Kiran Shankla examines evolving regulations on teeth whitening for under-18s and their effects on dental care, covering historical restrictions, current protocols and key considerations.
For many years there has been controversy in the dental industry surrounding the whitening of under 18-year-olds. Up until May 2014, whitening in under 18s was not permitted under any circumstances by the General Dental Council nor by UK Law. The GDC stance posed a serious dilemma for dentists who wanted to treat discolourations of teeth in minors. Under the EC Directive products containing more than 0.1% hydrogen peroxide could not be used by anyone under the age of 18 (Kelleher 2024).
This resulted in many young patients being denied any dental treatment for their teeth discolouration leaving them with both physical and psychological issues. Most teeth discolourations occur due to genetics or trauma and are of no fault of the individual suffering with them. Unfortunately, discolourations are perceived negatively by the public and result in bullying and depression in a young child’s life (Bannister and Harley 2012).
Current regulations
In May 2014, the GDC revised its position on under-18s whitening allowing bleaching to take place if it was wholly to treat or prevent disease (Greenwall-Cohen et al 2018). It is essential to understand the psychological and psychosocial effects of discoloured teeth and the negative impact it can have on a child’s life if treatment is delayed. It is important to try and treat the lesions to prevent mental health conditions from occurring and bullying by peers (Marty 2016).
Suggested indications for bleaching for those under the age of 18:
- Severe and moderate discolouration
- Enamel conditions
- White lesions, white markings and white flecks
- Brown, orange and yellow staining
- Coronal defects
- Molar incisor hypomineralisation (MIH)
- Hereditary factors
- Traumatised/non-vital discoloured anterior tooth/teeth
- Systemic diseases with dental effects (diseases of the liver, kidneys, or haemorrhagic diseases) (Greenwall-Cohen et al 2018).
These changes have now made it easier for dental professionals to carry out whitening in those under 18 as the risk of being prosecuted by the GDC has been reduced. However, caution should always be taken as whitening in under-18s is still illegal in the UK, and legal advice should be taken from indemnity providers as not all will cover this treatment.
Treatment options
When patients present with discolourations, it is our duty as dental professionals to provide options and solutions. There have been significant advancements in whitening technology, particularly with the introduction of SDI’s Pola products, which provide different options tailored to each patient. With Pola’s innovative formulations, including low-concentration hydrogen peroxide solutions, dentists can now confidently provide whitening treatments to minors. The shift in regulations has expanded treatment possibilities and addressed the physical and psychological impacts of teeth discolouration in young patients.
If you cannot provide the treatment, a referral should be offered to help with patient choice. Patients and parents should be informed of each option’s risk of tooth loss and the long-term maintenance and success.
Currently, the only dental treatment which requires no removal of tooth tissue loss is whitening and this should always be the first choice of treatment before picking up a drill. The risks and benefits of whitening should be discussed to gain consent before commencing treatment. Patients should also be informed further treatment may be required e.g. resin infiltration after whitening (Wallace and Deery 2015).
Examination
A detailed verbal history should be taken to help establish a diagnosis for the discolourations. The following questions should be asked:
- At what age did you notice changes to the teeth?
- How many teeth are involved?
- Did you have any issues pre/peri/postnatal?
- Do you think the discolouration is getting worse or the same?
- Does the presence of these discolourations impact your child’s life?
- Have you had any dental treatment before today?
A clinical examination should be done to assess the number of teeth impacted, the depth of the discolourations, if there is any enamel loss/hypomineralisation present, if any further treatment is required, etc.
Protocol
- Dental examination – To assess oral hygiene and caries risk
- Periapical radiographs of any dark teeth to establish the cause e.g. post RCT treatment/calcific metamorphosis/trauma
- A full set of high-quality clinical photographs
- Assessment of the discolourations on the teeth
- Discussion of treatment options
- Consent – verbal and signed
- Construction and delivery of whitening trays
- Review for further treatment.
To conclude
As professionals, we have a duty of care to provide the best possible treatment while protecting teeth from unnecessary harm. Young patients who suffer from discolouration are always very motivated when whitening and the physical and mental changes of this simple treatment plan are life-changing.
Book a Lunch & Learn or contact us now to learn more about the support you can get from a professional teeth whitening system that has a solution to suit all your patient’s needs.
References
Bannister R, Harley K. Vital bleaching for the management of hypomineralised enamel defects. Fac Dent J 2012; 3: 146–151.
Greenwall-Cohen J, Greenwall L, Haywood V, Harley K. Tooth whitening for the under-18-year-old patient. Br Dent J. 2018 Jul 13;225(1):19-26. doi: 10.1038/sj.bdj.2018.527. PMID: 30002517.
Kelleher M. The law is an ass: legal and ethical issues surrounding the bleaching of young patients’ discoloured teeth. Fac Dent J 2014; 5: 56–67.
Marty M. Time Loss. JDR Clin Transl Res 2016; 20: 1–2
Wallace A, Deery C. Management of Opacities in Children and Adolescents. Dent Update 2015; 42: 951–954, 957–958
Kiran Shankla is a restorative dentist based at Kendrick View Dental Practice. Follow her cases @shanklasmiles