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News Bulletin : ADA News Bulletin May 2011
28 MAY 2011 THE CURRENT STATUS of teeth whitening in Australia committee report The conviction of a Victorian beauty therapist for the illegal practice of dentistry was highlighted in the News Bulletin (October 2009). The conviction was as a result of a complaint from harm caused following a teeth whitening procedure in a beauty salon. The charge was brought against the beauty therapist after a customer who received teeth whitening complained of severe tooth mottling, a marbled colouration of her teeth, ulcerations of her oral soft tissues, and chemical burns. This trial was the first time that the legality of teeth whitening was considered by an Australian court. The court case brought to light a range of matters which distinguished the standard of patient care provided in a dental practice to a patient having an in-office teeth bleaching procedure compared to a client who had a procedure undertaken by a beautician. The range of matters included: • Recognition of the causes of the patient's problem and the selection of appropriate treatment; • Awareness of the composition of bleaching products and their mechanisms of action; • Understanding of the legal obligations imposed by using a regulated hazardous material in the mouth of an individual; • Recognition of adverse effects and the timely application of measures to prevent and reverse these; and • Standards of care in terms of infection control, isolation and protection of soft tissues, and environmental hygiene. KEY LESSONS FROM THE CASE Key lessons from the case were the importance of proper diagnosis and informed consent; the consequences of failure to follow recommended safe operating procedures to prevent soft tissue injury; and the benefits of having an antidote (Vitamin E) ready for use to reverse soft tissue irritation to the oral and peri- oral tissues. DENTAL BOARD OF AUSTRALIA INTERIM POLICY ON TEETH WHITENING/BLEACHING On 12 November 2010, the Dental Board of Australia released an Interim Policy on Teeth Whitening/Bleaching, which stated that teeth whitening/bleaching is an irreversible procedure in terms of its actions on human teeth, and that any teeth whitening/ bleaching products containing more than 6% concentration of the active whitening/bleaching agent, should only be used by a registered dental practitioner with education, training and competence in teeth whitening/bleaching. The identification of 6% as a concentration threshold aligns with the definition used by WorkSafe Australia for the hazard classification of hydrogen peroxide. The explicit statement of bleaching being an irreversible procedure in terms of its actions on human teeth was a critical point in terms of this procedure falling under the legal definition of the practice of dentistry in the 2009 Victorian case. The Dental Board of Australia has stated that it "continues to examine these issues further within its mandate of public protection", which is an important statement given that a number of beauticians continue to offer a teeth bleaching service on an opportunistic basis to members of the public. ADVERTISING CLAIMS A particular concern to practitioners has been claims made in advertising that the treatments from beauticians are equal or better than those delivered in a dental practice. It is noteworthy that promotional materials for products used by beauticians do not have to pass the TGA requirements for therapeutic claims, since most low concentration peroxide products are classified at the present time as 'cosmetics' rather than 'devices'. This unusual situation has been exploited by some manufacturers who claim that their whitening treatment "offers the best teeth whitening available", "produces superior results to other teeth whitening options", or words to that effect, surpassing professional in-office treatments, home gels and even laser whitening. A search of the published literature will quickly reveal that such statements come from an 'evidence-free' zone in that there are no peer-reviewed clinical studies indicating any benefits (let alone superior benefits). Quite correctly, matters of false and misleading advertising are handled through ACCC. CONCLUSION It is likely that current cases of individuals who have sustained damage to their hard and soft tissues from teeth whitening undertaken by those who are not dental practitioners will in due course come before the courts. It is important that all dental practitioners remain vigilant for patients who may have been injured through such treatments and document them as well as providing appropriate care. The ADA continues to emphasize to the public that only dental professionals have the skills, knowledge and training to deliver this form of dental treatment safely. Caveat emptor! Laurence J Walsh The University of Queensland On behalf of the Oral Health Committee See ADA Inc. website FAQ on a comparison of products used by dentists, non-dentists and over the counter products.
ADA News Bulletin April 2011
ADA News Bulletin June 2011