Whiter than whitening
Dental professionals are continuing the fight to prevent beauty salons illegally carrying out the popular procedure. But more has to be done to stop customers being ripped off, finds Stewart McRobert
When it comes to illegal tooth whitening there are still too many grey areas. That’s one of the claims made by individuals involved in efforts to make sure that this dental procedure is carried out only by those qualified to do so.
Until May 2013 the law had been somewhat vague. However, in a case brought by the General Dental Council (GDC) to the High Court in England, the ruling was made that tooth whitening constituted the practice of dentistry and therefore a non–dentist was prohibited from providing it by section 38 and section 41 of the Dentists Act 1984; and the general public had to be protected from receiving treatment from those not qualified to give it.
Previously, an EU directive of October 2012 had set out who can use what strength of product when carrying out tooth whitening. This meant that effective products could only be sold to dentists.
Despite these developments, unscrupulous companies have provided – and continue to provide – illegal and/or ineffective tooth whitening products direct to the public, or to beauticians to sell on to the public.
Beverley Carlyle has been an active campaigner against illegal tooth whitening for the past three years. Now based in Lisburn, she is a former dental nurse and practice manager. She first came across the subject when she worked in a large private practice in Edinburgh.
“A company nearby provided tooth–whitening services. I knew it was illegal so I contacted the GDC who asked if I had any evidence of any harm being perpetrated; because I had no evidence I was told they could not do anything about it.”
Determined not to let the matter lie, Beverley and her colleagues decided they would do what they could to start educating people about potential dangers. “If a patient asked about teeth whitening we would discuss it with them, advise them not to use a beauty parlour, and tell them why.”
In February 2013, she created a Facebook page, initially to get the message out to friends and family. However, within three days 1,000 people had signed up to the page and within three months that figure had risen to 2,000.
Since then she has been asked to speak at dental shows and write articles for dental magazines.
She believes the GDC and Trading Standards should be co–operating more fully and taking action to confiscate tooth–whitening materials even if they are within EU limits, that is below 0.1 per cent hydrogen peroxide. “That shouldn’t matter since the law says that to provide tooth whitening you must be a registered dental professional.
“If they aren’t going to be selling the products for the customer to take home and if they intend on providing the services on their premises, then the products should be confiscated.”
She urges dentists and the GDC to get local authorities involved. “When a business applies to open a premises, councils should ask about its nature – if tooth whitening is involved and the business is not a dental practice, they need to be told it’s not legal. In the same way, shopping centres can help prevent illegal pop–up tooth–whitening services.”
While the vast majority of dentists offer a tooth–whitening service they often face questions about costs – patients don’t always appreciate a service that comes with professional expertise and regulation. Beverley added: “Dentists contact me and ask about training their reception staff. I recommend talking about the issue of whitening, whether patients have seen articles in the press or on TV and explaining why beauty salons are able to charge such low prices.”
Understanding and experience
Training is a topic close to the heart of Andrew Wallace, who owns a practice in Lisburn. As well as general dentistry he takes referrals for prosthesis, orthodontics, endodontics, and restorative work. Notably, he has been described as a “key opinion leader” when it comes to tooth whitening.
He said: “Most newly qualified dentists receive no training in tooth whitening. Most of their understanding comes from colleagues, from on the job experience or from manufacturers – rarely do they get the chance to undertake independent training.
“That’s unfortunate since tooth whitening is probably the most frequently requested cosmetic procedure dentists do.”
As well as more training for dentists, Andrew proposes greater support for bodies such as the Tooth Whitening Information Group (see page 21) to make sure that they have the necessary funds, resources and people.
He called for clarification about the role of regulatory bodies, citing his own experience with the Regulatory and Quality Improvement Authority (RQIA), which regulates and inspects dental practices and beauticians, if they operate laser equipment, in Northern Ireland. He had informed the organisation about a company offering tooth whitening but also displaying the RQIA logo. He discovered they could take no action because of complex rules about where the whitening was taking place. “The relevant bodies should be giving dental practices clear information about responsibilities so we know what to report, and to whom, and what outcomes we should expect.”
