Perio Mental Dental Video 5

Calculus

• Calculus is the mineralization of dental plaque, occurring within 1-14 days.
• It is not a mechanical irritant to gingival tissues by itself, but its outer surface is covered with a layer of plaque bacteria, which can contribute to periodontal disease.
• Calculus is essentially a natural sealant and does not contribute to caries.
• There are two forms of calculus: supragingival (whitish-yellowish, mineralized by saliva, often found on lingual surfaces of mandibular anterior teeth) and subgingival (dark, mineralized by gingival crevicular fluid).

Detection of Calculus

• Calculus can be detected visually, especially if it's heavily accumulated.
• An air spray or tactile sensation with an explorer can help detect smaller accumulations.
• Proximal calculus can be detected radiographically, appearing as ledges on the mesial and distal surfaces of teeth.

Materia Alba

• Materia Alba is a soft, white, cheese-like accumulation of bacteria, proteins, shed epithelial cells, and food debris.
• It is easily displaced with water spray and is a precursor to plaque.

Extrinsic Stains

• Extrinsic stains do not contribute to gingival inflammation and are primarily an aesthetic concern.
• However, they can point to underlying factors, such as:
  • Orange stains: poor oral hygiene, often found on anterior teeth.
  • Brown stains: dark-colored beverages, poor oral hygiene.
  • Dark brown or blackish stains: tobacco use.
  • Yellow-brown stains: use of core hexadecane and stannous fluoride.
  • Black stains: thin lines on the cervical third of teeth, due to iron consumption.
  • Green and yellow stains: poor oral hygiene, Chromogenic bacteria.
  • Bluish-green stains: occupational exposure to metallic dust.

Malocclusion

• Malocclusion can contribute to plaque accumulation and indirectly to periodontal disease.
• Crowding can lead to plaque retentive areas, making it difficult to clean teeth.
• Prominent roots and teeth associated with high frena can experience gingival recession.
• A missing tooth can lead to food impaction and plaque retention, as neighboring teeth tip in and opposing teeth hyper erupt.

Restorations

• Restorations can contribute to periodontal disease due to:
  • Overhanging margins, open margins, rough surfaces, and open contacts, which create plaque retentive areas.
  • Over-contoured restorations, which are worse for gingival health than under-contoured restorations.
  • Subgingival margins, which can cause plaque accumulation and gingival inflammation, even if they are not faulty.

Appliances and Self-Inflicted Injury

• Appliances can contribute to periodontal disease, such as:
  • Removable partial dentures, which can increase mobility of abutment teeth and plaque accumulation.
  • Braces, which can increase plaque retention and create excessive forces on the periodontium.
  • Oral jewelry, which can result in recession, pocket formation, and bone loss.
• Self-inflicted injuries, such as aggressive horizontal brushing, can cause tooth abrasion and gingival recession.
• Improper use of toothpicks, fingernail biting, and other habits can damage gingival tissues.