Disclosing Parent Permission

Dear Parents/Guardians,
Plaque is a sticky, invisible layer of bacteria that forms on our teeth every day. Because it is nearly
undetectable, it is difficult to remove with a toothbrush and dental floss, and the result is
sometimes dreaded tooth decay and gum disease.
Since your child is participating in the Smile In Style program this year, he or she is learning to do a
better job of removing plaque with a toothbrush and floss. One activity that is very effective in
improving the children's skills is disclosing. You may be familiar with disclosing tablets, as many
dentists and hygienists use them during regular office visits. By chewing and swishing one of these
little pink tablets, students are able to see plaque and more effectively remove it!
Although students do not swallow the disclosing tablets or solution, it is important that you know
that the ingredients include: FDC Blue #1 and grape flavor.
ONLY return
the form below if you
want your child to participate in this
Thank you,
Carol L. Ash, R.D.H.
Suzanne H. Eustis, B.A.
Program Coordinators
-----------------------------------------------------Please cut, complete and return to teacher immediately if you do not want your child to participate
in the “purple tablet test” at school.
My child, _________________________________, does NOT have permission to use plaquedisclosing tablets during the dental health activity planned by Smile In Style.
Signed_________________________ Relationship to student ________________________