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 ID: 933203
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Tooth whitening: clinical and legal aspects
Andrew Beattie
Slide2Contents
Introduction and why?
What is tooth whitening?
Legal considerations?
Case selection?
Patient Consent?
Procedure and patient information
Uses of tooth whitening?
References
Slide3Tooth 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
Slide4What 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
Slide5Cosmetic 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.
Slide6No 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
Slide7Case 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
Slide8Patient 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
Slide9Clinical 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
Slide10Clinical 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
Slide11Patient 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
Slide12Treatment 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.
Slide13Follow 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
Slide14Alternatives
Micro abrasion
S+P
Permanent restoration
Do nothing
Slide15References
GDC-
www.gdc-uk.org/patients/illegal-practice/tooth-whitening
Position Statement on
toothwhitening
Emillie
McHantaf
- 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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