Tooth Whitening: Beauty Treatment or Dental Procedure?

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Permalink Reply by Jill Kring Carter on November 3, 2008 at 8:52pm

The questions are these. 1) Is it invasive? and 2) Is it reversible? If the answers are NO and YES, I see no debate, especially since we can buy professional grade whitening kits in our dentists office to do ourselves at home..........

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Permalink Reply by Sandy Roth on November 4, 2008 at 12:08pm

Three weeks ago I watched for about 30 minutes in a Sam's while two labcoat clad women worked with "patients." Very simple procedure and the labcoats did nothing in the mouth. The patients tried in the trays and placed the bleach-loaded trays. I didn't even see any gloves so I think the labcoats were definitely arms-length in the transaction. Don't think they are hurting dentists since it was clearly an impulse "buy" for people who came to Sam's for another purpose. They probably created new business.

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Permalink Reply by Juliene Klem on November 4, 2008 at 2:17pm

I acted as a potential customer for a booth that was set up in our local SAMS Club in Florida. I am a dental hygienist so I knew what kind of questions to ask. Everyone looked profesional with white lab coats,etc. but they couldn,t tell me much about their product. No one who worked there was a dentist or dental expert. The trays are self administered and they never "touch" a patient therefore it is considered legal. I feel that people are being misled with out knowing the pros & cons of bleaching. People just look for white teeth. I hope the Florida Board of Dentistry prohibits these operators because it does take away the seriousness of professional bleaching. Juliene Klem,RDH

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Permalink Reply by lin on November 4, 2008 at 5:27pm

I agree with you wholeheartedly! There are so many whitening products available online and OTC and I for one am seeing more and more cases of sensitive teeth and translucent enamel from people using these products continually. Have you heard of Celebrity White? sold online- 36% carbamide peroxide-- guaranteed to whiten 5 shades in an hour and "safe" to use everyday!???? SCARY!

These whitening kiosks are not in NH yet, but I will keep my eyes and ears open. They may be legal but are definitely misleading the public--- Lin RDH

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Permalink Reply by Penny Anderson on November 4, 2008 at 3:47pm

I was reviewing the October/November issue of the Virginia Dental Association journal and found a letter to Virginia Governor Timothy M. Kaine from Virginia Dental Association President Dr. Gus C. Vlahos. It was about this same subject. Here's what it said:


"Dear Governor Kaine,

"I wish to inform you of the illegal practice of dentistry occurring in many areas of Virginia. Various companies are setting up kiosks at shopping malls, Wal-Marts, Sam's Clubs, and Costcos, and performing the dental procedure of teeth whitening. As President of the Virginia Dental Association, I informed the Board of Dentistry of this situation at their June 6, 2008 board meeting. I know the Board of Dentistry has also received complaints from other licensed dentists in the state of Virginia. The primary purpose of the Virginia Board of Dentistry is to protect the citizens of Virginia from receiving harm from licensed dentists. I also believe they should protect these same citizens from nondentists performing dental procedures.

"The persons providing these services have had no formal training in dentistry and have no knowledge of the whitening solution that is being used in these procedures. The public needs to be protected — the solution used may not be FDA- approved and the individuals providing the services don't seem to know the concentrations. A strong concentration of peroxide solution used to whiten teeth can damage the teeth and the surrounding soft tissue of the mouth if proper precautions are not observed. Also, these operations may not have instructed the individuals in OSHA compliance and training in universal precautions to prevent the spread of infection and disease.

"At the June 6, 2008 Board of Dentistry meeting, I presented the board with a newsletter from the Commonwealth of Kentucky Board of Dentistry. It stated Kentucky considers these operations to be practicing dentistry illegally and the Board of Dentistry has taken actions against them. Numerous other states are taking the same actions, and the Board of Dentistry of Virginia needs to do likewise to protect the citizens of the Commonwealth.

"If you have any questions, please feel free to contact me or contact Dr. Terry Dickinson, Executive Director of the Virginia Dental Association.

"Sincerely yours,

"Gus C. Vlahos, DDS
"President, Virginia Dental Association"

Are you aware of other states who are requesting that action be taken against nondentists performing whitening procedures? Please add to our discussion of this topic if you are.

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Permalink Reply by Clara Lee, DDS on November 5, 2008 at 8:29am

I have seen them in the malls. Don't remember which one in particular... First of all, it cheapens the profession. It's akin to advertising with neon lights and high-kicking reindeer during the holiday season. Then more importantly, it does not address other issues that can only be diagnosed in a well-lit dental office. What about OSHA compliance? What about addressing cervical lesions or caries? How are these people trained? Qualifications? All for the sake of getting whiter teeth? They may wear white lab coats but there's more to that to be qualified to offer services that normally would be offered in a dental office. I haven't seen them in action anytime I've been to the mall but I've asked other people and they say they wouldn't go there because it's "creepy". One of my friends commented "Would you do a laser peel in a mall kiosk?"

