In April 2013, I became coordinator of the Tooth Whitening Information Group (TWIG) while continuing my own role as dental advisor and media spokesperson for the British Dental Health Foundation. This is an ideal role for me as I am passionate about oral health and educating the public on how to safely improve the appearance of their teeth using minimally invasive methods.
The TWIG was originally the ‘brainchild’ of Mhari Coxon (dental hygienist and senior professional relations manager for Philips Healthcare), who was concerned about the problems of unqualified persons carrying out tooth whitening and the many suspect tooth whitening products that are available. She approached Nigel Carter (chief executive of the British Dental Health Foundation) to how best to raise awareness of the issue and stop members of the public from potentially having their teeth damaged by this.
There has been plenty of bad press concerning the dental profession and tooth whitening, largely circulated by the 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 whole profession was just trying to stop the ‘little guy’ from earning a living and the concerns are not about public safety.
As the British Dental Health Foundation are a self-funded, independent and public-facing charitable organisation, it was felt that by Nigel Carter taking the lead on the campaign, the public would be able to trust that the information being given was impartial and without bias. Thus the Tooth Whitening Information Group was born. It is made up of members of dental professional bodies and representatives from leading manufacturers including:
- Members
- British Dental Health Foundation
- British Dental Association
- British Society of Dental Hygiene and Therapy
- British Academy of Cosmetic Dentistry
- British Association of Dental Nurses
- British Dental Bleaching Society
- British Association of Dental Therapists
- Representatives
- British Dental Trade Association
- Philips Oral Healthcare
- Henry Schein
- SDI
- Dentsply
- Voco
- Enlighten
- WY10
The main aims of the Tooth Whitening Information Group are:
- To protect the public and provide information on how to achieve safe tooth whitening with effective and long-lasting results.
- To support official bodies to prosecute unqualified people carrying out illegal tooth whitening, and companies that sell illegal and harmful products.
So where are we now? Well after 18 months of working the equivalent of one day a week on the campaign, whilst continuing with my own role, we feel that we are slowly making headway.
Last August the TWIG website (www.safetoothwhitening.org) was launched. This website was written by the team at the British Dental Health Foundation and built by our in-house website officer. We are very pleased with the reception the website has received, if you have not had a look already, I urge you to do so as it could be a useful
resource to direct patients to, to explain tooth whitening and the law.
The website is regularly updated with news and any other developments. Also on this website, you can report anyone you may suspect of carrying out illegal tooth whitening or suspect products which you may have come across.
The problem
As the problem is two-fold, it depends on whether the report is about a person or a product as to where we send the report onto.
If the report is concerning a person suspected of providing illegal tooth whitening, we would initially try and find out a little more using the internet and social media.
We will then send all of this to the General Dental Council.
Following the High Court ruling of May 2013, all confusion about who can provide tooth whitening has been cleared-up. Tooth whitening has been ruled the act of dentistry, and as such cannot be provided by anyone other than a dentist or a dental hygienist on the prescription of a dentist.
Some beauticians that are using pre-filled trays claim that as they are not touching the client, this ruling does not apply to them, however by prescribing and administering the tray to the client, they are still deemed to be practising dentistry, therefore it is illegal. The GDC will then out a warning letter explaining the law and asking the individual to stop their illegal practice. If they do not stop, more evidence is gathered and further legal action could result. We are seeing many more cases being brought by the GDC against people carrying out illegal tooth whitening. The GDC have won every case that has gone to court in regard to this problem.
In a case at Bromley County Court in October, Caroline Sumpter, a beautician, asked for her money back from Megawhite following a warning letter from the General Dental Council. Brian Christie, of Megawhite refused claiming that she was not doing anything illegal. During the case the judge was very clear that the process is deemed to be the practice of dentistry, including:
- Selling the packet
- Operator (beautician/whitening technician) taking a shade
- Operator telling client to read the packet
- Operator taking client to a seat
- Operator giving laser goggles, setting the time on the lamp and putting it in front of the client’s mouth
- Operator then removing the expelled mouth tray and goggles
- Operator taking a post-treatment shade
Ms Sumpter represented herself in court and was awarded her money back and her costs. Several members of TWIG were able to give Ms Sumpter advice and information on how to best to get the information across to enable her to win her case. She has been hugely grateful for the input that TWIG was able to give.
Education
I have a certain sympathy with the beautician that had been unwittingly been ‘sold’ a tooth whitening course by an
unscrupulous provider. It is the beautician/illegal provider who is not only risking their reputation but also the possibility of a criminal record and a fine, not the person who provided the training or the products.
