Vital Tooth Whitening and the Provision of Bleaching Trays

Added to Handbook: July 2008
Updated: September 2013

PURPOSE

To provide guidelines for the provision of bleaching trays and the removal of stain by vital tooth whitening.

BACKGROUND

Health Canada considers tooth whitening to be a cosmetic procedure and in BC vital tooth whitening is not considered a restricted activity. Dental hygienists, in accordance with section 4 of the Dental Hygienists Regulation, may "assess the status of teeth and adjacent tissues and provide preventive and therapeutic dental hygiene care for teeth and adjacent tissues". The dental hygiene scope of practice includes removing stain using various methods. Stain removal is therapeutic in that it contributes to the client's emotional well-being and is a motivational factor for oral hygiene practices.

There are numerous in-office and at-home whitening products available to remove stain, including solutions that are activated with heat or light, and others that are activated chemically. Dental hygienists are educated to perform all steps of the various methods including the manufacturing and placement of bleaching trays. The only exception is the use of lasers for the purpose of whitening.

Section 6(1)(c) of the Dental Hygienists Regulation states that dental hygiene services are provided in accordance with any instructions that may be given by a dentist. Effects of tooth whitening may impact dental treatment. Registrants considering tooth whitening for their clients should consult with the client's dentist to ensure that the procedure fits with the overall treatment plan and is in the best interest of the client.

It is a legal and professional responsibility to follow the CDHBC Regulations and Practice Standard Polices. These policies outline the ADPIE process of care and apply to the process of vital tooth whitening. Professional judgment is used to determine the appropriate assessments required to develop a dental hygiene care plan. The care plan should incorporate appropriate referrals, along with informing the client of the risks associated with the whitening procedure, obtaining informed consent, and evaluating the results of the procedure.

POLICY

Dental hygienists are educated to perform the various steps for vital tooth whitening with the exception of the use of lasers. Taking impressions and fitting bleaching trays are not considered restricted activities in BC. As such, these services may be completed by dental hygienists provided that the appropriate ADPIE process of care is followed and that appropriate education related to the whitening process has been completed. "Appropriate education" is defined in the Scope of Practice Statement and for vital tooth whitening would consist of self-study, formal or continuing education sessions.

Dental hygienists may remove stain using tooth whitening products provided they adhere to the manufacturer's directions for the products and ensure the proper use of equipment involved in the whitening process. Whitening gels may be provided to clients for use in custom-fitted bleaching trays. Appropriate instructions must be provided that align with the manufacturer's directions.

It is recommended that registrants considering tooth whitening for their clients consult with the client's dentist to ensure the procedure fits with the overall treatment plan for the client.

REFERENCES