Maltese dentists are expressing concerns about the use of teeth-whitening products and treatments, particularly when these are administered by people who are not dentists by profession.

It is a delicate practice, not quite as simple as whitewashing or painting a wall, as some might think.

Edward Sammut, of Sammut Specialists Advanced Dental Clinics, says that logically, the practice of dentistry should be restricted to qualified practitioners only.

“It’s not really about who administers these treatments, it’s about how they go about it,” Sammut told MaltaToday.

“Consider a trained chemist using a dangerous acid, compared to a lay person; the chemist will know all there is to know about the safe handling of the acid,” he said, adding that the situation is pretty much the same in this case.

Under EU law, it is only products containing not more than 0.1% hydrogen peroxide concentrations that do not require a dental practitioner to apply them. Indeed, many of the products with such low concentrations of the material are available over the counter in the form of toothpastes or washes that have somewhat negligible results.

Local teeth-whitening treatment distributors Pearl Smile Malta, told this newsroom that its products were peroxide-free, which means that they can ultimately be sold over the counter as, according to EU Cosmetics Regulations, it is only in treatments with peroxide concentrations of 6% or more that a dentist or dental hygienist is required to carry out the treatment.

However, it should be pointed out that the American Dentist Association points out that peroxide is required in order to alter the natural colour of the tooth, but that concentrations higher than 0.1% are in fact required in order to attain any tangible results.

“Dentists are trained to use potentially dangerous chemicals in safe ways,” Sammut said, explaining that most dentist-administered treatments contained higher concentrations of peroxide.

In a blog post on his company’s website, Sammut further explained that there have been cases overseas where salon based treatments have been found to use higher levels of hydrogen peroxide than advisable.

“High concentrations of peroxide can be harmful to the gum tissue, causing chemical burns, so therefore their use must be carefully controlled to avoid gum contact.”

He added that some companies tried to use other materials like chlorine dioxide as whiteners to circumvent the law. However, the substance has been linked to tooth erosion and permanent sensitivity among others.

In other cases, sodium perborate has been used. It is “a substance which breaks down to release hydrogen peroxide, and which is also classified as carcinogenic and mutagenic, and therefore banned,” reads his blog.

Although Pearl Smile have confirmed that their products do not contain any of these dangerous chemicals, other companies providing similar products have not yet informed the newsroom about their products. And questions sent to the Standards Directorate over tests on products of this kind, have gone unanswered.

Cosmetic teeth whitening treatment processes are all similar, with clients being fitted with a mouth tray containing the treatment gel.

Once the tray is placed on patients’ teeth, an LED light is switched on close to the mouth tray.

In some cases, Sammut explains, the kits are actually sold to clients who then self administer treatments. However, Sammut stressed the importance of having a dentist check the condition of a person’s teeth prior to any whitening treatment.

“Dentists will look for tooth decay, cracks, gum disease, mouth cancer and other problems before picking up the colour chart to see how darkly stained the teeth are,” he said, adding that using whitening products in situations where there is a pre-existing problem like a crack in a tooth could aggravate the problem and cause pain, infection or other complications.

Sammut explained that although someone might be allowed to use such materials legally, it should be clear that the level of knowledge of a non-dentist is not appropriate for examining someone’s mouth to say it is safe for them to have teeth whitening treatments.

“Worse, they could miss an opportunity to diagnose something that is life threatening, such as mouth cancer.”