Here’s a guest post by Dr.James Goolnik – his views not mine!
1. My defence organisation covers me to carry out whitening procedures?
Not all defence organisations are created equal. Dental Defence Union charges you double fee if you plan to carry out tooth whitening. Dental Protection does not charge you any extra. I would advise you give your organisation a call before you start offering whitening to confirm if there is any extra fee. I heard from a hygienist that her enterprising dentist paid her £150 fee as he sees the long term benefit both in terms of patient care and financially of her carrying out his tooth whitening.
2. The higher the percentage peroxide the quicker the result.
This is not true – the higher the concentration the more likely the patient will have sensitivity and the colour will rebound i.e. fade from the end of treatment colour. 10% carbamide peroxide is the gold standard to offer your patients – you have to have a good reason to stray from this tried and tested formula that works.
3. Tetracycline stained teeth do not bleach.
Tetracyline discolouration is only found in the dentine. It can be successfully treated but it needs a dedicated patient. It often requires a prolonger course of home whitening of around 3 months.
4. One day hands-on course is enough to offer teeth whitening to your patients.
This will get you started but to grow your confidence I would advise to start with two treatments initially under the direct supervision of a dentist. Get the dentist to check isolation (if carrying out surgery whitening) and check the fit of the trays (if doing home whitening). Then they check the outcome of these two procedures. The second stage is five procedures on their own with the dentist merely checking and assessing the outcome.  A logbook should be kept of this supervised training period.  In addition it might be useful to demonstrate that the process and outcome had also been audited from time to time.
5. Peroxide does not go near the pulp.
Peroxide placed directly on the teeth has been found to be in the pulp within 15 minutes. It causes a mild inflammatory reaction which leads to some mild discomfort for the patient.  The pulp suffers no irreversible damage and there have been no reports in the literature of pulpal dead even with prolonged exposure to carbamide peroxide.
6. I am ok the dentist referred the patient to me.
You have a duty of care to the patient and have to act “in the patients best interests” no matter what the dentists prescription states. You both have a duty of care to the patient.
7. Crest white strips are not a good idea.
Crest white strips are great, they get patients to start to thinking about improving their smile. They whiten the anterior teeth and then notice the posterior teeth are still the old colour and then visit their dentist to get their back teeth bleached. They also notice old fillings and crowns that they would like replaced. At present you cannot buy these other the counter like in the States as they contain 6% hydrogen peroxide. That is sure to change.
8. Post op sensitivity cannot be managed and you just have to deal with it.
If we get patients who have sensitive teeth that want to whiten them we make them custom fit trays and fill them with a product containing Potassium Nitrate twice a day 30 minutes a time for 2 weeks prior to the bleaching. In the UK two such products are Relief gel by Discus Dental and Sensodyne total care extra fresh by GSK.
9. I will get sued by the GDC if I offer tooth whitening to my patients.
The General Dental Council protects the public by regulating dentists and dental care professionals. They are not interested in you unless you are practicing unregistered, or beyond your skill or training. The local trading standards officers are the ones that enforce the 1996 Cosmetic Product (Safety) Regulations. One of the board of directors of the British Dental Bleaching Society recently met a trading standards officer and they reinforced the fact that they were ONLY concerned with teeth whitening products freely and directly available to the consumer. That means over the counter (OTC) products. He is not concerned with teeth whitening treatment supplied and supervised by a dental care professional.
10. If anyone rings up and asks what percentage products we do not tell them.
You should not hide what services you offer. I would suggest saying you offer all types of tooth whitening in your practice, the application, dose and timings depend individually on each case. It depends on starting colour of teeth, what type of stain – extrinsic or intrinsic, what colour they are looking to achieve and in what time frame. We do say we offer power whitening containing 25% hydrogen peroxide. It is administered by a dental professional whilst they are in the controlled environment of the dental practice.
Dr. James Goolnik is Vice-President of the British Academy of Cosmetic Dentistry and has set up a company “Smiles by James” to specifically training hygienists and therapists. Based in central London they will spend a full day learning theory of tooth whitening and then hands-on practice of both power and home whitening. Please see www.smilesbyjames.co.uk for further details and to book.