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White or Right?
I thought I`d recap (pun intended) on the position regarding whitening. The actual legal position seems to have confused people for several years.
Under the Cosmetic Products (Safety) (Amendment) Regulations 2012, which came into force on 31 October 2012, tooth whitening compounds containing or releasing up to 6% hydrogen peroxide are legal under the following conditions:
- They are sold to dental practitioners.
- For each cycle, the treatment is first administered by a dental practitioner, or under their direct supervision if an equivalent level of safety is ensured. It can then be completed by the patient.
- The patient is 18 years old or over.
Tooth bleaching compounds containing or releasing more than 6% hydrogen peroxide remain illegal. The maximum penalty for illegal use of these is six months imprisonment.
The first use of these products must be carried out by a dental practitioner or under their direct supervision. This means that dental hygienists and dental therapists can carry out the first cycle of whitening products, provided that a dentist is on the premises at the time of the first bleaching treatment and a dentist has previously assessed the suitability of the patient for the treatment. Basically, products cannot be supplied to patients without an examination by a dentist, and then the first application by either a dentist or a trained dental care professional. The same rules apply to home bleaching kits containing up to 6% hydrogen peroxide. The new regulations also make it clear that the higher concentration of hydrogen peroxide (more than 0.1%) is not to be used on patients under 18.
The GDC regards all tooth whitening procedures, including bleach and laser treatment, as the practice of dentistry. It adds that, as with any treatment, dental professionals 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.
So, when providing tooth bleaching treatment, you should make a complete, clear and contemporaneous record of the treatment plan, the consent process, any instructions given to the patient (such as how to continue the treatment at home) and any adverse outcomes. This is an important part of effective patient care and can also provide evidence that you have complied with the law.
Dr John Shapter - QCS Expert Dental Contributor