This is what I brought in to my dentist and it is tailored for my needs/level of sensitivity. You will need to modify it, but it’s a good place to start.
Dental Cleaning Instructions for ________________
Products Okay To Use:
powder-free nitrile gloves
white cosmetic (kaolin) clay (provided by patient)
cup for rinsing provided by patient
Desert Essence Tea Tree Dental Tape
No paper/disposable cups.
No mouth rinses/mouth wash.
- When I rinse, I need to use my own water from home.
Topical anesthetics, disinfectants, or any other products in the mouth or on lips that were not discussed ahead of time.
X rays: I react to the plastic sheath you use for the digital receiver. I need to use my own sandwich bags for this.
-My first point of reaction is always my mouth: tongue swelling, difficulty swallowing, sometimes lip swelling. In extreme cases I will have an asthma attack. I may need your help to watch out for swelling if we’ve missed anything about the ingredients or products used.
– If there is a swelling reaction, I have a benadryl pill that I can take.
– If my airway begins close off, I will need to use my epi-pen and then go to the emergency room.