Therefore TWIG is committed to working with the beauty industry to educate non-qualified persons from parting with their hard-earned cash for a training course which could leave them open to prosecution. I have had articles published in several of the beauty industry professional magazines, including The Beauty Guild and British Association of Beauty Therapy and Cosmetology (BABTAC) explaining why tooth whitening is a dental procedure and why it should not be carried out by anyone other than a dentist or a dental hygienist, on the prescription of the dentist.
We also intend to put together a training package for schools and colleges providing beauty therapy training and we have been in contact with the main providers of this training, such as BTEC and City and Guilds. We feel that if we
can educate the beauty therapists of the future they will not be conned into attending one of the very expensive tooth whitening training courses.
It is amazing when you have a conversation with someone who is either thinking of or is providing illegal tooth whitening about the problems and effects that this so-called simple, ‘cosmetic’ procedure have not only for the person having the procedure, but also for the provider. I speak to them about the importance of taking a full medical history and what implication not doing so could have, for example, the lady that telephoned the British
Dental Health Foundation’s Dental Helpline following a tooth whitening procedure at her local hairdressers. She is a type 1 diabetic which, as no medical history questions were asked in her consultation, was not noted; the provider then proceeded to over-fill the non-custom made tray, the chemical (which is unknown) then liberally covered the gums during the treatment causing chemical burns to this poor ladies gums and lips. Obviously being a type 1 diabetic she is slow to heal, which meant she was in discomfort for several weeks.
When I discuss the issue of cross infection and HTM 01-05 it genuinely seems that this has never crossed their minds that not only could they passed infection to their client, but possibly worse, the client could pass infection to
them! By the time I get to hepatitis B vaccinations they are usually hanging up their ‘laser’ lamp and ditching the ‘high quality’ nonperoxide, whitening gel.
Suspect products
Anyone who has ever looked online for tooth whitening products will be met with array of products, the majority claiming to meet the European legislation and containing 0.1 per cent hydrogen peroxide, as we all know this
amount of peroxide will not have any effect on the natural colour of the teeth and at best may remove staining on the teeth, however there are lots of products which are available to the public which contain significate levels of
hydrogen peroxide and carbamide peroxide.
Suspect products can be reported to the local Trading Standards office of where the company supplying the product is trading, however as the majority of the suppliers are based overseas, they are not in the jurisdiction of Trading Standards. On the website www.safetoothwhitening.org there is a clip from the BBC television programme Fake Britain where one UK based supplier was eventually brought to justice.
This supply of counterfeit products is also a problem for many of the legitimate manufacturers of tooth whitening
products. There are many of the largest manufacturer’s products available to purchase over the internet, as the supply chain is extremely difficult to trace, there is no guarantee that these products are the genuine article or a fake. They could therefore be detrimental to the health of the teeth and gums and also damage the reputation of the manufacturer.
As the laws on tooth whitening differ outside of Europe, tooth whitening products which contain over the UK legal limit of 0.1 per cent are often obtained by the wholesale suppliers from a source outside Europe to sell to the UK market via the internet.
Unfortunately, as soon as one website is closed down, another is opened and so on…
So again, we are looking towards educating the public of purchasing non-verifiable products over the internet not only can their efficacy not be guaranteed, the very high percentage of hydrogen peroxide is potentially harmful to the teeth and gums.
If we can provide this information and the warnings about these illegal products perhaps we can reduce the demand and protect the public this way. To this end we are preparing articles for the ‘lifestyle’ type magazines, explaining
about how to safely improve the appearance of your teeth and the laws surrounding tooth whitening.
The future
We have never thought of this as a short-term project and TWIG will continue to work away and in the coming year, funding permitting these are the areas that we are looking to pursue.
We are looking to test suspect produces which we can then pass onto Trading Standards which, hopefully will lead to prosecution and removal of this product from sale.
Produce Infobites on tooth whitening to explain how to safely and legally whiten your teeth.
Continue to work with the beauty industry, schools and colleges to educate beauty therapists of the implications of illegal tooth whitening.
Continue to liaise with the GDC and Trading Standards by collating report forms from the website.
Attend dental exhibitions to inform the dental profession of the progress so far and how we intend to move forward.
Following the Judge’s comments concerning the use of pre-loaded trays and his ruling that this is the act of dentistry, we should be able to move forward with the other companies which are selling this type of service to unqualified persons.
The Tooth Whitening Information Group remains committed to putting a stop to illegal tooth whitening and the supply of legal tooth whitening products. On our website you can sign up as a supporter of the campaign. By signing up as a supporter this will allow us to send you regular updates on how the campaign is moving forward.