Part 1: an audit of practice in the Belfast and Cork restorative departments prior to the release of the 2012 European Cosmetic Directive
Part 2: an audit on the perceived clinical impact of the 2012 European Cosmetic Directive in the Belfast and Cork restorative departments
An audit of clinical practice in the Belfast and Cork restorative departments before the release of the 2012 European Cosmetic Directive. The findings led to the introduction of a clinical protocol and pro forma to the restorative departments to improve compliance with the gold standard. These could be used in any dental setting. An audit on the perceived clinical impact this Directive has had since its release found that the greatest perceivable impact was the inability to treat patients under 18 years of age.
Intrinsic discolouration of teeth often requires bleaching to improve the aesthetics. There are three techniques available for non-vital bleaching: chair-side; walking; and, inside/outside. Before the 2012 Cosmetic Directive was released, an audit of non-vital bleaching practice in the Belfast and Cork restorative departments was undertaken (Part 1). Results showed a variation in clinical procedures from the gold standard and therefore the latter was used to develop a clinical protocol and pro forma for use in the restorative departments. These were designed to be useful in the hospital and general dental practice settings, and should hopefully increase compliance with the gold standard and therefore improve both the consent process and record keeping.
With the change in the European Cosmetic Directive Guidelines on October 31, 2012, dentists were confined to using a maximum of 6% hydrogen peroxide in tooth bleaching products provided the first application was by a dentist or under their direct supervision. A high proportion of audit responses in Part 1 involved concentrations of hydrogen peroxide, in both the walking and chair-side techniques, that no longer complied with the new Directive. This suggested that the new Cosmetic Directive could significantly impact the practice of non-vital bleaching in the Belfast and Cork restorative departments. This in turn prompted an evaluation on the perceived clinical impact of the European Cosmetic Directive since its release in 2012 (Part 2). Surprisingly, clinicians found similar clinical outcomes following the restriction in the concentration of bleach, although 50% felt that more treatment visits were required to achieve an acceptable result. Moreover, the results of the audit revealed that clinicians were most concerned that the introduction of a ban on treating patients under 18 years of age might exacerbate psychological issues in this vulnerable age group if discoloured teeth were left untreated.
Journal of the Irish Dental Association 2016; 62 (6): 335-342
BDS(Belfast) MFDS RCSP(Glasg)
Specialty Trainee in Restorative Dentistry, Newcastle Upon Tyne Dental Hospital
BDS(Hons) DGDP(UK) MFDS RCPS(Glasg) FDS(Rest Dent) RCPS(Glasg)
Consultant, Department of Restorative Dentistry, School of Dentistry, Belfast Health and Social Care Trust, Grosvenor Road, Belfast
Honorary Lecturer, Queen’s University Belfast
Corresponding author: Jenna Trainor, Restorative Department, Newcastle Dental Hospital, Richardson Road, Newcastle Upon Tyne NE2 4AZ, UK