CONDTRINDICATIONS:

Braces

Very sensitive teeth, serious holes and cracks, white spots, extremely dark stains (grey/blue tetracycline).

Clients with body dysmorphia, unrealistic expectations, or a lack of understanding of the procedure may not be suitable candidates.

Pregnancy or breast feeding.

Under 16 years old.

Fillings, veneers, or artificial teeth can only revert back to their original color.

Description

The Hollywood Whitening™ treatment is designed to lighten the color of my teeth using a combination of the specially formulated whitening gel and a uniquely designed cold light. The treatment involves using a single-use 2ml whitening capsule gel and the Hollywood Whitening light in conjunction with each other to provide the whitening action. During the entire treatment, you will be asked to put on protective eyewear. Lip cream will be applied as the plastic retractor will be placed in the mouth to help keep it open. The single-use gel capsule is being applied 2-3 times every 15-20 minute cycle. After the treatment is completed, the client will be instructed to rinse their mouth with water. Before and after the treatment, the tooth shade will be assessed, shown to the client, and recorded. 

AFTERCARE INSTRUCTIONS:
For 48 hours (up to 1 week for best results), avoid staining foods and drinks. Stick to a white diet:

Recommended Foods: Egg whites, white bread, potatoes (no skin), white cheese, plain yogurt, cottage cheese, light-colored vegetables, white onion, bananas, peeled apples, pears, coconut, rice, chicken, and milk.

Foods to Avoid: Berries, beets, spinach, soy sauce, tomato sauce, chocolate, citrus fruits, soda, pickles, candy, colored cereals, and processed snacks.

Use a soft toothbrush the day of treatment and brush gently with non-abrasive toothpaste. Mild sensitivity is normal and should subside within 24 hours.

For best results:

Frequent coffee/red wine drinkers & smokers: Touch up every 7-10 weeks
Casual smokers & infrequent drinkers: 10-12 weeks
Non-smokers/no staining drinks: 12-15 weeks
The Hollywood Whitening Pen is available for touch-ups between treatments.

Terms and Consent

1. Background

We provide this information to give you insight into the Hollywood Whitening™ teeth whitening system. Your cooperation and understanding of this material is necessary as we strive to achieve the best results for you. The safety of teeth whitening is very high. Like all cosmetic procedures, there are limitations and considerations (which will be discussed below). Absolute success is variable and cannot be guaranteed.

2. Expecations upon Completion

Significant whitening can be achieved in many cases, but there is no definite way to predict how light your teeth will get. Candidates with yellow or yellow-brown teeth tend to whiten better and quicker than people with grey or grey-brown teeth. The teeth discolored by antibiotics, decalcification (white spots), root canal therapy, or trauma do not always respond as quickly or predictably and may require additional treatment. If your teeth are already a light shade off the Vita-shade guide, your additional whitening results could be minimal. The level of whiteness improvement varies with each individual.

3. Maintenance

It may appear that there is a slight change in the shade of your teeth within 24-48 hours. This is due to the reformation of a salivia coating. Also, through the normal staining process of day-to-day eating and drinking, you may experience a slight regression of shade. You could also see increased whiteness in the next 24-48 hours. Ask us about maintenance products.

4. Considerations and concerns

Teeth whitening has some considerations and limitations. Problems that can occur in professional teeth whitening are generally infrequent and are usually minor in nature. Please read the following information. If you are concerned about these points, please ask us before signing this consent form. 

Tooth Sensitivity -

During the whitening process, some clients may experience tooth sensitivity. This sensitivity is usually mild if your teeth are not normally sensitive. If your teeth are normally sensitive, please inform us before treatment so that we can make certian adjustments designed to reduce the risk of sensitivity. We cannot eliminate this risk. Sensitivity will completely subside within 24 hours.

Gums and Soft Tissue Irritation -

Temporary inflammation of the gums and other soft tissues of the mouth can occur during this treatment. This is generally the result of the whitening paste coming into contact with these tissues. Despite our best efforts, it can still sometimes occur. This is generally very mild and will completely subside.

Fillings and Other Dental Restorations -

Tooth-colored fillings (composites) composite veneers/bondings, porcelain crowns, and/or porcelain veneers may not whiten at all or evenly with your natural teeth during this treatment.

White Spots -

The most common thing that makes white spots is called "hypocalcifacation/hypoplasia." This means there was less calcium deposited there while the tooth was developing. In some cases, after the whitening treatment, hidden white spots may be more noticeable. This will be less noticeable after a few days when your teeth are remineralized. 

5. Confidentiality and Use of Information

Your signature below is your confirmation that you understand the information obtained in this form will be treated as privileged and confidential and will consequently not be released or revealed to any person without your express written consent. You do however agree to the use of any information for research or quality control purposes.

Legal & Liability Disclaimer

 I acknowledge that Hollywood Whitening™at Deluxe Wax Studio LLC is a cosmetic procedure and not dental treatment. I understand the risks, accept full responsibility, and release the studio and its staff from all liability related to the procedure, including results and side effects. I also consent to treatment and promotional photos unless otherwise stated.