“Tooth whitening is a conservative and effective method to lighten discoloured teeth and has been practiced in dentistry for many centuries” (Perdigão, J. 2016). Due to the public’s growing desire to achieve the perfect aesthetic smile that is portrayed by the media, tooth whitening is becoming more and more popular in today’s society. In response to this growing trend, many different products and treatments have become available in practices and salons, as well as on the market. Dental practices and salons carrying out tooth whitening most commonly do so by applying high concentration chemicals to the teeth in order to bleach them. (Carey C. 2014)
Hydrogen Peroxide is the most commonly used chemical to treat discoloured teeth, yet other bleaching agents such as carbamide peroxide and chlorine dioxide are also used (Tooth whitening investigation uncovers illegal treatments. 2007). Tooth whitening products containing a hydrogen peroxide concentration of up to 0.1% are deemed safe for use by the public and can be sold on the market. Dentists may use tooth whitening products containing up to 6% hydrogen peroxide in practice (practice, R. and position?, W. 2018). Products with concentrations over 6% may not be used as they are capable of damaging the patient’s teeth and gingival tissue (Beckett, H, 2010) (Tooth whitening investigation uncovers illegal treatments, 2007).
According to the regulatory body for dental professionals in the UK, the General Dental Council (GDC), tooth whitening is a form of dentistry, “Assessing people's teeth, putting your hands in their mouths, painting a substance on their teeth and permanently changing their appearance – we say that's dentistry” (Mathewson, H. and Rudkin, D. 2008). The GDC also state that only those who GDC registrants may practice dentistry “under the current version of the Dentist Act 1984, only a registered dentist or dental care professional may practice dentistry. A non-registered individual carrying out the practice of dentistry may, in certain situations, be criminally prosecuted by the UK dental regulator, the General Dental Council (GDC).” (Beckett, H, 2010). This therefore means that beauticians carrying out tooth whitening in salons do so illegally, even if they use products with a hydrogen peroxide concentration of less than 0.1%.
In order to be a GDC registrant, dental practitioners must have successfully completed the necessary training, and therefore display that they have the knowledge and skills required to practice. The GDC set out 9 key principles, titled ‘Standards for the Dental Team’, these key principles must be followed by all dental practitioners to ensure patient safety within the profession. Beauticians have not received the necessary training to practice dentistry and are not contracted to follow the same guidelines as dental professional, this imposes a risk to patient safety and is the outstanding reason why this practice is deemed illegal. Before carrying out the process of teeth whitening in practice, a dentist will assess the patient’s teeth by looking at their condition, before concluding whether tooth whitening is a safe option for them. Beauticians do not have the skills nor knowledge to carry out this assessment, and therefore may administer teeth whitening to those who are not in a position to receive it. (Mathewson and Rudkin, 2008)
According to a study carried out in Portsmouth by the Faculty of General Dental Practice (UK), which investigated the practice of tooth whitening by dentists and beauticians in the city of Portsmouth, eight out of 76 responding salons admitted to administering teeth whitening. Of these salons, five said it was carried out in-salon by a non-dentist. The responding salons admitted to using tooth whitening products with a Hydrogen Peroxide concentration ranging from 16% to 38%, this is significantly over the legal limit and could cause chemical burns which appear as white spots on the patient’s gingival tissue or lips (Tooth whitening investigation uncovers illegal treatments, 2007). These results show that the beauticians sampled are not whitening patient’s teeth safely. Not only are they treating patients out with their knowledge and capabilities, but they are using products of illegal strengths which may harm the patient’s oral health. (Beckett, H. 2010)
After having explained to the young female patient that receiving this treatment from a non-dentist in a beauty salon is out with the law, I would go on to explain the risks associated with this and why it is deemed illegal.
When handling this situation, I must ensure I follow the nine principles set out by the GDC, this ensures I handle the situation correctly with the patient’s best interest at heart. The first guideline states ‘Put patient’s interest first’, in order to do this, I must first identify the reason the patient wants this treatment. After establishing why, I would communicate effectively with the patient in order to inform them of which options are available both in practice and to take home. (Standards.gdc-uk.org. 2018).
The second GDC guideline is to ‘communicate effectively with the patient’, in order to do so, I would provide details of the price, what each treatment option entails, all pros and cons associated with each treatment, and the outcomes of the treatments. Giving the patient an opportunity to ask questions ensures they understand what they are being told, allowing them to question any issues they have or anything they are unsure about and make an informed decision on what is best for them. The patient stated that they would have the treatment carried out at a salon due to it being significantly cheaper, I would also discuss any options that were available to pay the for tooth whitening in several instalments. I must be capable of adapting my communication style to suit the patient and their understanding. If the patient decides to go ahead with one of the treatments on offer, a treatment plan must be constructed. The treatment plan consists of a document held by the patient and dentist, outlining which treatment is being carried out, whether this treatment will be done on the NHS or privately and the overall cost of the treatment, the patient is required to agree and sign the treatment plan before any treatment will proceed. (Standards.gdc-uk.org. 2018)
Before going ahead with any form of treatment, it is essential that the patient gives consent on the form of a written signature, this is guideline number three on the GDC’s ‘standards for the dental team’. During the process of gaining patient consent, I must record my discussion with the patient, this ensures that the consent I have obtained is credible. It is important that the patient is aware they have the right to stop or refuse treatment at any point even after having given valid consent. (Standards.gdc-uk.org. 2018)
Guideline number seven states ‘Maintain, develop and work within your professional knowledge’. When informing the patient of the risks associated with the illegal practice of in-salon teeth whitening, I must provide information which is accurate and obtained from valid sources, this may include systematic reviews, research papers and review articles. It is my duty as a dental professional to maintain my knowledge and ensure it is up to date to allow me to correctly inform patients and answer their queries. (Standards.gdc-uk.org. 2018)
If the patient were to go ahead and have her teeth whitened at the salon, her oral health would put at risk. In order to abide by guideline number eight, ‘Raise concern if patients are at risk’, It is therefore my professional duty to report this illegal business to the General Dental Council. Doing so will not only protect the young female patient whom I am treating at my practice, but other members of the public that are unaware of the danger associated with this criminal field. (Standards.gdc-uk.org. 2018)