Dentaltown June 2018 - 81

VASQUEZ PHOTO COURTESY OF KATERINA VORONTSOV

by Mary Jane Livingston and Jennifer Vasquez
Mary Jane Livingston, RDH, BSDH, is an adjunct professor at the NYU
College of Dentistry and a clinical hygienist at Dr. Jonathan B. Levine
& Associates in Manhattan. Livingston, who has practiced hygiene
for eight years and has more than a decade of dental experience,
began her teaching career in 2014 in Phoenix. She is also an
educator at Glo Science Professional, focusing on beauty and health
as well as the oral-systemic link. An active member of the Glo Good
Foundation, she participates in the group's annual dental/medical
mission trips.

Practicing dental hygienist Jennifer Vasquez, RDH, BS, has
more than 16 years of clinical experience in private practices
in Manhattan and New Jersey, including her current position at
Dr. Jonathan B. Levine & Associates in Manhattan. Vasquez educates
her patients on the value of proper oral hygiene and systemic
health. She has been the clinical director at Glo Science Professional
since 2014, and lives in New Jersey with her husband and son.
The authors would like to thank Levine for his research in the field of
whitening, which they have cited in their article. (See References.)

ow often do we hear, "I know I have cavities ... but how do I get my teeth whiter?"
We all cringe over that question, but over the years the smile has found a niche in
the beauty industry. Whitening is the most commonly requested dental procedure,
with $1.4 billion in sales per year; it's been proven to be the fastest way to enhance
the beauty of the smile.1 Patients are interested in having brighter, younger-looking smiles,
and are purchasing the whitening products to do so.
Professionally administered whitening products, which have the supervision of the
dentist and their hygiene team, are always in the best interest of patients' oral health and
beauty. Patients who are concerned with the color and beauty of their smiles are better dental
patients, who tend to seek additional treatments and are more conscious of their oral health.
In addition, creating a strong whitening program within the dental office provides a natural
platform to discuss tooth shade with your patients, and facilitates a financial gain to your
hygiene or ancillary production. Integrating whitening into a sequenced oral care plan allows
for a comprehensive approach to aesthetic dental cases.2
With so many options and delivery systems available, how can the dental professional
determine which is the best whitening system-one that ensures the best results with
minimal tooth sensitivity? Here's what you need to know when choosing a whitening
system for your practice.

The science of whitening
What makes up tooth color? Three factors that affect tooth shade are genetics,
environmental factors (e.g., medication and nutritional habits) and the patient's ability to
maintain a healthy mouth.3
The enamel is the most highly mineralized substance of the tooth, consisting of calcium
phosphate and packed hydroxyapatite.4 Because the enamel is semitranslucent, its color may
vary from yellowish to grayish, but it's only partially responsible for the color of the teeth.
Enamel rods are arranged in rows perpendicular to the secondary layer of the tooth,
the dentin.5 The color in dentin comes from color molecules known as chromophores. These
chromophores contain double bonds that can absorb visible light rays that contribute to
the darkened or stained appearance of teeth. Hydrogen peroxide breaks down into water
and peroxide ions.3 These peroxide ions then bind to the chromophores, which breaks the
double bond. The single-bonded chromophores absorb less light (reflecting light), resulting
in whiter teeth.
We are also aware of the role of intrinsic and extrinsic staining in tooth shade. Intrinsic
stains lie within the dentin surface and are more difficult to remove. Intrinsic stains may
be caused by medications, fluoride exposure, and environmental factors such as genetic or
systemic conditions.3 Extrinsic stains are surface stains that attach to the biofilm and enter
the enamel matrix. This type of staining is typically derived from a patient's habits, such
as smoking or coffee consumption, over a period of time.
dentaltown.com \\ JUNE 2018

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Table of Contents for the Digital Edition of Dentaltown June 2018