Safety first for tooth whiteningUncategorised
Posted by: The Probe 16th April 2020
The appearance and the colour of the teeth is important, and discolouration is a common complaint. As a result, the most popular cosmetic dentistry procedure is tooth whitening and this industry is estimated to be worth over £40 million in the UK. The demand for treatments and products that whiten the teeth is high, however, as the dental profession is aware, patients should proceed with caution.
As the law stands in the UK, whitening products containing or releasing up to 6 per cent hydrogen peroxide can only be sold to dental practitioners offering whitening treatment in their practice. These products contain bleaching agents and safety regulations state that they can only be provided by qualified dental practitioners registered with the General Dental Council (GDC). Lower strength bleaching kits or whitening products containing or releasing less than 0.1 per cent hydrogen peroxide are available over the counter (OTC) or on the internet. These are considered safe for patients to use without supervision but several applications may be required to achieve the desired results.
Legislation has been put in place in the interest of safety and there has been strong public support for policies regulating tooth whitening. In fact, 75 per cent of the general public surveyed in 2010 agreed that the GDC should prosecute anyone practicing illegal tooth whitening. Nevertheless, if the recent news is anything to go by, it appears that illegal tooth whitening is still a big business.
A national survey has revealed that almost half (45%) of single adults in the UK have had illegal tooth whitening. This represents a significant risk to thousands of people as those that carry out whitening treatments illegally are not qualified to assess a patient’s suitability or intervene should an emergency arise. Fortunately, the GDC makes the legal position regarding whitening very clear and reports of illegal practice is taken very seriously. For example, following a complaint from a member of the public that experienced burnt gums after illegal whitening treatment, two females were found guilty of illegally practising dentistry. Consequently, in October 2019 they were ordered to pay over £4250 in fines, compensation and legal costs by Sheffield Magistrates’ Court.5
According to a surveillance study carried out between 2013 and 2017 by the European Directorate on the Quality of Medicines and Healthcare (EDQM), 78 per cent of brush on whitening products and 50 per cent of tray-based tooth whiteners and strips were non-compliant with European or national regulations. Laboratories tested the ingredients of tooth whitening products that contained hydrogen peroxide, carbamine peroxide, sodium hypochlorite and sodium perborate, along with preservatives (triclosan, isothiazolinones and brominated preservatives), fluorides and colourants. The issues identified were higher than permitted hydrogen peroxide content and the presence of CMR substances, i.e. those which are carcinogenic, mutagenic or toxic. Several products were also found to be incorrectly labelled or wrongly reported CE marking. These findings led to the voluntary withdrawal of some products as well as demands for corrective measures and sales bans. It was also advised that tooth whitening products should remain under close surveillance. 6
In February 2019 a study was also carried out to determine the lightening effects and safety of non-hydrogen peroxide OTC whitening products available in the UK. Microhardness tests and scanning electron microscopy (SEM) analysis were undertaken and the results revealed surface morphology alterations in varying degrees and several samples demonstrated a distinct etching pattern post-exposure. It was concluded that the non-hydrogen peroxide OTC products tested produced lightening effects but had the potential to damage tooth enamel.
It appears that whitening products that have the potential to make the teeth weaker, more sensitive or more susceptible to abrasion are available on our high streets. Furthermore, patients may apply them too frequently or for too long. Therefore, patients should speak to a qualified dental professional before using whitening products and also ensure that any individual offering whitening treatment is qualified to do so.
On the plus side, successful tooth whitening can encourage patients to maintain good oral hygiene habits, thereby preventing the build-up of bacteria and plaque and keeping the teeth and gingiva cleaner and healthier. A product that dental professionals can confidently recommend is the Waterpik® Whitening Water Flosser. This innovative dental adjunct provides patients with an easy and effective way to floss plus, it safely removes tooth stains to restore the natural whiteness of the teeth. The Waterpik® Whitening Water Flosser uses whitening infuser technology to mix a stain removing agent – which is as gentle as regular toothpaste – with water, to remove tooth stains that other products miss. It has been clinically proven to remove up to 25 per cent more stains than brushing alone and patients are motivated to continue by its noticeable brightening effects.
Armed with this information, dental professionals can inform patients of the safest ways to achieve and enjoy whiter teeth.
Waterpik® products are available from Amazon and in store or online at Asda, Boots and Superdrug.
 Shah R.J. et al. A study of patient satisfaction with maxillary anterior teeth restorations and desirable aesthetic treatment options. IOSR Journal of Dental and Medical Sciences. 13(10). https://www.researchgate.net/publication/267212409_A_Study_of_Patient_Satisfaction_with_Maxillary_Anterior_Teeth_Restorations_and_Desirable_Esthetic_Treatment_Options [Accessed 18th November 2019]
 Independent research commissioned by GDC. TNS Research International Omnibus Survey: Dec 2010. Public attitudes to tooth whitening regulation. https://www.gdc-uk.org/docs/default-source/research/publicattitudestotoothwhitening.pdf?sfvrsn=993a40cf_2 [Accessed 18th November 2019]
 Oral Health Foundation (2017) Research carried out as part of National Smile Month. ‘National Smile Month 2017 United Kingdom Survey’. https://www.dentalhealth.org/news/single-adults-leading-growth-in-uks-illegal-tooth-whitening-industry-study-finds [Accessed 18th November 2019]
 Jennifer Stewart, Head of In-House Appeals and Criminal Enforcement, GDC. Quote taken from “Providers of illegal tooth whitening prosecuted by GDC.” October 2019. https://www.gdc-uk.org/news-blogs/news/detail/2019/10/09/providers-of-illegal-tooth-whitening-prosecuted-by-gdc [Accessed 18th November 2019]
 Councils for Europe. European Directorate for the Quality of Medicines & HealthCare (EDQM). Market Surveillance Study on Tooth Whitening Products Summary Report. April 2019.
https://www.edqm.eu/sites/default/files/edqm_occls_summary_market_surveillance_tooth_whitening_products_april_2019.pdf [Accessed 18th November 2019]
 ChemSafetyPRO. CMR Catergory 1A/1B Substances. https://www.chemsafetypro.com/Topics/Restriction/REACH_annex_xvii_restriction_CMR_substance_1A_1B.html [Accessed 18th November 2019]
 Greenwall-Cohen J. et al. The safety and efficacy of ‘over the counter’ bleaching products in the UK. Br Dent J . Feb 2019. 226, 271-276. https://www.ncbi.nlm.nih.gov/pubmed/30787399 [Accessed 18th November 2019]
 Milliman J.L. et al. Evaluation of Tooth Whitening using a Liquid Dentifrice Delivered by the Waterpik® Whitening Water Flosser. Study conducted at Salus Research, Fort Wayne, IN. 2014
https://www.waterpik.co.uk/professional/clinical-research/whitening-water-flosser-stain-removal-milliman-2014/ [Accessed 18th November 2019]
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