Robert L. Simmons, DMD
Family Dental Care, Implants & Orthodontics
Creating Beautiful Smiles

Whitening For Life!



Whitening For Life!

Simmons Family Dental Care is proud to offer this new, unprecedented program to our patients. We pride ourselves on the smiles that leave our practice. We also pride ourselves on knowing our patients are maintaining the best possible oral health.

Professional Whitening For Life! was developed for those patients that are already taking their dental health seriously, and as an incentive for those who need a little help keeping up with their dental care.  The patient will receive custom made, professional, take home whitening trays and bleaching gel for personal use.

As with any program, there is always fine print, but the details are simple. Outlined below are the details for the Whitening For Life! program.  At your next appointment, a staff member will explain in detail and have you read and sign the necessary forms to participate.

Dental Office Responsibilities

Simmons Family Dental Care will fabricate custom whitening trays for any of our current patients age 18 and older that are medically and dentally able to receive tooth whitening. (See exclusions below), following a regular cleaning and exam.

For new patients, Whitening For Life! is free with a paid exam, x-rays and the completion of any needed dental treatment.

The patient will be scheduled for custom impressions of their teeth, after which the whitening trays will be ready for pick up within two weeks.

The custom trays will be delivered along with 2 syringes of whitening gel. Patients will be given instructions on the proper usage and answer any patient questions or concerns.

Dental Exclusions:

Upon examination by the dentist, there may be circumstances which would not make a patient a candidate for the program if you currently have any of these dental conditions. The dental exclusions are as follows:

  1. Active decay is present.

  2. Tooth ache or active infection.

  3. Periodontitis ( pocket depths of greater than 3 mm) requiring deep cleaning.

  4. Gingival recession ( teeth will become too sensitive for take-home bleaching)

  5. History of sensitivity from past bleaching procedures.

  6. Permanent anterior restorations (do not respond to whitening)

Other exclusions ,limitations and conditions

  1. Any patient currently on Government subsidized dental coverage is ineligible for this program.

  2. Must not have any outstanding accounts

       3. Must maintain all scheduled appointments and checkup visits. Your long-term oral health is as important to us as it is to you. Our patients have found that regular checkups greatly reduce dental pain and the cost of dental services Therefore, we are happy to provide this extra bonus to our patients who are committed to their oral health.   

        4.  A minimum of 24 hours’ notice must be given for cancellations, and the original                                            appointment must be rescheduled within the following 2 weeks. In order to provide exceptional services like Whitening For Life! to all our patients, we ask that you give us the courtesy of advance notice for all schedule changes.

        5. Must be 18 years of age.

        6. Two whitening gel syringes will be rewarded at each cleaning appointment. Additional         syringes can be purchased for $15.00 each.

        7. Lost or destroyed trays will be replaced at a cost of $50 per tray to the patient.

        8. Should any of the rules not be met, you will be disqualified from the program but will be provided the opportunity to re-enroll for a $99.00 reactivation fee.

        9. Teeth whitening is considered by the American Dental Association as a cosmetic procedure. If you become sensitive through the use of these products, it is imperative that you discontinue the use of the product and inform us immediately. Constant stimulation of soft tissues and teeth with bleaching agent may permanently damage the nervous ttissue within the tooth or chemically burn the gingival tissues. If the nerve within a tooth  become overexcited ( inflammation of the pulpal tissues inside the tooth), you may need root canal therapy followed by a build up and crown to treat the symptoms and protect and seal the tooth.





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