The Probe Article: Whitening in under-18s

The Probe Article: Whitening in under-18s

A 10-year-old patient was externally referred to the practice (Image 1,2 and 3).

On initial meeting the patient was very shy, reserved, and lacked confidence to speak without looking at the floor.

Prior to carrying out any examination a detail, history was taken from the patient’s mother to help establish a diagnosis for the discolorations. The following questions were asked:

It is very important to ask specific questions to help diagnose and identify the best treatment options as spots, which have been present since birth, are more difficult to treat than spots that appear later in life.

It is also extremely important to understand the physical and mental effects associated with discolouration and the emotional effect on a child resulting from delayed treatment.

Test results

An intraoral examination should then take place. When carrying out an intraoral exam for whitening, the following areas should be assessed:

In this case, a diagnosis of Localised Fluorosis was made.

Treatment options

  1. Monitor: As the patient was getting bullied for her teeth, this was not a viable option
  2. Whitening: The only non-invasive option for the treatment of tooth discolorations
  3. Whitening + Icon: A combination technique to help camouflage and remove discolourations
  4. Composite bonding: Would require drilling of the natural tooth tissue

The treatment options for this case were discussed in detail with the patient and mother. Currently, the whitening of teeth in under 18-year-olds is illegal in the UK. The GDC states, ‘Products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for the purpose of treating or preventing disease.’

Given the patient was being severely bullied at school and she fulfilled the GDC’s criteria of whitening for under 18-year-olds, a decision was made to whiten the teeth followed by a round of Icon Infiltration to seal the porosities.

Treatment plan

The following treatment plan was made:

Results, conclusion, summary points

The patient carried out at-home bleaching for a period of two weeks. She reported minimal sensitivity and got on well with the whitening trays. Polo Night is my whitening of choice due to being fluoride-releasing and having a high-water content, minimising sensitivity and having a neutral pH.

As you can see from the images, a great result was achieved with the whitening alone. A round of Icon Infiltration was carried out after to remove any white spots (Images 6, 7, 8).

As professionals, we have a duty of care to provide the best possible treatment while protecting teeth from unnecessary harm. Young patients who suffer from discolouration are always very motivated when whitening, and the physical and mental changes of this simple treatment plan are life changing.


  1. Marty M. Time Loss. JDR Clin Transl Res 2016; 20: 1–2.
  2. Haywood V B. History, safety and effectiveness of current bleaching techniques: applications of the nightguard vital bleaching technique. Symposium on Esthetic Restorative Materials. 1993. November: 82–92.
  3. Li Y, Greenwall L. Safety issues of tooth whitening using peroxide-based materials. Br Dent J 2013; 215: 29.
  4. L H. Greenwall. Tooth Whitening Techniques Second Edition. Taylor and Francis: London, 2017
  5. Greenwall-Cohen, J, Greenwall, L, Haywood, V & Harley, K 2018, ‘Tooth whitening for the under-18-year-old patient’, British Dental Journal, vol. 225, no. 1, pp. 19- n

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