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Permalink Reply by Sandy Roth on November 5, 2008 at 9:10am

While I, too, wish people would choose to come to the dentist for these services, the fact is that - if they are working inside the law (and I bet they have a hoard of attorneys making sure they do so) - this is just another indicator of a competitive marketplace. This isn't being promoted as dental care. It is promoted as a tooth whitening booth. An earlier comment likened it to Whitestrips. I remember when Crest came out with the product and dentists got all up in arms. What happened? People started coming to the dentist to get a better whitening result. I'm not really sure how this "cheapens" the profession. While I wouldn't choose this and certainly wouldn't choose a laser peel in the mall, I can see why many people would be attracted to it. The prices are very competitive and it is very convenient. Hmmmm. What can we learn from that? Maintain proper standards of professionalism, of course. But we must realize that there are lots of entrepreneurs out there who will not let an opportunity go by.

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Permalink Reply by Jill Kring Carter on November 5, 2008 at 11:45am

I so agree, and honestly, if we are going to take these kiosks out of the malls, we better too, take the do-it-yourself whitening products off the shelves at the stores, and the professional strength products off my dentists shelf for sale to do at home, because that's all it is, another do-it-yourself option, but with an actual sales team.

I for one asked my dentist his opinion on which do-it-yourself products are, in his opinion, safe to use. He gave me his short list. It's up to everyone to use their brains, as it is with so much in this world.

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Permalink Reply by sally gambone on November 16, 2008 at 6:43pm

I am a dental hygienist who was recently laid off. I will soon be opening one of these kiosks in our local mall. I do not see a problem with this. The bleach is over the counter strength and the customer asministers it themselve. Nothing illegal about that.

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Permalink Reply by Stuart Friedman on December 25, 2008 at 10:44pm

I am an attorney working to advise a tooth whitening service before it opens the door. I've read the ADA resolution, tracked the effort to ban these businesses (with mixed result), and think I can safely create a set of guidelines to keep these businesses outside the boundaries of my state's definition of the "practice of dentistry."

The problem right now is that these businesses are vulnerable whatever course they take (other than shut their business). If they give basic warnings to the patient, people treat this as evidence that they are practicing dentistry without a license. If they don't, people scream that they withhold important information and create a public health risk.

We considered having making arrangements with a local dentists where he would be available for telephone consultation to help customers who were unsure of things, but this increased our vulnerablity. It is difficult to establish a consulting relationship with a local dentist because this arguably puts you under the Board of Dentistry's jurisdiction. You are far better just pushing forms at people, having a rack of boilerplate information, and hoping that people read carefully and actually know their own dental history. It is legally the safer move, but it is not in the customer's interest.

Rather than simply saying that these businesses should be banned, it would be nice to see the dentistry boards and these groups sit down and reach an accommodation where we could both working on helping people. I am pretty good at what I do and think I can probably protect a business from a cease desist action, but I would actually like to provide the customer with more information than my approach will give them.

Despite professing a protective rationale, however, I think the interest is more economic than the dentists will admit. I know my profession was guilty of this in a prior generation, but the courts did not side with us and the sky did not fall.

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Permalink Reply by Mary Jane RDH BS on December 19, 2009 at 4:49pm

Are they ready to deal with the patient's who over use these and cause their tissue to slough off

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Permalink Reply by Stuart Friedman on December 19, 2009 at 6:06pm

As noted above, the more that they prepare for that contingency, the more they encroach on the practice of dentistry. From a legal point of view, they are best taking their clients at their word and having them sign boilerplate waivers. I suspect that many providers of these services would prefer to take a more responsible course, but they are in a legal "Catch 22."

We faced these issues in law when many other companies moved into our turf. Real estate agents routinely write contracts; will and trust companies sell trusts; and there are services that offer online bankruptcy petition drafting and DOIY divorce petitions. Have clients ever shot themselves in the foot using these services? Absolutely! I'm currently litigating a case where my brain child of a client downloaded a contract over the internet and changed it around. He left in passages that said the case was governed by Louisiana law and that venue was in Jefferson Parish. Neither party had any connection with the matter and there is no way to file suit in Louisiana. To avoid a couple hours of lawyer time, my client created a legal mess that will cost him significantly more than a lawyer's cost for drafting a client.

Many professions have faced competition from unlicensed competitors. In such a situation, a potential client takes on a greater risks to save some money. On some occasions they will surely shoot themselves in the foot, but the protective rationale is often been used to shelter a profession from competition. If the purpose of these laws is truly to protect the client, shouldn't they have the right to voluntarily waive those protections?

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