Q. I am keen to involve my hygienist in providing tooth whitening in the surgery for our patients and the GDC has recently indicated that hygienists can perform the procedure. My hygienist, who has seen me perform the procedure on many occasions over the years and I feel that she is perfectly capable of doing this safely if she attended a suitable course. I wonder if her experience at the chairside constitutes adequate training or does she need to attend a course?

Can you also tell me what information would I need to put in a prescription for her to provide this treatment legally?

1. Irrespective of who is undertaking the treatment, the whitening of teeth using hydrogen peroxide in a concentration of more than 0.1% still remains illegal within the UK and is likely to continue to be for some significant time yet. This means that the dentist who writes the prescription for such a procedure and the DCP carrying it out do leave themselves open to prosecution by the local Trading Standards Office. That prosecution, if successful, could lead to the possibility of a £5,000 fine and/or two years in jail. This of course would be followed by a referral to the GDC and the possibility of removal from the register. This has been the case since 2002 and to the best of our knowledge there have been no prosecutions of any dental professional during that time. The risk however is not insignificant and does need to be considered carefully.


2. It is Dental Protection's view that a prosecution is less likely when the clinician concerned can demonstrate that bleaching is in the best interests of the patient. To a certain extent this is the dentist's responsibility as it will be s/he who will be writing the prescription. It could also be argued that any hygienist or therapist that carries out that prescription also has a duty of care and must therefore satisfy themselves that the treatment being undertaken is appropriate and in the best interests of the patient when balanced against the other treatments that may be possible (including no treatment at all).


3. The maintenance of records is most important as it helps demonstrate the conversations and discussions that may have taken place and therefore confirms the consent process. The more information contained in the records, the easier it is to defend a dentist's or DCP's actions should the need arise.


4. There is no set format for the wording of a prescription written by a dentist for a DCP.  Dental Protection suggests that the prescription should contain sufficient information for the DCP to understand precisely what treatment is being proposed and allow them to satisfy themselves that that treatment is in the patient's best interests. This would include a brief description of the treatment to be undertaken, the concentration of the active ingredient and how the procedure is to be carried out (ie, home bleaching, in-surgery bleaching, etc). There may be additional requirements that reflect the nature of that treatment such as the need for impressions, blocking out, etc. This should be clearly stated. It is not necessary for the prescription to detail the bleaching technique to be used once the DCP is experienced with this type of treatment, although the need for follow up treatment (of any type) should be clearly stated. In short, the information contained within the prescription should be sufficient to ensure that the DCP is left in no doubt as to what treatment is to be carried out, how it is to be carried out and when it is to be carried out.


5. Perhaps the most difficult aspect for a DCP is the ability to demonstrate that they have received the necessary training to carry out this treatment. The GDC have offered no guidance in this respect and therefore it is open to interpretation. It seems logical to assume however that a DCP should attend a recognised training course before undertaking a number of treatments initially under the direct supervision of a dentist, and latterly on their own with the dentist merely checking and assessing the outcome. A record (perhaps a logbook) should be kept of this period of supervised training. In addition it might be useful to demonstrate that the process and outcome had also been audited from time to time.

Dental Protection's position statement on tooth whitening by DCPs is available here;
Bleaching and Tooth Whitening by DCPs