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Trading Standards (Tooth Whitening)

I thank the Minister for coming. The one advantage of being the last man standing is that the gates might be open when he leaves. Let me first declare a simple interest and then add to it because of the specifics of the debate. I am a qualified and practising—admittedly very part-time practising—dentist. In addition, I am a member of the British Dental Association, the British Academy of Cosmetic Dentistry, the British Endodontic Society and the British Dental Bleaching Society. That explains why I become a target of considerable pressure on dental issues, so I hope the Minister will bear with me. I am trying to persuade the Minister to help us sort out a situation that has been confusing dentists and trading standards officers throughout the UK for a considerable number of years. If the Minister will bear with me, I will endeavour to explain a little of the process of dental bleaching and why the present situation is producing a dilemma for dentists. Bleaching by dentists has been around for a very long time. I first used dental bleaching about 30 years ago. My tutor was my now retired dental partner who qualified during the second world war, and his tutor was his father who qualified shortly after the first world war. It has been used for nigh on 100 years. In the early days, we used a 30 per cent. solution of hydrogen peroxide—better known as Superoxol. It was destructive to soft tissues, which needed to be protected; in those early days, that was done via a mechanism called a rubber dam. This is a small sheet of latex rubber with holes placed in it so that the teeth can go through; a tight seal then comes round the neck of the tooth so that the gingival and other oral soft tissues, including the lips, can be protected. The aim of bleaching is to remove discolorations from the teeth without harming the teeth themselves. The discolorations can come from a number of sources: from tobacco, hard water, tea, coffee and so on. Teeth may also be iatrogenically discoloured, the most famous example being tetracycline discoloration. In the early days of antibiotics, children were given an antibiotic called tetracycline, which was one of the early broad-spectrum bacteriostatic antibiotics and was widely used. While it dealt with the targeted infection, if taken by children it discoloured the developing teeth, sometimes to a grotesque degree. Second or adult teeth that may have received a blow can often darken quite quickly, particularly if the individual is young. The teeth most frequently hurt in this way are the upper incisors, particularly the upper central incisors. Endodontically treated teeth often darken, particularly if the operator has been unable to remove or has not removed all the pulpal tissue from the internal dentine. Increasingly nowadays, dental restorations are of a more cosmetically acceptable material. If someone is to have a filling, it is good to do it in a cosmetically acceptable way. It is becoming increasingly accepted as standard practice that when such restorations as porcelain crowns, porcelain veneers and porcelain inlays are used for restorations, it is sensible to bleach the teeth first. That achieves a benchmark colour to which the new restoration is colour-matched. As the patient's teeth become more discoloured over subsequent years, it is possible to use the same process to bring the teeth back to that benchmark level. Otherwise, we will end up with white teeth sticking out among the brown, which I have seen particularly in some areas of London. Dental bleaching is not available on the national heath, but I believe that in some cases it should be because it is the less destructive treatment. To provide a simple example, if a national health patient has badly tetracycline-stained teeth, the only option on the NHS to restore normal appearance is by extensive crowns or veneers. These are destructive to the teeth and much more costly, and in time they will need replacing. The cheaper approach is dental bleaching, which leaves the teeth intact and of an acceptable colour. Techniques of dental bleaching have improved. First, the dentist must check that the patient's teeth are in good order. Then there are essentially two different bleaching techniques available. The first is the so-called home technique, where the dentist constructs close-fitting clear trays that the patient wears for a period of time at home. The bleach trays are designed to hold the gel against the teeth but away from the soft tissues. The second method is so-called power bleaching, which is done in the surgery and generally uses much stronger hydrogen peroxide concentrations. The soft tissues are protected either with the aforementioned rubber dam or nowadays a foam that is set by an ultraviolet light. Some techniques advocate the use of light or heat source, although I personally believe that this does more for the image of the procedure to the patient than it actually benefits the bleaching process. Hydrogen peroxide is generally delivered in varying strengths of carbamide peroxide nowadays. These strengths vary between 10 per cent. and 38 per cent. carbamide peroxide. The hydrogen peroxide concentration delivered is lower. For example, 10 per cent. carbamide peroxide delivers approximately a 6 per cent. concentration of hydrogen peroxide. As logic will tell the Minister, the higher the concentration the faster the bleaching, but the more likely it is to produce