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| industry report teeth whitening and remineralisation Update on teeth whitening and remineralisation with nHAp— 5 years after the EU regulations Author: Prof. Martin Jörgens, Germany Consider this the new era of painless teeth whit- ening and the end to soft tissue damage caused by hydrogen peroxide. Developments in the past five years have made a huge impact on the daily work of dentists, dental hygienists and well-trained dental nurses in the EU regarding the parameters for in- office teeth whitening and the purchase of teeth bleaching products containing hydrogen peroxide or carbamide peroxide. Impact of EU regulations for teeth whitening professionals In 2011, a new EU regulation called the EU directive 2011/84/EU brought about massive changes in teeth whitening across the blossoming industry in Europe. Following the new EU regulations, patients must be under constant dentist supervision and see the dentist before, during and after the teeth whitening process. Delegated, supervised and well- trained dental assistants are still allowed to perform teeth whitening procedures if supervised by a den- tist on-site. Economic effect on dental hygienists and cosmetologists In the Netherlands and other EU countries, self- employed dental hygienists have been severely eco- nomically affected. Professional hygienists are no longer allowed to whiten teeth as they did for many years as independent business owners. To continue teeth whitening therapy and running their own local clinics, self-employed dental hygienists had to hire dentists for supervision purposes to fulfil the new EU regulations. Cosmetologists and cosmetology studios were also required by the EU regulations to remove their teeth whitening practice. Even before the new EU regula- tions, some courts had already ruled that teeth whitening belonged in the dental field only and could only be performed by dentists and supervised by dental assistants and/or dental hygienists. In Germany specifically, teeth whitening in cosmetol- ogy studios where cosmeticians, dental students and dental assistants were employed, had to stop their non-regulated businesses or had to hire den- tists for supervision. Professional products banned in EU countries Professional teeth whitening products above 6 % hydrogen peroxide and 16 % carbamide peroxide were banned from the market and are no longer available in all restricted EU countries. The only cos- metic products available to consumers for at-home teeth whitening contain less than 0.1 % hydrogen peroxide and can only be purchased online. Reactions have been varied in different EU coun- tries. Most of the countries are following and monitoring EU regulations completely. Several EU countries are only allowing teeth whitening by the dentist or dentist supervised dental assistants. The same countries are no longer allowing teeth whitening products above 6 % hydrogen peroxide or above 16 % carbamide peroxide. The current countries following these regulations are: the Netherlands, Belgium, Luxembourg, United Kingdom, Ireland, Slovenia, Croatia, France, Romania, Sweden, Finland, Norway and Denmark. Different guidelines in Germany Missing from this list is Germany. Usually Germany is the first country to follow new restrictive guide- lines, no matter where they come from. However, hydrogen peroxide is still being used in higher con- centrations and is still available in Germany. At the moment, the German government allows higher concentrations above 6 % hydrogen peroxide. 46 cosmeticdentistry 1 2017