Tooth whitening: questions and answers

What is 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.

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 fully informed 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.

Who has 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. They should not assume that they will be covered in respect of the use of controversial bleaching products and should expressly discuss with their insurers the use of products which are illegal under the terms of the Cosmetic Products (Safety) Regulations. The registration of anyone practising in any field without appropriate indemnity arrangements will be at risk.

What are the regulations on tooth whitening products?

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.

What happens if the cosmetics regulations are breached?

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 the 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.

The requirement to obtain fully informed consent before treatment places an obligation on GDC Registrants to discuss with their patients the nature of the product they are intending to use.

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, including in the area of informed consent and or indemnity insurance the GDC could and would investigate that thoroughly.

Please read our statement on tooth whitening for more information.