sensitive teeth. I hope that the Minister understands from this that this material should be in the hands of a trained dental professional, as misuse can cause harm. Recent decisions of the General Dental Council state that dental bleaching by trained dental professionals is part of professional dental treatment. That has been accepted by the Secretary of State for Health for England, and I have written asking for the position of the Ministers of Health for Northern Ireland, Scotland and Wales on this issue. To date, the Minister for Health for Wales has replied and agrees with the position taken by the Secretary of State. I await the post from Scotland and Northern Ireland. The reason for this preamble is to explain to the Minister that the dangers of the material when misused are understood, and that organisations such as the British Dental Bleaching Society run certifying training courses to ensure that the dental professional teams undertaking this treatment are properly trained. Unfortunately, there are a number of non-dental professionals, in beautician salons in particular, who are illegally bleaching teeth. Sadly, some of these individuals are using a material called chlorine dioxide, which, although it produces an initial appearance of bleaching teeth, actually damages them. As the Minister will be aware, the fly in the ointment is the European cosmetics directive, which restricts the sale of tooth-bleaching materials containing more than 0.1 per cent. hydrogen peroxide. Clearly, this makes eminent sense when applied to over-the-counter medicines, but from a dental treatment point of view 0.1 per cent. hydrogen peroxide is absolutely useless. Enforcement of the cosmetics directive is in the hands of local government trading standards officers on behalf of the Minister's Department. Most trading standards officers and departments are too busy to bother dentists. Also, most of those who do look at the issue recognise that higher concentrations of hydrogen peroxide delivered as part of dental treatment are quite different from over-the-counter sales. Indeed, some trading standards officers have visited dental surgeries that I know of and have accepted the use of such products as part of dental procedures, but not for over-the-counter sales. Unfortunately, there are a few trading standards officers who continue to threaten to prosecute dentists using more than the 0.1 per cent. concentration. I was approached in the last few weeks after dentists in Northern Ireland and, of all places, Redcar received quite aggressive letters threatening prosecution. Incidentally, if the Minister ever contacts the Redcar trading standards department, he might like to point out that his Department is no longer called the Department of Trade and Industry. In 2005, the European Commission Scientific Committee on Consumer Products recommended that, although tooth-whitening products containing 0.1 to 6 per cent. hydrogen peroxide are not safe to be sold over the counter and should not be used freely, they are safe to be used after the approval of, and under the supervision of, a dentist. In December 2007, the SCCP reinforced this, and in November 2008 the Council of European Dentists unanimously stated that it"““Recognizes the need for regulation of availability of tooth whitening products at EU level on the basis of the December 2007 SCCP opinion; Feels that the aim of such regulation should be to protect consumers from potential harmful effects of excessive exposure to tooth whitening products and to enable distribution of the full range of tooth whitening products, under the responsibility of a dentist, as justified by scientific evidence; Expresses concern about continued delay in implementing the SCCP opinion and calls on all actors involved to ensure that a solution is found as soon as possible in the interest of patient safety; Supports the intention of the European Commission to amend the Cosmetics Directive in line with the final SCCP opinion and Encourages the European Commission to schedule a vote to amend the Cosmetics Directive at the earliest opportunity and urges Member States to contribute to a positive outcome.””" That leaves me with two simple requests for action to sort out this nonsense. First, I urge the Minister to press the Commission to change the directive speedily. The nonsense to which I refer has continued for many years, in the face of the evidence of many decades of successful and safe bleaching in the hands of dental professionals. Such techniques are commonly used in the rest of the world; it is the EU that has got itself bureaucratically out of step. I realise—and, indeed, remember from my days as a Minister—that it will probably take some time to get the change through the EU bureaucracy, no matter how much the Minister pushes for it. It would therefore be helpful for him to suggest to trading standards departments that a more enlightened approach should be adopted to dentists using these materials in the way intended. However, I back their approach to such products when they are used as over-the-counter medicines. It would be more logical for trading standards officers to concentrate on other public sources of bleaching gels that are being sold over the counter by the likes of beauticians who are not legally qualified to undertake any dental treatment. At present, dentists and others in north America laugh at our smiles. We must stop that, and the way to do that is to allow the full range of dentistry, including bleaching.