums will experience no discomfort during the Quintessence Whitening process. If you have any adverse reactions to whitening agents such as carbamide or hydrogen peroxide, or are not sure, please consult your dentist prior to having your teeth whitened. A tingling or slight sensitivity is normal and not harmful to your gums or enamel. Occasionally, gum or lip discomfort is experienced by particularly sensitive individuals. To prevent this, lightly coat the affected areas with Vitamin E. For teeth sensitivity it is best to use a Potassium Nitrate/Fluoride mix such as Sensodyne toothpaste. Following the treatment for those individuals who have sensitive teeth and or
gums, it should subside within 24 hours.
EXCLUSIONS FOR TREATMENT:
Have allergies or reactions to either carbamide, peroxide or glycerin.
Have existing tooth decay, periodontal disease or gingivitis.
Are photosensitive to light or on any photosensitive drugs.
Are pregnant, suspected of being, or are breastfeeding.
Under the age of 18.
Have had oral surgery or extractions within the last 28 days.
Are wearing a piercing or metal object in the oral cavity. (Please remove, as they may turn black)
AFTERCARE AND FOLLOW UP
For a minimum of 24 hours after the process, avoid consuming coffee, tea, dark colored soda, red wine, berries, candy, red sauces, beets, chocolate or any other foods that have a propensity to stain your teeth. A good guideline is, if it stains a white shirt, it will stain your teeth. Of course, brush and floss as directed by your dentist. There is no definite answer as to how long the whitening effect will last; this is highly dependent on many individual factors, including the current condition and age of your teeth, diet, alcohol and tobacco consumption, genetics and
dental, general and periodontal health. Whitening Specialist on-site will suggest follow up whitening sessions if necessary. The use of a whitening pen 3 times after your first whitening treatment has been shown to help blend, brighten, and maintain the smile longer.
I HAVE READ AND UNDERSTAND ABOVE, AND CERTIFY THAT I HAVE HEALTHY TEETH AND GUMS AND I AM NOT PREGNANT, BREASTFEEDING, UNDER THE AGE OF 18, HAVE HAD NO ORAL SURGERY IN THE PAST 28 DAYS, NOT ALLERGIC TO CARBAMIDE /HYDROGEN PEROXIDE, NOT TAKING MEDICATION THAT WOULD CAUSE ME TO BE PHOTOSENSITIVE TO LIGHT, HAVE NO EXISTING PERIODONTAL DISEASE, NO OPEN CAVITIES, AND THAT I HAVE CONSULTED MY DENTIST ABOUT TEETH WHITENING AND I AM CONSIDERED TO BE A GOOD CANDIDATE.