Confusion for dentists and patients over whitening

‘Carry on a normal’ is the message from the British Dental Bleaching Society ( in the confusion over whitening. This follows action allegedly being taken against a dental supply company and one or more dentists by Trading Standards officers. At present there are few hard facts, but there may be clarification at the BDBS AGM on June 17.

According to the British Dental Bleaching Society dentists and their patients are confused about how to safely get a whiter smile. The following appears on its website.

1. Legality - The tooth whitening products are classified as Cosmetic Products and as such they fall under the Cosmetic Regulation Act which states that no product supplied for tooth whitening purposes should contain more than 0.1% hydrogen peroxide. This amount of hydrogen peroxide is ineffective for tooth whitening.

2. It is unfortunate that that the bleaching materials have been classified as cosmetic products. Realistically, they should be classified as medical devices as the oxygen which is the active ingredient in the breakdown process of hydrogen peroxide penetrates through the enamel of the tooth through the dentine and into the nerve of every single tooth within a period of 15 minutes. This is not a cosmetic effect. Since the nerves are penetrated in this way, it should only be a dentists who is qualified to carefully assess the patient, the health of their teeth and gums and ascertain that it is appropriate to carry out tooth bleaching treatment. Certainly, the bleaching of non- vital and vital teeth with Dystrophic calcification must be classed as medical/dental treatments.

3. It would be extremely difficult and costly to get the ruling of the Law Lords changed even though different legal opinions have been sought to see whether this is possible.

4. The government body, LACORS (Local Authorities Coordinators of Regulatory Services) advises local authorities and coordinates over 200 separate trading standards to police the current rules. LACORS officials had recently been focusing their attention on dentists who provide tooth whitening gel for patients.

5. The DTI had started making phone calls to random dentists as a form of spot checks. This is causing fear and apprehension amongst dentists who are now beginning to cease to provide tooth whitening services for patient. Recently a dentist from Glasgow was visited by a DTI inspector from Sheffield, who asked the dentist to see a sample of the bleaching products which was used for patients. The officials took the sample away for analysis following which it was pronounced that the sample was outside the recommended limit 0.1%. It was in fact 10% hydrogen peroxide. Other dentists have reported that the DTI have contacted them via the telephone and spoken to their receptionists to ask what concentration of hydrogen peroxide was used in their practice.

6. As with Tooth Jewellery, Tooth Whitening is not part of the Dentists Act. This is because when the Dentists Act, which was ratified, there were no such things as tooth whitening or tooth jewellery. It is considered that the ratification of the Act would have allowed for any other tooth related service that were yet to be invented to be included in the Dentists Act. It is because of this apparent “loop hole” that other practitioners such as beauty therapists, hairdressers, tanning salons, cruise liner operators and opticians have been able to offer additional services such as tooth whitening. The General Dental Council have stated that tooth whitening is the practice of dentistry and as such should only be carried out by dentist registered with the General Dental Council.

7. Chlorine Dioxide Many of the non-dentists provide tooth whitening using chlorine dioxide. There is no published research on chlorine dioxide at all. This product has a pH of 3-4, is ineffective and may etch the tooth enamel. Instead of the tooth becoming white, it turns gray as a result of using Chlorine Dioxide. Cases have been reported of permanent damage to the enamel surface. There are no long lasting whitening effects of this product. Furthermore the patient literature accompanying the treatment is misleading the public not only about the treatment, but about the post treatment care and long term effects.

8. The European Union Scientific Committee on Consumer Products (SCCP) in their report conclusions of January 2008, recommended that 6% hydrogen peroxide can be used for patients for home bleaching. However, over-the-counter products will not be available in Europe. There has been a delay applying these recommendations to the UK Law. This delay has resulted in UK dentists not being able to supply the appropriate gel to patients for the purposes of tooth whitening.

9. The Tooth Whitening Dental Trade The Dental Trade Industry members are concerned that the complaints are leading to a deterioration of the relationship of the BDTA and LACORS with the DTI. There have been many issues concerning the supply of the bleaching products and their packaging.

10. There are still many dangerous tooth whitening home kits available to patients from catalogues and the internet. These can cause harm to patients as they have a very low pH which in turn can damage tooth enamel. The companies supplying these home kits are not concerned about the legislation or the DTI. There seems to be no method of policing these suppliers yet at the same time, carefully researched and scientifically proven materials are not allowed to be used by professionals who know how to use them.

In Conclusion of these issues; It is feared that should the situation remain unchanged and the legislation is not challenged and changed patients in UK will continue not to be able to fully benefit from this treatment.


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