Vital tooth whitening: the legal and ethical issues

Abstract

Email: nicholas.lewis@uclh.nhs.uk Tooth-whitening procedures have now become commonplace within restorative dentistry as a frontline treatment for the management of discoloured teeth. The use of bleaching has dramatically risen in the last 15 years and there is wide-ranging documented evidence within the dental literature of the efficacy and uses of tooth-whitening procedures (Hasson et al, 2008). There are now a variety of techniques documented in the dental literature for the management of both vital and nonvital teeth as well many variations in the products that can be used clinically. These include vital bleaching, non-vital whitening and combination techniques such as the ‘inside-out’ technique. The most commonly used method is the tray method of tooth whitening (also known as ‘night-guard’ or ‘at-home’ whitening) where a peroxide-based whitening agent is placed in a custommade tray that patients can then wear overnight or for a prescribed period of time. This technique uses a form of either carbamide peroxide ranging from 10–22% with the most commonly used agent being 10% carbamide peroxide. Tooth discolouration is a common dental complaint and has many different causes. The aetiology of discoloured teeth is multifactorial and varies in severity as well as which part of the tooth is affected. There has been great interest in the development of new techniques for tooth bleaching over the last 20 years, although the first reported attempts to whiten teeth date back more than 200 years ago. The ability to alter the colour of teeth without removing otherwise healthy (albeit discoloured) tooth structure can never be underestimated. The development of the peroxide-based toothwhitening products has offered the dental profession a conservative and effective method of altering the colour of teeth without the removal of tooth structure and the inherent biological cost that this incurs. More invasive procedures, such as the provision of crowns and veneers, can require the removal of large amounts of healthy, albeit discoloured, tooth tissue which will invariably lead to additional procedures such as root canal treatment due to the trauma to the dental pulp. Nearly all currently prescribed toothwhitening agents are peroxide based, with the two main active products being either hydrogen peroxide or carbamide peroxide. Carbamide peroxide has now largely superseded hydrogen peroxide as the main constituent in commercially