Sir, in view of the recent Trading Standards review of over-the-counter (OTC) tooth whitening products, the GDC's declaration that tooth whitening can only be performed legally by a registered dentist and EU report on 'hydrogen peroxide, in its free form and when released, in oral hygiene products and tooth whitening products', it becomes clear that we need to address the situation regarding this procedure.

A recent survey conducted on behalf of the British Academy for Cosmetic Dentistry (BACD) (downloadable from http://www.bacd.com) revealed that a third of the population is concerned with the look of their teeth. Also, since the smoking ban came into force in England last summer some of our members have reported a 40% increase in the demand for whitening treatment.

However, Trading Standards discovered that 18 out of 20 tested DIY tooth whitening kits contained illegal levels of hydrogen peroxide. There are even whitening kits from abroad on the internet that contain acids/abrasives that permanently damage teeth.

Their advice to anyone seeking this treatment is to consult a qualified dentist who will provide a comprehensive service and ensure that there are no underlying oral health issues like periodontal disease.

This supports the findings of the EU report which found that products containing over 6% hydrogen peroxide were unsafe for patients to apply on their own (we expect Trading Standards to crack down on those supplying potentially harmful products). However, products with between 0.1% and 6% hydrogen peroxide carry less potential risk only after clinical examination.

This is also important because of the correlation between oral and systemic health. For instance, someone seeking to improve their smile might in fact be inadvertently taking steps towards preventing cardiovascular disease, bacterial pneumonia, diabetes mellitus, etc. OTC products prevent consumers from getting an accurate and complete diagnosis.

It is our belief that all OTC whitening products containing over 0.1% hydrogen peroxide should be banned outright and that this is enforced to include products offered on the internet. Proper whitening techniques should be taught in dental schools to ensure that every practitioner understands the principles and whitening procedures should be carried out only after examination by a dental professional. Self-administered treatments are dangerous and counter-productive, and whitening toothpastes are ineffective. We should familiarise ourselves with the latest techniques and recommendations, advise our patients of their options and inform them that some of the OTC products cause sensitivity and gum ulceration, and at best do not work at all.