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Tooth whitening: clinical and legal aspects

Tooth whitening: clinical and legal aspects. Andrew Beattie. Contents. Introduction and why? What is tooth whitening? Legal considerations? Case selection? Patient Consent? Procedure and patient information Uses of tooth whitening? References. Tooth whitening- why?.

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Tooth whitening: clinical and legal aspects

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  1. Tooth whitening: clinical and legal aspects Andrew Beattie

  2. Contents • Introduction and why? • What is tooth whitening? • Legal considerations? • Case selection? • Patient Consent? • Procedure and patient information • Uses of tooth whitening? • References

  3. Tooth whitening- why? • Increased prevalence • people seeking Hollywood smile • social media/ reality TV/ marketing • Affects people of all ages • Loss of vitality • Staining • Extrinsic- tobacco, tea, coffee, red wine Medication- iron supplements Chlorhexidine • Instrinsic- trauma, tetracycline, fluorosis

  4. What is tooth whitening? • Chemical process that uses oxidising agents on tooth surfaces to penetrate enamel and dentine, resulting in a change of colour • Hydrogen peroxide/ carbamide peroxide/ zinc peroxide • Carbamide peroxide is 1/3 concentraion of hydrogen peroxide • 10% Carbamide Peroxide = 3.6% H2O2 • 16% Carbamide Peroxide = 5.6% H2O2

  5. Cosmetic Products Enforcement Regulations 2013- EU Cosmetic Regulations • Replaced cosmetic products (safety) (amendment) Regulations 2012 • Illegal for tooth whitening products which contain more than 6% hydrogen peroxide or any associated products which release greater than 6% hydrogen peroxide to be supplied or administered for cosmetic purposes. • New regulations continue to state that tooth whitening products containing or releasing between 0.1%- 6% hydrogen peroxide should not be made directly available to the consumer, other than through treatment by a registered dentist • Or dental hygienist or dental therapist or clinical dental technician working to dentists prescription • Criminal offence - law responsibility of trading standards and Health and Safety executive.

  6. No one under age of 18yrs • Less than 0.1% still available and freely on the market • Appropriate clinical exam carried out to ensure on risk factors or any oral pathology concerns • Concentrations over 6% available but only for the purpose of treatment or prevention of disease • GDC registrants need indemnity for treatment which they provide- GDC fitness to practice

  7. Case selection • Contraindications to Vital bleaching • Medical- Radiation/ Chemo- melanoma • Pregnant/ Breast feeding- no research • Age- no to under 18’s • Allergy- previous problems • Dental- inappropriate when surface/ thickness or health of enamel compromised • Patient habits- heavy smoking habit due to rapid reoccurrence of discolouration

  8. Patient information • Valid informed consent • Procedure- risk and benefits • Cost • Awareness that outcome relies on patient compliance • Existing restorations- no effect on crowns/ bridges/ dentures- may need replacement- part of treatment plan? • Risk of sensitivity- if experienced often worse at day 3

  9. Clinical records • All aspects of discussion recorded in clinical notes • Record starting shade or take photo with shade tab in photo- patient should agree with shade

  10. Clinical procedure • Take impressions for tray production • Indicate to lab tray extension- vacuum formed splint • Upper and lower? • Indicate teeth to be bleached • Fit- ensure good clinical fit • if not good cervical fit bleaching agent will drain away

  11. Patient instructions • Brush teeth • Match head sized spot of gel to be place din trays towards buccal surface of teeth being bleached( give demo) • insert tray- remove excess gel- cotton wool tip • Do not eat or drink while wearing the trays- • avoid tea/ coffee /chocolate/ tobacco products • Remove after time period, rinse mouth and trays with cold water • Repeat daily for initial 2 week period

  12. Treatment plan If part of a treatment plan wait two weeks after completion of course to allow bond strength to return to normal and shade to stabilise.

  13. Follow up • Review patient to assess results of whitening, record shade achieved • Agreement with patient. • Shade may regress • May last between 1-3 years • Important to ensure patients understand that bleaching is not a permanent treatment • Tooth whitening can be repeated • buy more gels from your practice

  14. Alternatives • Micro abrasion • S+P • Permanent restoration • Do nothing

  15. References • GDC- www.gdc-uk.org/patients/illegal-practice/tooth-whitening • Position Statement on toothwhitening • EmillieMcHantaf- Frequently Asked Questions about Vital Tooth Whitening- Dental Update 2017; 44:56-63 • Almeida, dos Santos-Clinical Evaluation of the effectiveness of Different Bleaching therapies in vital teeth. Int Journal of Perio and Restor Dentistry. Vol 32, No3 2012 • Li. Y, Greenwall L- Safety issues of tooth whitening using peroxide- based materials. BDJ vol 215 no1 Jul 13 2013 • BDA- BDA advice- Tooth whitening. April 2016

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