Under 18’s & Teeth Whitening
Dr. Linda Greenwall talks about the strict guidelines surrounding teeth whitening, and Dr. Rahul Nehra shares how he worked around the legalities to transform an 11-year old’s life with whitening a single tooth.
Teeth whitening, despite its popularity, is heavily regulated in the UK and is an illegal procedure for under 18’s, but what does mean for the kids with white spots on their teeth or a single dark tooth that would get bullied without having whitening?
Dr Linda Greenwall talks us through the key guidelines and how they’re working to change them.
There are several issues revolving around under 18’s teeth whitening. These days there is an increase of 20 to 40 percent of children who have white spots on their teeth. This means we as dentists are faced with the challenge of coming up with strategies to overcome this. As with any dental procedure we must remember to have the patients best interests at heart. More importantly however we must keep in mind that for the children who have discolouration on their teeth, this has an impact on their day to day life and we must do our utmost to provide a solution for them. As a result of discolouration many are often troubled with low self-esteem and may encounter some form of bullying at school.
The guidelines with regards to how under 18’s can be treated with teeth whitening are determined by the General Dental Council. Whilst European bodies prohibit any children under 18 from receiving treatment under any circumstances; the laws need to be changed in order to provide solutions in exceptional cases. However, the guideline from the General Dental Council states that if there is a specific disease that a child is suffering from, then treatment is permitted.
There are 8 to 10 categories where whitening is appropriate if a child is suffering from a disease. One instance where whitening would be necessary is in a case of trauma where a child has sustained an injury and the tooth has turned black. This would require the patient to undergo a root canal treatment and due to the black tooth, it would need to be internally whitened. Other common causes would be white spots, brown spots, amelogenesis, imperfecta and fluorosis. Click here to read our article on the British Dental Journal where we listed the different categories as to when whitening is appropriate for use on under 18’s.
What is our new strategy?
At the British Dental Bleaching Society we are aiming to reform the legislation. One way of this doing this would be to re-write the document which was submitted for scientific evidence. It is in our agenda for this to be amended and re-submitted to reassure its safety, which can then be channelled through Europe. Another way we’re looking to tackle this situation, following Brexit, is to make a petition in an attempt to encourage changes. We must remember a child’s right to health is a basic human right. This means treatment cannot be denied if a condition is detrimental to their health and it’s a key reason as to why we are hoping to influence legislation.
We feel so strongly about this issue that we have organised a conference on 15th November at Lords Cricket ground. The key researcher Kevin Donlley, from Texas, who has undertaken extensive research into under 18 whitening and its safety will be presenting his evidence. We will be going into more detail about the 8 different categories where whitening is appropriate as well as case studies of the types of treatment that can be undertaken in a minimally invasive way.
Difficult case of a young patient
Only a dentist registered with the GDC can perform teeth whitening on patients. But it is still an illegal procedure for anyone under the age of 18. So, when Dr. Rahul Nehra found himself with an interesting case of a bullied child on his hands, he was forced to seek advice from several bodies before being able to give his young patient the most conservative treatment for his particular case.
Read on as Dr. Rahul Nehra sits down with Dr. Payman Langroudi to tell the whole story.
Payman: Rahul recently found himself in an interesting situation where he had a child patient who needed teeth whitening and because of that he found himself on the wrong side of the law.
Maybe you can just elaborate for us Rahul, tell us the full story.
Rahul: So about 18 months ago, an 11-year-old kid fell down at school, as most kids do, but unfortunately the fall devitalised to his upper left tooth. It went completely black.
We had the endodontist carry out a root canal but unfortunately, the child was getting bullied at school and he was finding it very difficult to then go into school. His parents had begun looking into options that were quite extreme like veneers and home schooling.
How Teeth Whitening Became an Option
That’s when we stepped in and told them that there’s easier options and we could simply whiten his tooth inside out. We knew if we used Enlighten it would work so we contacted you guys and got an answer back within a few hours. The parents consented and we spoke to the Dental Defence Union and they were happy for it to go ahead because we were doing something to protect the child and we had the parent’s consent.
