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GDC changes position on bleaching teeth for under-18s

05 Jun 2014

Dental bleaching to correct discolouration of teeth prevents the need for destructive removal of sound tooth structure. However, up until now, the interpretation of EU legislation has effectively prohibited the use of scientifically proven, safe, low concentration bleaching products from being used for patients under the age of 18.

Common causes of tooth discolouration include trauma, inherited dental conditions, or the swallowing of medicines while the adult teeth are developing. Opacities (white patches) on the tooth surface are among the commonest type of enamel defect.These can be caused by a variety of prenatal, neonatal or childhood illnesses. Chickenpox, asthma and pneumonia have all been linked to enamel defects as well as to the use of some antibiotics.

In a recent paper, entitled: The law is an ass: legal and ethical issues surrounding the bleaching of young patients’ discoloured teeth' published by the Faculty of Dental Surgery, which is a part of the Royal College of Surgeons, Martin Kelleher, a Consultant in Restorative Dentistry at King’s College, London wrote that `paediatric dentists have an important ethical and legal duty of care to young patients. Yet, when it comes to considering dental bleaching for under-18s in the UK,  serious dilemmas have arisen from various European Community (EC) directives and how they are interpreted.’

The paper raises concerns regarding the psychological impacts of discoloured teeth on young patients. It says that though young patients may understand the reasons for their dental discolouration, it is often a different story among their peer group. Discolouration can be perceived as showing a lack of ‘dental grooming’ or ‘personal hygiene’ and can become a major cause of bullying and unhappiness in vulnerable young people.

However, this week, the GDC has updated its guidance after two years of campaigning by senior dentists. This means that practitioners will now be able to provide dental bleaching treatment for diseased teeth in patients under the age of 18, without fear of disciplinary action by the GDC.

In a revised position statement on their website the regulator states: ‘Products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for the purpose of treating or preventing disease.’

Martin Kelleher, Consultant in Restorative Dentistry at King’s College, said:

'It has always seemed perverse to many that dentists are continually encouraged by  academic and regulatory authorities to use ‘evidence-based dentistry’ and yet when there is overwhelming evidence of  the safety, efficacy and appropriateness of low concentration dental bleaching, dentists were told not to use it on under-18s. I am glad that this unscientific position has been revised so that all patients, irrespective of age, can benefit from safe and effective treatment of their discoloured teeth in a regulated environment.’

Kathy Harley, Consultant in Paediatric Dentistry and Dean of the Royal College of Surgeons Faculty of Dental Surgery, said:

`Finally common sense has prevailed. As professionals we have a duty of care to provide the best possible treatment for this deserving group of patients while protecting their teeth from unnecessary harm.’


Notes to editors

The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808.

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