Is conscious tooth whitening the only way?

Over-the-counter tooth bleaching kits should be scrapped in favour of in-surgery whitening under the prescription of a dentist only.

That’s the view of whitening guru and Clinical Associate Professor of Warwick Medical School, Dr Wyman Chan, whose own-brand bleaching gel wy10 was at the centre of the recent whitening controversy.

In an exclusive interview, he suggests that the only way to ensure patient safety is to carry out tooth bleaching treatments under the prescription of a dentist.

‘Overnight wear is risky and dangerous. Studies show that anything between 10-25% of the tooth-bleaching product can be swallowed when a patient is asleep – unconscious even – and this impacts upon the margins of safety’

With rumours abound within the industry as to what led trading standards officers to clamp down on dental companies selling the tooth whitening kits to the profession, Dr Chan was keen to set the record straight – this the day after he met with trading standards officers in Hull to clarify the science behind the treatment and the dentists’ stance on it.

Speaking from his Smile Studio clinic in London’s West End, he explained: ‘It all started in January when a patient in Hull complained to trading standards about the bleaching product she received which was over the recommended limit re: hydrogen peroxide.

‘Information had recently been circulated in the area about what was acceptable and the patient looked at the product to find the hydrogen peroxide limit was above what was regulatory. She reported this to the Hull trading standards agency that has to react to a complaint by a consumer.

‘Two officers went to talk to the dentist about using the product which contained 10% hydrogen peroxide.

‘They asked where he had got it from and this led to the situation we now find ourselves in.’

This chain of events also saw CDO Barry Cockcroft meeting with the Department for Business, Innovation and Skills (BIS) and the Medicines and Healthcare products Regulatory Agency (MHRA) to secure a proposed amendment by the Commission on tooth bleaching which, it’s hoped, will go to the EU Parliament.

It also prompted a debate in the House of Commons last month. Practising dentist and Conservative MP for Mole Valley, Sir Paul Beresford, himself a member of the British Dental Bleaching Society, told fellow parliamentarians: ‘The fly in the ointment is the European cosmetics directive, which restricts the sale of tooth-bleaching materials containing more than 0.1% hydrogen peroxide.

Clearly that makes eminent sense when applied to over-the-counter medicines, but from a dental treatment point of view 0.1% hydrogen peroxide is absolutely useless.’
After full consideration, trading standards agencies backed down on their clampdown and declared they had no issue with peroxide-based whiteners over 0.1% being supplied to GDC registered dentists for use in the course of a professional whitening service conducted by a registrant.

Dr Chan welcomes the fact that tooth bleaching has been brought into the public arena.

‘This has been necessary for so long and it’s a good thing it’s now under the spotlight. The profession will have to face the fact that we have to enter into discussion with the trading standards agencies to resolve this.’

‘Each trading standard authority thinks differently and we need one set of rules and regulations because the current situation is ridiculous from a dentist’s point of view.

‘Now it is top of the agenda, not only in dentistry but at the Department of Health  – with the CDO getting involved – and in Parliament. They had to react to this crisis within the dental profession.’

But Dr Chan is not about to advocate a future where tooth whitening becomes strictly a medical procedure.

‘Ultimately, it is a cosmetic device. It’s classed at the GDC as a dental procedure but, although in the US it is often used as an oral hygiene product, there is no scientific evidence to back this.

Tooth bleaching has no therapeutic effect – and this is the basis of the definition of a medical device.

‘A petition to change this failed in the House of Lords as far back as 2001 and this is now set in stone.’

That said, how does Dr Chan feel about the many other ‘cosmetic’ agencies  – such as hairdressers and beauty salons – carrying out tooth whitening in high streets and shopping centres?

‘As a dedicated teeth whitening dentist,, my opinion is that it’s not within the remit of dentists to tackle this. It is down to the GDC to enforce this.

‘The GDC has prosecuted one company for illegally carrying out tooth whitening and, in a recent report claims hundreds of others are being investigated.

‘Dentists should be vigilant and report those beauty salons along the road from them in order for the GDC to take action.’

To this end, he says he was pleased the GDC set out guidelines on their website recently.

The EU Cosmetic Commission’s Scientific Committee for Consumer Products (SCCP) stated that it is safe for the use of teeth whitening products by a consumer up to 6% hydrogen peroxide after clinical examination, and first use by a dental professional and, as a leader in the field of research into bleaching products, Dr Chan is best placed understands the science behind bleaching.

For the future, Dr Chan urges all dental professionals to seek training before they carry out the procedure and argues it should be a compulsory requirement that dentists, hygienists and therapists have proof that they have been on a recognised course run by a recognised expert in the field.

He is also slightly incredulous that it is still not taught to undergraduates.

This, he suggests, is necessary for them to understand the risks as well as the procedure and the damage can do if not carried out properly.

Dental professionals, he says, have a job to do to ensure the product they use is safe and that the patient is using it safely and this is dependent on the way it is delivered.

This is where he advocates an in-surgery prescription protocol only for take home.

‘Overnight wear is risky and dangerous. Studies show that anything between 10-25% of the tooth-bleaching product can be swallowed when a patient is asleep – unconscious even – and this impacts upon the margins of safety.

‘The EU’s SCCP worries about how much is swallowed when a patient uses overnight trays which is why I advocate conscious bleaching. We have to change the way we deliver take home whitening.’

‘The trading standards officers wanted to have a dialogue with an expert dentist in the field that is why I met them in Hull. Many dentists perhaps assume the officers know what they are doing but they are not scientists.

‘I had to explain that home whitening is not over the counter and that it is delivered under the prescription of a dentist. I think the problem is now with the trade as they still have a problem with regards to supplying the dentist.’

He adds: ‘I’d like to have more discussion with them if it helps the profession.

‘Do not knock the trading standards officers; I sympathise with them as they have a job to do. Dialogue is definitely the way forward.’

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