Q. My local gymnasium has asked me to provided bleaching sessions in a vacant treatment room at the site. As this is not the same as providing dental treatment would this be alright?

Your comments might seem to suggest that you are trying to decide whether or not tooth whitening is deemed to be an activity regulated by, for example, CQC. As you may already be aware the regulated activities which commonly apply to dentistry are: diagnosis and screening, treatment of disease, disorder or injury and surgical procedures.

On first glance it would appear that this is not a regulated activity in itself, but it is important to consider the bigger picture. In order for a dentist to be in a position to carry out tooth whitening, they would first need to carry out the appropriate examination and make a diagnosis and take the patient appropriately through the consent process. As I am sure you may already be aware, a dentist could not provide a treatment without first of all carrying out an examination and making a diagnosis.

We also need to consider the circumstances in which the treatment is being provided. The GDC has indicated that it takes the view that tooth whitening is the practise of dentistry. In this respect then you would need to have all of the appropriate procedures, protocols and equipment in place. This would include the appropriate cross infection control procedures and the appropriate emergency drugs and equipment. The other issue to consider is whether or not you would be providing treatment for another practitioner’s patient.

Currently, under the European Cosmetics (Safety) Regulations, it is illegal to supply for the purpose of tooth whitening any product which releases 0.1% or more hydrogen peroxide. The local authority has a duty to enforce safety provisions within its area and can initiate its own investigations without being restricted to the need to react as specific complaints. Local authority investigations are usually carried out by a Trading Standards Officer. The Chief Dental Officer of England has indicated that he is taking steps to get the EU regulations changed.

Dental Protection’s view is that the best position for a healthcare professional to adopt is to act in the patient’s best interest at all times:

• Take individual therapeutic decisions in respect of each patient. 
• Avoid advertising the use of tooth whitening products as this may constitute ‘intent to supply the goods’ beyond an individual therapeutic decision. It is also likely to attract unfavourable attention from local Trading Standards Officers. 
• Take advice if you have concerns or are approached by a Trading Standards Officer. 
• If you have concerns about providing tooth whitening products then you should consider delaying treatment until the legal situation is resolved rather than proceeding to provide more destructive techniques. 
• Ensure that patients are fully informed as to the risks and benefits of both bleaching procedures and the more interventive alternatives, including a decision about the current legal status of tooth whitening procedures. 
• Document all consultations carefully in the patient’s clinical notes – this is essential in order to demonstrate that appropriate discussions have taken place with the patient before the procedure is carried out.

There is further information in the following DPL position statement