The ins and outs of tooth whitening procedures

Updated February 2023; Originally published in the November/December 2012 issue of Dispatch

Both patients and dentists are increasingly interested in cosmetic procedures. With tooth whitening now widely performed both within and outside dental offices, there is some confusion about what is legally permitted.

The College considers that tooth whitening is best provided in the dental office in the context of total patient care and under the supervision of a dentist. When these services are performed in the dental office, the dentist is responsible for performing the examination, prescribing any necessary radiographs, diagnosing the cause of tooth discolouration, communicating the diagnosis to the patient, developing the treatment plan, and obtaining the patient’s consent to treatment.

Who can take impressions for tooth whitening trays in the dental office?

Dentists are able to authorize dental hygienists, Level II dental assistants and preventive dental assistants to take impressions for the fabrication of tooth whitening trays. The dentist must authorize the procedure and ensure that the impression is suitable for the fabrication of a tooth whitening tray.

It is not necessary for the dentist to be present in the dental office when the impression taking procedures are performed by dental hygienists, Level II dental assistants or preventive dental assistants. 

Can Level II dental assistants perform tooth whitening in the dental office?

Dentists can only authorize Level II dental assistants to perform tooth whitening using tray-based systems. This could include authorizing a Level II dental assistant to fit a tooth whitening tray intended for home use, dispensing the tray to the patient with the tooth whitening agent and instructions for its use. 

It is not necessary for the dentist to be present in the dental office when tooth whitening services using tray-based systems are performed by a Level II dental assistant.  

What kinds of tooth whitening can dental hygienists perform in the dental office?

Dentists can authorize dental hygienists to perform tooth whitening using tray-based and other systems. This could include the application of a liquid dam to protect the soft tissues and application of tooth whitening agents directly to patients’ teeth.

It is not necessary for a dentist to be present when the tooth whitening services are performed by a dental hygienist in the dental office.

Can other staff members assist with tooth whitening procedures in the dental office?

A dentist can authorize a Level II dental assistant to place a rubber dam for an in-office tooth whitening system. Only a dentist or a dental hygienist may apply the tooth whitening agent directly to the teeth.

A dentist can authorize any dental staff member with appropriate training in the use of the device to hold a laser, composite curing light, or heat lamp to activate a tooth whitening agent once it has been applied to the teeth by a dentist or a dental hygienist.

Are whitening clinics operated by non-dentists and non-dental personnel legal?

Tooth whitening agents are classified as cosmetics, except for formulations containing fluoride. Health Canada does not restrict the sale of tooth whitening agents but does require safety labelling for concentrations higher than 3 per cent hydrogen peroxide or 10 per cent carbamide peroxide.

Tooth whitening is not a controlled act. While tooth whitening falls within the scope of practice of dentistry and dental hygiene and is performed in dental offices and independent dental hygiene practices, tooth whitening is also considered to be in the public domain. This means that there are no restrictions in the Regulated Health Professions Act, 1991 on the performance of these procedures in settings outside of dental and dental hygiene professional practices.

The College does not have regulatory authority where tooth whitening services are provided in an independent business outside the dental office.

Questions and concerns regarding the standards and scope of practice of any other non-dentist regulated health professional who is performing tooth whitening in a professional practice should be directed to that regulated health professional’s college.

As a dentist, can I be involved financially with an independent tooth whitening business?

Dentists may become involved in partnerships with non-dentists or as investors in businesses owned and operated by non-dentists, only if these businesses are separate and distinct from their dental professional practices.

Dentists who refer patients to independent tooth whitening businesses in which they are partners or investors must declare their financial interest to their patients to avoid a conflict of interest.

Dentists who refer patients to independent tooth whitening businesses that are distinct and separate from the dentists’ practices, and are not satellite or secondary practice locations, must indicate to their patients that they will not be involved in their patients’ treatment in a supervisory or any other capacity.

As with any business venture related or ancillary to the practice of dentistry, the College recommends that dentists obtain independent legal and accounting advice from advisors who understand the regulatory framework for dental practice in Ontario.