Teeth whitening is one of the areas of oral care that pharmacy teams are asked about most, and it is getting more common as social media pushes kits bought online. Customers want to know what works, what is safe and why there may be fewer products in the pharmacy than they see on their phones. The reason for the latter is the law, and it is worth every counter assistant knowing about it.
The peroxide rule
Most whitening products work by releasing hydrogen peroxide. The Cosmetic Products Enforcement Regulations 2013 set three bands for the level of hydrogen peroxide present in, or released by, a tooth whitening product:
- 0.1% or less: no restriction, so these can go on any shelf, including those in pharmacies
- More than 0.1% and up to 6%: for dental practitioners only. A dentist has to carry out, or directly supervise, the first application in every course, and these products cannot be used on under-18s other than to treat or prevent disease
- More than 6%: not allowed in a cosmetic product at all.
In practice that means a pharmacy cannot sell a product in the 0.1–6% band to a member of the public, however it is packaged and however popular it is online. The restriction covers hydrogen peroxide and the compounds that release it, which includes carbamide peroxide and zinc peroxide.
Written around peroxide, not whitening
The detail most people miss is that the rule is written around peroxide levels rather than around whitening. A product that neither contains nor releases hydrogen peroxide above 0.1% falls outside the restriction and can be stocked and sold over the counter. That includes peroxide-free whitening products, most of which use an active ingredient called PAP (short for phthalimidoperoxycaproic acid), and everyday whitening toothpastes that sit within the limit.
The carbamide trap
Labels do not always help. Carbamide peroxide sometimes turns up in products marketed as “peroxide free”, yet once it is in contact with saliva it releases hydrogen peroxide equivalent to about a third of its own strength. So the front of the pack is not enough. Check the ingredient list for hydrogen peroxide, carbamide peroxide or zinc peroxide before deciding which category a product sits in.
Fluoride works the same way
The same principle of cosmetic limits applies elsewhere in the oral care aisle. Toothpastes sold as cosmetics can contain up to 1,500 ppm fluoride. Higher-strength toothpastes, such as 2,800 ppm and 5,000 ppm, are prescription-only medicines, so a customer asking for one needs a prescription from their dentist.
Sell it, do not apply it
There are two separate rules here, and clearing one does not clear the other. The product rules govern what may be sold. The Dentists Act 1984 decides who may carry out whitening, and in General Dental Council v Jamous (2013) the High Court held that whitening teeth counts as practising dentistry, regardless of who does it. A pharmacy can sell a legal whitening product, but it should not offer to apply one or run an in-store whitening service.
When to refer
Some customers are better pointed to a dentist than to the shelf. Refer anyone who:
- Has sensitivity or pain after using a kit bought online. They need a dental check, not a stronger product
- Has gum disease, bleeding or sore gums, mouth ulcers, exposed roots or recent oral surgery
- Is under 18 years and using a peroxide kit bought online
- Expects crowns, veneers or fillings to whiten. They will not change colour, although built-up surface staining on them can lift.
A quick counter checklist
- Read the ingredient list, not the front of the pack
- Anything containing hydrogen, carbamide or zinc peroxide above 0.1% is not for sale to the public
- Anything called peroxide-free or within the 0.1% limit can be stocked and sold
- Fluoride toothpaste above 1,500 ppm is only available on prescription
- Patients with sensitivity, gum problems or unrealistic expectations should be referred to a dentist.
Whitening is not going away, and customers will keep asking about it. A counter team that knows where these lines sit can give a straight answer, and steer people away from products they should not be using and towards their dentist when that is what they need.
Daniel Smith is the founder of Pure Glow Teeth Whitening. He writes for the dental trade press on at-home whitening and the law.