The application of bleaching agents to lighten the colour of teeth is an accepted and common dental treatment modality. The process can be undertaken:
- In the dental clinical environment utilising a bleaching agent alone or in combination with some form of energy to accelerate the effects of the agent, or
- At home by the patient under the instruction and ongoing monitoring of the prescribing dental practitioner, or
- A combination of the above.
The active bleaching agent in teeth whitening procedures is hydrogen peroxide. Some products contain hydrogen peroxide in its base form while others contain carbamide peroxide. The latter ultimately achieves its effect by generating hydrogen peroxide as the active agent.
The use of bleaching agents is not without risk, especially in high concentrations. Possible adverse effects may include:
- Irritation or burning of exposed skin, eyes and mucous membranes
- Oesophageal and stomach irritation on ingestion
- Inflammation of the dental pulpal complex.
The Dental Board of Australia has published a factsheet: Dental Board of Australia – Guidance for registered dental practitioners: Using and supplying teeth whitening products
which refers to the role of the Therapeutic Goods Administration (TGA) and the role of the Australian Competition and Consumer Commission (ACCC) in regulating the sale, supply and use of tooth whitening products. The factsheet describes what the DBA expects of dental practitioners who use or supply tooth whitening products in their practice.
The effects of the positions outlined by the DBA, TGA and ACCC are as follows:
- Teeth whitening products containing more than 18 per cent carbamide peroxide or more than six per cent hydrogen peroxide may only be sold, used or supplied by registered dental practitioners as part of their dental practice
- Dental practitioners, are not permitted to provide take-home teeth whitening kits to patients that contain more than 6% hydrogen peroxide or more than18% carbamide peroxide
- Advertising of tooth whitening products containing the above concentrations of active ingredient is regulated and, in most States and Territories, prohibited
- Registered dental practitioners can perform teeth whitening in chair using any concentration of hydrogen peroxide/carbamide peroxide in accordance with the DBA’s regulatory Codes, Policies and Guidelines including the Scope of practice registration standard
Advisory Services offers the following general comments to practitioners undertaking teeth whitening/bleaching procedures for their patients:
- Ensure an appropriate pre-treatment assessment has been undertaken to minimise the risk of adverse outcomes such as pulpal irritation
- When using heat or other forms of energy to accelerate the action of the active agent, take all possible care in applying such energy so as to avoid pulpal damage and burns to adjacent soft tissues
- Undertake an appropriate informed consent process which canvasses options and discusses advantages, disadvantages and risks of the proposed procedure
- Informed financial consent should also be obtained
- Ensure information is delivered in a non-coercive manner and give the patient time to consider whether they wish to proceed as well as an opportunity to ask questions
- Manage expectations effectively. The outcome of such procedures can be unpredictable, including subtle or dramatic change (and, on occasions, no change at all) and possibly an uneven result. The patient also needs to understand that dental restorative materials will not change colour as a result of the treatment.
For ADA (Federal)  policy (Policy Statement 2.2.8) Teeth Whitening (Bleaching) By Persons Other Than Dental Practitioners updated in August 2022 click here.