The results were incredible.
Payman: Did the parents come to you initially asking for veneers?
Rahul: Yes. We had several consultations where they said they wanted veneers or tooth straightening, anything that would just improve the way the tooth looks. They made it clear that if I wasn’t willing to help then they’d find another dentist. So, I had to explain to them that it’s not down to me alone and the decision comes from somewhere else.
After talking to a few different companies, yourself and then the defence union we were told to go ahead as the results will show for themselves. The parents were over the moon with the results and the child has now integrated back into school.
Payman: So you find yourself in a difficult situation whereby it’s legal for you to go ahead and prep this eleven year old’s teeth but illegal for you to do something as conservative as bleaching.
Rahul: Exactly.
Payman: So how did you feel?
Rahul: Strange, very strange. It’s one axis cavity, it’s a small axis. And the thing is the axis cavity was already produced by the endodontist. I wasn’t even cutting the tooth away. And the mother was happy to carry out the whitening. Both sets of parents had individual meetings with me to say you need to protect my son, you need to help him.
Payman: How bad was it?
Rahul: It was bad. He’d come in and even when talking to us as adults he would slowly just quieten down. He wasn’t the same as before.
The Law on Teeth Whitening
Payman: I think the GDC’s now said that if the discolouration is due to a disease process then you’re okay to do what you did. So, I think in the end It’d have been okay, but the situation needed clarification for sure.
Something so basic and simple has improved his lifestyle.
And it reminds me of 2001 to 2012 when bleaching was illegal in the UK. A bunch of us were supplying teeth whitening products to patients and a bunch of us got together; Linda Greenwell, Chris Law, Martin Canada and the idea was that if this goes to court, we’d be willing to stand by it because at the end of the day your number one concern is your patients well-being. So, I can understand why you went ahead. But the situation needs clarifying and Linda’s doing something about that now, she’s finding twelve situations where it’s okay to bleach the teeth of someone under 18.
Rahul: Something needs to be done. It was such a basic treatment and everyone’s happy. The parents are over the moon the, child is over the moon. He didn’t need to whiten the rest of his teeth, he literally had a tooth whitened and just something so basic and simple has improved his lifestyle.
Payman: I mean you just try to do your best for this patient find yourself in this difficult situation.
Rahul: If it was my 11-year-old I wouldn’t be crowned prepping on him. So why would I crown prep on someone else’s 11-year-old? If it’s as basic as putting a back filling on and a little bit of whitening. You can’t go wrong.
Payman: What steps did you take it before you went ahead?
Rahul: I gave my patient all his options. Both parents were involved in this process. I sent them away with home whitening, the veneer and seeing a specialist option. They decided that the whitening was going to be the option they wanted to go for. They realised it was the most conservative and the results were going to be the best. We gave them that cooling off period sent them away with the literature. I then spoke to the defence union who were happy to go ahead.
Payman: Which defence union was that?
Rahul: The TDS defence union and they were great. They said as long as you’ve done all the right steps. Go ahead.
After that what we did was, send the patient away and let them make their own decision and once it decision was made, I went ahead and did the treatment because my patient’s best interest is all I care about.
The result
Payman: And you got to the result you wanted.
Rahul: I got the result and the patient is over the moon.
Payman: Well hopefully this is going to be one of one of the cases that Linda can use in her campaign, she’s trying to get that law changed so that we can treat people younger than 18 in the right situations because we know it’s completely safe. Whereas the other option would have been completely unsafe.
Rahul: My team went through it as well. Everyone at the smile gallery said this is your best option. We showed them before and after pictures of previous whitening’s we’ve done. And if it works on an adult why wouldn’t it work on a child?
Payman: Brilliant. Thanks a lot for coming in to discuss that with us.
To read more on single dark tooth whitening click here.
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