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Essay: Tooth Whitening: Uncovering The Dangers and Risks To Health

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  • Published: 1 June 2019*
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  • Words: 1,574 (approx)
  • Number of pages: 7 (approx)

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As the digital era progresses and scrolling through social media becomes part of daily routine, the desire to have the perfect image is becoming increasingly evident in society. To achieve this image, tooth whitening is becoming a common procedure, and with dentists charging upwards of £300, people are turning to beauty salons to have the procedure done at a cheaper price, but at what cost to the patient’s health?

Dental procedures have risks and dentists are trained to understand and convey these risks to their patients, allowing the patient to make an informed decision on whether they want the treatment. Tooth whitening is no different, having the ability to cause permanent damage to someone’s mouth. Tooth whitening or tooth bleaching uses a substance called carbamide peroxide to achieve the effect of lightening teeth. Carbamide peroxide contains hydrogen peroxide as it’s active ingredient and dentists use between twenty-five to forty percent hydrogen peroxide. (Li and Greenwall, 2013) Many beauty salons have been found to used chloride dioxide as the active ingredient of bleach rather than hydrogen peroxide, and studies have shown this to cause more damage to the teeth than hydrogen peroxide. Very small concentrations of chloride dioxide have been shown to reduce the sheen of the enamel and even strip teeth of their enamel. These are irreversible processes which will lead a patient to costly restorative work further down the line. (Li and Greenwall, 2013)

Hydrogen peroxide is potentially damaging to the oral environment if not used correctly so a dentist will ensure the soft tissues of the mouth are well protected from the product. High concentrations of hydrogen peroxide can lead to tissue burns if the substance comes into contact with the tissue. If the bleach is quickly removed there will be very minimal effect but if left for longer ulceration may occur which would be very painful for the patient (reference here)

Fundamentally, someone chooses to have their teeth whitened because they are unhappy with the natural shade of their teeth. Tooth discolouration may be due to surface staining, but there may be an underlying, more serious problem causing the discolouration. These would be problems that only trained dentists who are able to carry out radiographs would be able to detect. Having teeth whitening done at a beauty salon would mean the patient would be at risk of having these problems go undetected as beautician would not be able to diagnose the cause of the discolouration and would therefore mean the patient would not receive the treatment they need before proceeding with tooth whitening. (Haywood and Sword, 2017)

Perhaps one of the most common side effects of tooth whitening is tooth sensitivity with almost half of people who have the procedure done complaining of tooth sensitivity. (Li and Greenwall, 2013) The dental pulp contains many sensory afferent nerves which take signals to the central nervous system and in healthy teeth these nerve endings will be surrounded by the dentin and enamel, preventing tooth pain. In order for bleaching to have the desired effect, the bleach needs to be able to pass through the enamel into the tooth. This creates diffusion pathways in the tooth and hence a way for stimuli to reach the nerve endings in the pulp (Markowitz, 2009) Dentists will try to minimise this sensitivity for patients by carrying out the treatment over several appointments which allows the pulp inflammation to decrease before the next session of whitening (Rodrigues et al., 2018) The dentist will also be able to offer the patient products, such as toothpastes, to try and combat the sensitivity. Beauticians may not be trained in dealing with problems like sensitivity and so would not be able to give the client advice on how to deal with it. This suggests that having tooth whitening done at a beauty salon will increase the patient’s risk of developing lasting sensitivity from the procedure.

The patient has come to the dentist to have restoration work on two of the upper, anterior teeth, both of these teeth are visible when smiling. The bleach used to bleach the teeth will not alter the colour of the restorations done by the dentist, so it is important for bleaching to be matched to the restoration colour as the restorations are being done before the bleaching. Since the dentist is not carrying out the bleaching, they will have no say in what colour the teeth are bleached, and a beautician may not be aware that restorations cannot be bleached. This may cause the patient to have teeth bleached lighter than the restoration colour, meaning the patient would have to come back to the dentist to have these restorations replaced. This would be costlier for the patient. It is important for the dentist to inform the patient of this to prevent the patient from just picking the lightest whitest colour possible.

There are many legal and ethical issues surrounding tooth whitening, but the law is very clear. The Dentists Act 1984 states that “by law, all dental professionals in the UK must be registered with the GDC in order to work legally and safely.” (General Dental Council, 2018) From this it is clear to see that beauty salons offering tooth whitening is a criminal offence and something which needs to be reported. The beauty salons are putting the people’s health at risk and therefore they should be prosecuted.

As a dentist, the General Dental Council (GDC) have a strict set of standards that must be adhered to. There are nine dental standards and four of them are particularly relevant in this case. The first two of these principles are to “put patients’ interests first” and “communicate effectively with patients” (General Dental Council, 2018). This is an important in the case of illegal tooth whitening as the dentist needs to clearly convey to the patient that the salon is carrying out tooth whitening illegally and that you would recommend, they didn’t have the procedure done in the beauty salon. As a dentist, you can’t just tell the patient not to have the tooth whitening done, you need to explain to why it’s a bad idea. As a dentist you should also allow the patient to express their own ideas and opinions and don’t be dismissive of their opinions, which may help you to understand why they want to have tooth whitening done at the beauty salon. The other two standards which should be considered in this situation are “raise concerns if the patients are at risk” and “make sure your personal behaviour maintains patients’ confidence in you [the dentist] and the dental profession” (General Dental Council, 2018). It is important as a dentist to tell the patient about the risks associated with tooth whitening but in doing so also explaining how these risks are amplified by having whitening done in a beauty salon. As a dentist, you need to convey these risks in such a way that the patient will choose not to have the whitening done at the beauty salon, but in doing this it is important not to be derogatory towards the beautician even though what they are doing is illegal. It is important not to speak about the beauticians in a hurtful or offensive way as it will make the dentist come across as unprofessional, which may change the way the patient views you.

There are many ethical issues surrounding illegal tooth whitening and how the dentist should deal with it. This is because the dentist knows what the beauty salon is doing and so needs to make the patient realise the legal issues surrounding the tooth whitening. The dentist has been put in a difficult situation as they cannot force the patient to not have the whitening done but equally the dentist needs to report the beauty salon. This is why it’s extremely important to emphasise to the patient that tooth whitening should only be carried out by registered dental professional and be clear with the patient that what the beauty salon is doing is regarded as a criminal offence. It would be good for the dentist to point the patient towards the GDC website where they are able to find more information on the illegal practice of dentistry. It is important to report the beauty salon as you need to adhere to the GDC regulation, and by not reporting the salon you may be endangering the patient. This links back to the first principle of the GDC – “put patients’ interests first” (General Dental Council, 2018), and so have a duty to report the beauty salon in order to protect the patient and the public.

To conclude, tooth whitening has risks when being carried out by qualified dental professional and these risks are further amplified when having the procedure done by a beautician. Paying the extra money to have the treatment carried out by a dental professional may be worth it in the long run as it may prevent costlier restoration work down the line. As a dentist you have a duty to protect the public from anyone who is offering dental treatment when they are not GDC qualified. I think that the dentist has been put in a difficult position, but they have no choice but to report the beauty salon to the GDC in order to protect the patient. Tooth whitening by a dentist is an expensive procedure but the cost definitely outweighs the risks of having the procedure done in a beauty salon.

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