General Dental Council statement on tooth whitening

The practice of dentistry

The practice of dentistry is limited to GDC registrants. It is the Council’s view that applying materials and carrying out procedures designed to improve the aesthetic appearance of teeth amounts to the practice of dentistry. So too does the giving of clinical advice about such procedures. Therefore all tooth whitening procedures, including bleach and laser treatment, are seen as the practice of dentistry by the General Dental Council. The carrying out of dentistry by non-registrants is a criminal offence and the Council will prosecute any persons undertaking this activity in appropriate cases.

Which GDC registrants can undertake tooth whitening?

Until recently, it was the Council’s position that only dentists could undertake tooth whitening. At the Council meeting in June 2008, it was decided that in addition to dentists being able to carry out tooth whitening, dental hygienists and dental therapists, on the prescription of a dentist, can carry out tooth whitening as an additional skill.
It has also been decided that dental nurses can, as an additional skill, take impressions and make bleaching trays to a dentist’s prescription.
Any registrant who undertakes work for which they are not sufficiently competent risks fitness to practise proceedings which may affect their registration.

What are the ethical considerations?

Ethical issues arise in treating patients, whatever the legal position. GDC registrants must:

• act in the best interests of the patient in providing a high standard of care;
• obtain consent for treatment, which they must be competent to carry out *;
• obtain a medical history of the patient before starting treatment;
• give necessary explanations about benefits and risks.

These and similar issues can arise in connection with any dental treatment proposed or carried out, including treatment designed to improve the appearance such as tooth whitening. They apply whether the registrant personally delivers the treatment or gives advice to patients about the use of home kits. It is open to patients to complain to the GDC about these matters, as with any form of care or treatment.

Do I have indemnity cover to carry out tooth whitening?

Registrants must always check with their defence organisation or other indemnity provider, because different organisations have different rules and policies. Do not assume that you will be covered in respect of the use of controversial bleaching products. If you practise in any field without appropriate indemnity arrangements, your registration will be at risk.

Cosmetics regulations

Tooth whitening products contain bleach and need to be handled with caution. Under the terms of the Cosmetic Products (Safety) Regulations it is illegal for tooth whitening products to be supplied which contain more than 0.1% hydrogen peroxide or for any associated products which release greater than 0.1% hydrogen peroxide to be supplied.

Prosecution for breach of the cosmetics regulations

The GDC does not prosecute dentists or hygienists or therapists or anyone else in the criminal courts for breaching the cosmetics regulations. This is the responsibility of local Trading Standards Officers. The national co-ordinating authority for Trading Standards (LACORS) previously advised officers to take a low-key approach to the enforcement of the cosmetics regulations, because they and the Department of Trade and Industry were of the view that the legal limit was too low. However, this advice was withdrawn in September 2006.

LACORS understands that although the European Commission may sanction an increase in the percentage of hydrogen peroxide allowed in products used in dental treatment, the 0.1% hydrogen peroxide level is likely to remain in place for products sold over the counter, by mail or via the internet. LACORS has therefore advised local authorities to tell suppliers of bleaching products that the levels in the regulations should be complied with and that failure to comply will result in enforcement action.

Queries about prosecution policy should be directed to your local Trading Standards office.

Where any GDC registrant is convicted of a criminal offence, we are told about the conviction and decide whether the registrant should be dealt with under our Fitness to Practise procedures.

What does the GDC think about all this?

The present situation is unsatisfactory for patients and practitioners. The GDC cannot offer immunity from prosecution by Trading Standards officers, and will deal fully with complaints received from patients and with any reports of convictions.

We can confirm that in the absence of a conviction we would not initiate disciplinary action solely on the basis that a product was used which contravened the Cosmetics Regulations. On the other hand, if the use of a particular product went beyond that, to raise an issue of professional standards or conduct, the GDC could and would investigate that thoroughly.

What is tooth whitening and what does it involve?

A dentist will be able to advise patients whether or not they are suitable for tooth whitening treatment. Dentists, hygienists and therapists will be able to discuss the options available to patients along with an estimation of treatment costs. The treatment options are professional bleaching or laser/halogen light whitening although neither treatment is available on the NHS. There isn’t a set price for private dentists or hygienists or therapists providing tooth whitening treatment therefore patients should request a written estimate.

The most common treatment method is professional bleaching which involves the dentist or hygienist or therapist on prescription putting a rubber shield or gel on the patient’s gums and applying the whitening product to the teeth using a tray that is fitted to the mouth. The active ingredient, usually hydrogen peroxide or carbamide peroxide, is broken down which allows oxygen to get into the tooth enamel thus lightening the teeth. This treatment usually takes between three to four weeks including two or three visits to the dentist or hygienist or therapist and continued treatment at home. Dentists or hygienists or therapists will take impressions at the first appointment to create a mouth guard.

For whitening using a laser or halogen light a rubber dam is put over the patients’ teeth, then a bleaching product is painted on and a light is shone on to the teeth. The light speeds up the chemical reaction and therefore the colour change takes less time.

What about home kits?

As tooth whitening involves the use of chemicals it is safer for it to be done by a dentist, or a hygienist or therapist on prescription after a thorough examination and assessment by a dentist. The GDC does not recommend or endorse any tooth whitening product.

* Please refer to the question Which GDC registrants can undertake tooth whitening?