Naturally, the topic is one that concerns the British Dental Association (BDA). Its Northern Ireland Director, Claudette Christie, said: “Tooth whitening needs to be carried out safely and in the best interest of patients and only dental professionals registered with the General Dental Council are allowed to carry out such treatments.
“Non–dental professionals are not trained to consider a patient’s wider health and detect problems, such as gum disease, that could impact on their suitability to have their teeth whitened.
“That is not the only concern as some illegal whiteners are using inappropriate and dangerous chemicals, such as sodium perborate, which is banned by the EU.”
She said the BDA is pleased to see more cases being successfully prosecuted in the courts, but the instance of repeat offenders indicates that the fines imposed are insufficient to stamp out illegal tooth whitening. The fines should reflect the profits made from unsafe and illegal tooth whitening, and imprisonment should be considered to deter persistent offenders.
Claudette added: “The BDA would also urge local trading standards officers to take robust action against suppliers of illegal whiteners.
“The GDC can take firm action, but only if anyone who suspects that tooth whitening is being carried out illegally reports this matter to them.
“The beauty industry needs to ensure that its members, and those who train them, are aware that providing tooth–whitening treatments can only legally be carried out by a registered dentist or dental care professional.”
This point chimes with the views of Beverley Carlyle who emphasised the need to prevent tooth–whitening companies having a presence at beauty shows, as well as the role beauty schools and colleges can play in advising beauticians about the law.
One of those with direct experience is Caroline Sumpter, a former beautician who now campaigns to eliminate illegal whitening. In 2014 she was successful in gaining compensation from a firm named Megawhite which had sold her a tooth–whitening kit. She had signed up for the kit at a beauty show, but after having then been told by the GDC that she was offering an illegal service she took Megawhite to court and is continuing to help beauticians who seek her help. “I get contacted every week by people who have been ripped off,” she said.
“I’ve created a petition on the government website to try to stop teeth whitening companies from selling to non–dentally qualified people.”
She is also concerned about lack of control in the beauty industry. “Anyone can set up as a beautician. There needs to be enforced regulation for beauty salons and people supplying beauty services from home. That would safeguard the public and protect the beauticians – some of those I’ve been helping are young single mums who may have invested £4,000 – £5,000 to get tooth– whitening products and found they can’t use them.”
One thing is clear. Illegal tooth whitening harms more than patients and dentists, but co–ordinated and sustained action could help stamp out this dangerous practice.
TWIG supports safe practice
“We encourage anyone who suspects unsafe and illegal tooth whitening is being carried out to report it the General Dental Council.” That’s the advice from Karen Coates, co–ordinator of the Tooth Whitening Information Group (TWIG).
The Group was formed after the European Council’s directive on tooth whitening, released in October 2012. Leading dental bodies came together to promote and ensure safe legal tooth whitening.
Karen added: “There has been plenty of bad press concerning the dental profession and tooth whitening, largely circulated by the unsafe and illegal tooth whiteners and ’training’ establishments.
“This is centred on their idea that tooth whitening is a simple, cosmetic treatment that anyone can undertake after a few hours training. There is also the ill–conceived perception that the dental profession just wants to keep this ’nice little earner’ for themselves and the profession was just trying to stop the ’little guy’ from earning a living, and the concerns are not about public safety.”
That view is certainly not shared by the authorities. Previously, if a member of the public reported injury or damage following illegal tooth whitening, those responsible could face fines limited to £5,000. However, there is now no upper limit to the fine a court can impose.
TWIG’s members support that more robust stance. They include the British Dental Association, the British Dental Health Foundation, the British Society of Dental Hygiene and Therapy, the British Academy of Cosmetic Dentistry, the British Association of Dental Nurses, and the British Dental Bleaching Society. Dental industry representatives include the British Dental Trade Association, Philips Oral Healthcare, Henry Schein, SDI, Dentsply, Enlighten and VOCO.