The Dental Board of Australia (DBA) has released new guidance about teeth whitening for dental practitioners. It clarifies a number of aspects that may previously have been poorly understood or open to interpretation. Dr Simon Parsons, Dentolegal Consultant at Dental Protection, walks us through the changes

The guidance makes note of a number of specific issues, including the need for careful patient selection, the safe supply and use of high concentration whitening products, and awareness of local and national regulations about the management of poisons.

Ensuring patients are suitable for whitening

Dental practitioners have an obligation to ensure that whitening is a suitable treatment for a patient before providing any products for use by the patient, not only in the surgery setting but also when used at home. Dental practitioners are professionally obliged to practise safely and act in the best interests of patients, and the DBA notes that patients should be assessed or examined to enable a determination around their suitability for whitening prior to any whitening procedure, or having products supplied for use at home.

To determine a patient’s suitability, a practitioner must be competent in teeth whitening procedures and patient selection. The practitioner must use his or her professional judgement as to what is best for a patient, and should only perform those procedures for which they have been educated or trained in and are competent to perform. In other words, a practitioner must work within their own scope of practice and have sufficient knowledge to be able to decide if whitening is a clinically appropriate treatment for a patient.

High concentration teeth whitening products are almost always used during in-surgery teeth whitening procedures, and may be supplied to patients for application at home. These products may pose a risk of harm to a patient if misused.

Further, informed financial and clinical consent for teeth whitening procedures must be clearly documented and the proposed treatment able to be justified as being suitable for a patient.

How to ensure compliance

Dental Protection recommends that any:

 • Clinician who has not been appropriately trained or educated in teeth whitening procedures, or the assessment of patients for their suitability to have this performed, should not supply teeth whitening products for home use, nor perform in-surgery whitening procedures 

• Patient wanting to undertake in-surgery or take-home teeth whitening first undergo a clinical examination, if this has not occurred within a recent and clinically appropriate timeframe

• Teeth whitening treatment has clear and thorough consent documentation around the risks, benefits, limitations, costs and any other issues relevant to a patient’s care. 

 

No specific restriction on the concentration of teeth whitening agents for home use

The DBA’s guidance does not specifically state that practitioners may only supply products up to a maximum concentration of 6% hydrogen peroxide or 18% carbamide peroxide for use by patients at home. Rather, it advises that only registered dental practitioners can use, supply or sell high concentration teeth whitening products (having a concentration greater than 6% hydrogen peroxide or 18% carbamide peroxide). These products are S6 substances under the current Poisons Standard. 

To ensure compliance, ensure that:
• Where high concentration teeth whitening agents are to be supplied and sold for home use, this only occurs under the specific instructions of a dental practitioner, and are not simply sold to a person over the counter upon request

• Clinicians document that a patient has been examined and deemed suitable for the treatment

• Appropriate instructions are provided to patients outlining the safe use, storage and disposal of these products, including guidance around keeping these products out of the reach of children.

Be aware of all applicable requirements under state and federal laws and regulations  

The DBA refers to the Poisons Standard, state and territory medicines and poisons laws, Australian Consumer Law, the Therapeutic Goods Administration’s advertising requirements and the Health Practitioner Regulation National Law’s advertising requirements in the new guidance. They note that dental practitioners must be aware of the medicines and poisons laws that apply in the state or territory of their practice, and should be aware of any obligations they may have for ensuring any supplied products are of acceptable quality. Additionally, anyone advertising teeth whitening products must comply with all regulatory requirements.

To ensure compliance, Dental Protection recommends that all dental practitioners who use, supply or sell teeth whitening products be familiar with the:

• Relevant laws and regulations that may apply to their location and circumstances. This will assist the dental practitioner in understanding the requirements for the supply, storage and disposal of these products, as well as any obligations they may have as a supplier to a consumer.

• Advertising regulations and restrictions on advertising controlled substances, including those relating to advertising a therapeutic good, advertising a regulated health service, and general advertising requirements under the National Law.

Further information

Dental Board/AHPRA, Guidance for registered dental practitioners: Using and supplying teeth whitening products

Dental Board/AHPRA, Communiques