During the past few years, teeth-whitening kiosks have begun to pop up in Hawaii's malls, at Sam's Club and even at swap meets. This trend deeply concerns Hawaii's dentists and dentists around the country. And it should concern those who are responsible for protecting consumer safety.

Whitening kiosk operators are not licensed and lack the training, experience and rigorous oversight that should be required to perform such procedures.

Dentists across Hawaii have encountered several instances of patients suffering damage to their gums, tongue, lips and areas of the face, as well as tooth sensitivity, resulting from visits to teeth-whitening kiosk operators. In many instances, tooth decay has gone undiagnosed because it has been masked by bleaching. Had these unfortunate individuals seen a licensed dentist, their problem would have been correctly diagnosed and the decay treated before a whitening or an over-the-counter whitener was recommended.

Untrained kiosk operators must determine the size of the dental device to be used for the procedure, a decision that requires professional judgment and training. In one case, the use of an oversized dental tray resulted in a woman swallowing the bleaching chemicals during a whitening at a kiosk at Sam's Club on Keeaumoku Street. Only when the woman began choking did the employees of the kiosk take any action. And none of the employees was trained to properly respond to such a situation; they simply guessed.

Kiosk customers also are subject to infections, unlike in a dental office, where extreme care is taken when handling dental trays and other devices. Poor sterile procedures increase the risk of customers contracting diseases, including AIDS, norovirus, tuberculosis, hepatitis B and C, or any number of other diseases that might be encountered when multiple individuals are treated with the same equipment.

Basic hygiene and sterilization of all items used in a dental office are standard, essential requirements. No such requirements or standards are applied in whitening kiosks. Inspections of kiosks reported in the media revealed that sterilization of dental trays was not observed. In some kiosks, a rubbing alcohol rinse was used, which will not decontaminate a device sufficiently to protect the next user.

Kiosk employees are not required to undergo training in medical or dental procedures. They could be exposed to medical waste or disease-bearing trays because of their failure to understand the risks involved with what appear to be simple tasks. Even worse, employees could unknowingly take a serious medical problem home to their own families or pass it on to the next customer who sits in their chair.

Across the nation, state dental boards have successfully taken kiosk operators to court, which have determined that these retail teeth-whitening activities are, in fact, the practice of dentistry. States such as Tennessee and West Virginia consider teeth-whitening a practice of dentistry and have banned the operation of bleaching kiosks. The issue also is being addressed in states like Wyoming, Louisiana, North Carolina, Minnesota and New Mexico, which so far have reached conclusions similar to those of Tennessee and West Virginia.

Dentists are not opposed to the use of over-the-counter teeth-whitening products, which come in appropriate strength and with instructions that consumers can easily and safely follow. But those who require a stronger bleaching procedure should visit a licensed dentist.

The Hawaii Dental Association is supporting Senate Bill 51, which expands the definition of dentistry to include “;teeth-whitening services.”; If enacted, it will require anyone who performs teeth whitening in the Hawaii to have a dental license. Hawaii's dentists hope more public awareness of this issue will encourage our lawmakers to pass it and protect the health of Hawaii's consumers.

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Gary Umeda, D.D.S., is president of the Hawaii Dental Association, a statewide, professional membership organization representing licensed dentists.