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By Julie Deverick

Over the years there has been a noticeable change in patients' behaviour and perception of appearance. This could be attributed to an increasing influence of social media platforms such as Facebook and Instagram and the 'selfie' culture that these platforms have created. Before, dental treatments were by and large a necessity, but now, dentistry seems to be just as much about achieving a perfect smile as it does managing dental health. As such, the profession has seen a sharp rise in cosmetic treatments, with the UK's cosmetic dentistry industry now valued at a staggering £2.2 billion. This is expected to increase by a further 8% by 2021.1

Of all the treatments available, tooth whitening is one of the most popular with patients, with a recent survey showing that nearly a quarter of participants underwent the procedure to improve the appearance of their smile.2 This was using either a home kit, through a dental surgery or at a specialist clinic.

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Of course, what the numbers don't take into consideration is illegal tooth whitening carried out by untrained professionals - a problem which, unfortunately, is becoming an increasingly troublesome issue for the dental profession. In 2018 alone, there were 30 prosecutions for illegal tooth whitening3 resulting in severe fines and a criminal record. There have also been incidences of individuals reoffending despite being prosecuted and fined, even as recently as November 2019, according to a local news story.4

Perhaps it was only natural that a rise in cosmetic dentistry would result in an increase in illegal practice too - after all, there's a lot of money to be made in tooth whitening. Still, there can be no denying that the prevalence of the issue is alarming to say the least and begs a great deal of attention from the profession, particularly in regards to prevention and raising awareness of the risks of illegal whitening.

But first, it might help to understand why patients are putting themselves in harm's way. In many cases, it's likely that a lack of understanding is to blame, as many people are likely unaware that only a registered dental professional is permitted to carry out the procedure.5 The other reason is money. Despite the risks, some patients are happy to cut corners and undergo treatment with an untrained provider if it means they save a few pounds. Interestingly, the worst culprits for this are singletons, with a survey showing that 45% of single adults who had undergone whitening treatments had done so illegally. By comparison, just 12% of people in a relationship sought the unlawful option.5

It might help to understand why patients are putting themselves in harm's way. In many cases, it's likely that a lack of understanding is to blame, as many people are likely unaware that only a registered dental professional is permitted to carry out the procedure. The other reason is money...

Of course, there's no smoke without fire, and the reason why this continues to happen is because untrained professionals think it's acceptable to provide illegal tooth whitening treatments within their clinics. Some sources would argue that not all providers are aware they are breaking the law as many 'undergo a brief training period with an unscrupulous company and then believe they are qualified to carry out the treatment'.5 This indicates that a greater awareness of safe tooth whitening is required across the board - not just by patients - and that more must be done to educate the nation on who is allowed to carry out the treatment.

On a practice level there are a number of measures that can be taken that would help to improve people's knowledge of the subject, including providing educational talks in the community, putting up helpful posters and having one to one chats with patients during a dental visit. Dental hygienists and dental therapists should be trained, competent and feel confident to carry out the treatment, and take the opportunity to teach patients that they are allowed to provide whitening. This is, of course, as long as a dentist has carried out an oral examination first, a prescription has been issued and the dentist is on the premises when the first course of treatment is carried out (if they don't do it themselves). This could help to improve understanding of how whitening is provided and might help to make the procedure seem more accessible to patients if they realise it's not just dentists who provide the treatment.

In the meantime, the British Society of Dental Hygiene and Therapy (BSDHT) will carry on providing advice to the public about tooth whitening and will continue to support dental hygienists and dental therapists in their quest to raise awareness. Illegal tooth whitening isn't likely to be eradicated anytime soon, but with the profession's ongoing efforts it's likely that together we can help reduce the numbers of people receiving illegal tooth-whitening and keep them safe from any potential harm.

For more information about the BSDHT, visit www.bsdht.org.uk.