By law, dental professionals (NHS and private) must be registered with the General Dental Council (GDC) in order to practise dentistry in the United Kingdom.
In order to be able to register with the GDC, a dental professional must successfully:
- achieve the correct level of education
- meet a defined standard of health
- have suitable indemnity in place
Once registered, the dental professional must agree to abide by the GDC's official guidelines as set out in Standards for Dental Professionals and engage with a programme of continuing professional development throughout their career.
When a dental professional has complied with these defined standards and gained registration with the GDC, they can legally make use of an appropriate protected title from the following list:
- dental nurse
- dental technician
- clinical dental technician
- dental hygienist
- dental therapist
- orthodontic therapist
Protected titles are enshrined in legislation and used by health professionals to indicate their field of practice to patients and the public.
The correct use and control of such titles exists to ensure public protection, patient safety and public confidence in both the health profession and the regulatory system that is established to oversee the profession. Under section 26(1) of The Dentists Act 1984 (Act):
- A registered dentist shall by virtue of being registered be entitled to take and use the description of dentist, dental surgeon or dental practitioner
Further, section 39 of the same Act prohibits the use of such protected titles by laymen:
- A person who is not a registered dentist, a visiting EEA practitioner entered in the list of such practitioners or a registered medical practitioner shall not take or use the title of dentist, dental surgeon or dental practitioner, either alone or in combination with any other word.
- No person shall take or use any title or description implying that he is a registered dentist unless he is a registered dentist.
- Any person who acts in contravention of this section shall be liable on summary conviction to a fine not exceeding the fifth level on the standard scale.
It is therefore a criminal offence for an individual who is not registered with the GDC to practise under a protected title.
As well as the application and enforcement of protected titles, the law restricts against the 'practice of dentistry' by laymen. Part IV of the 1984 Act, at section 37(1) defines the practice of dentistry as:
- For the purposes of this Act, the practice of dentistry shall be deemed to include the performance of any such operation and the giving of any such treatment, advice or attendance as is usually performed or given by dentists; and any person who performs any operation or gives any treatment, advice or attendance on or to any person as preparatory to or for the purpose of or in connection with the fitting, insertion or fixing of dentures, artificial teeth or other dental appliances shall be deemed to have practised dentistry within the meaning of this Act
Section 38 of the Act prohibits the practice of dentistry by laymen:
- A person who is not a registered dentist, a visiting EEA practitioner entered in the list of such practitioners, or a registered medical practitioner shall not practise or hold himself out, whether directly or by implication, as practising or as being prepared to practise dentistry
- Any person who acts in contravention of subsection (1) above shall be liable on summary conviction to a fine not exceeding the fifth level on the standard scale
It is therefore a criminal offence for an individual who is not registered with the GDC to undertake the practise of dentistry.
Is cosmetic treatment the practice of dentistry?
As defined in Section 37 of the Act, the practice of dentistry shall 'include the performance of any such operation and the giving of any such treatment, advice or attendance as is usually performed or given by dentists'.
Subsection 37(1) also makes it clear that any treatment, advice or attendance, which is usually performed by dentists, must be carried out by a GDC registered dentist.
There is currently a growing trend of cosmetic dental treatment being carried out by individuals not registered with the GDC. Dr Martin Fallowfield, chair of the British Dental Association (BDA) Principle Executive Committee said in a consultation paper, 'recent years have seen growing patient interests in treatments that enhance their appearance'.
In light of this growing interest, the BDA and the GDC will submit evidence to The Department of Health as part of an overarching consultation into the cosmetic surgery industry. The consultation is to be led by the National Health Service's medical director Professor Sir Bruce Keogh.
The consultation examines the current levels of GDC regulation. In particular, how the regulations control the 'treatments' being carried out by lay people when they should only be carried out by registered professionals with a protected title. Dr Martin Fallowfield states that 'the BDA supports appropriate, proportionate regulation'.
There is specific reference in the consultation to teeth whitening. However, it is expected that general 'cosmetic intervention' will also be considered which includes other dental treatments such as dental implants. The GDC's position is that teeth whitening may only lawfully be provided by registered dental professionals.
It would appear that the consultation into the current level of regulation is being conducted in response to a number of recent breaches of GDC regulations.
Several companies producing teeth whitening products have suggested to the GDC that since teeth whitening products are regulated by the European Council Directive on Cosmetic Products 76/68/EEC, their agents are carrying out a cosmetic procedure and are therefore not practising dentistry.
The GDC has made it clear that it is often wrongly stated that the Optident Limited and Another v. Secretary of State for Trade and Industry and Another  case, commonly known as 'Optident', is authority for this proposition.
The GDC states that the Optident case was concerned solely with the classification of teeth whitening products and has no bearing on their view that carrying out teeth whitening treatment amounts to the practice of dentistry.
The GDC has successfully prosecuted unregistered individuals who were carrying out teeth whitening procedures.
In March 2011, Mr Paul Hill, director of Style Smile Clinics, entered a guilty plea to offences under the Dentists Act 1984 including the practice of dentistry whilst not registered as a dentist.
In December 2011, Mr Carl Espano, describing himself as a 'cosmetologist', was successfully prosecuted by the GDC for offering tooth whitening treatments. Mr Espano unsuccessfully relied upon the Optident precedent to mitigate his actions. The court gave this argument little or no weight when sentencing, describing the offence as 'serious'.
On 3 August 2012 the GDC successfully prosecuted a beautician, Elaine Taylor-Valles. Ms Taylor-Valles was charged with the unlawful practise of dentistry and unlawfully carrying out the business of dentistry.
The GDC investigated a complaint from a member of the public about the manner in which her teeth had been whitened. Ms Taylor-Valles stated to the GDC in correspondence that she was a 'fully qualified beautician' and was therefore entitled to carry out teeth whitening procedures. The GDC successfully prosecuted Ms Taylor-Valles because 'beautician' is not a title recognised by the GDC, and she was not permitted in law to carry out the practice of dentistry.
It is clear that the GDC is concerned about treatments being carried out by individuals who are not legally permitted to carry out the practice of dentistry. In a GDC factsheet dated June 2012 entitled Tooth Whitening, the GDC states 'tooth whitening is being carried out by non-registrants all over the country'. In this factsheet, the GDC encourages any interested parties to check whether an individual is registered and if not to contact the GDC's 'illegal practice' team.
The consultation into current regulation is a clear indicator of the GDC's aim to ensure that cosmetic procedures which cross the boundary into the practice of dentistry are only to be carried out by those who hold a protected title. The recent successful criminal prosecutions are demonstrative of the GDC's intention to ensure the safeguarding of 'protected titles' and the power and value of the relevant legislation.