Dental Calculus PDF

Dental Calculus Mineralized bacterial plaque Calculus Formation  Plaque  Pellicle formation  plaque maturation  Mineralization  Where ever a solution of calcium and phosphorus are unstable and so...

Dental Calculus Mineralized bacterial plaque Calculus Formation  Plaque  Pellicle formation  plaque maturation  Mineralization  Where ever a solution of calcium and phosphorus are unstable and so available  Often has a layered structure  Mineralization  Complicated and not well understood  Within 24 -72 hours of plaque formation mineralization centers develop in plaque, close to tooth surface in the intermicrobial matrix  Average of 12 days from plaque to calculus  Forms in layers parallel with tooth surface  Incremental lines form between layers of calculus  Minerals involved  Calcium Ca  Phosphorous P  Carbonate CO3  Sodium Na  Magnesium Mg  Potassium K  Fluoride Fl  Sources of minerals  Supragingival  Saliva  Subgingival  Sulcular fluid and exudate Two thirds of inorganic part is crystalline -apatite  Most common Hydroxyapatite-  main inorganic portion is 75.9% calcium phosphate  Brushite- precursor to apatite  Magnesium Whitlockite  Octocalcium phosphate  Modes of Attachment  By acquired pellicle  On enamel and planed root surfaces  Easily removed Attachment cont.  By tooth irregularities and undercut areas  Cracks in enamel  Pits and grooves  Gouged areas of cementum Very difficult to remove  Attachment cont.  Direct contact between calcified intercellular matrix and tooth surface  Interlocking of inorganic crystals of the tooth structure with the mineralizing bacterial plaque  Very difficult to distinguish between calculus and cementum in this case  Difficult to remove  Hard Deposits  Hardness of calculus % inorganic substance 96% enamel 75-85% calculus 65% dentin 45-50% cementum/bone **the higher the inorganic %, the greater the degree of calcification  Heavy calculus formers  High levels of calcium and phosphorous in saliva  High salivary pH  High bacterial protein and lipid concentration  Elevated protein and urea in submandibular salivary gland secretions  Light calculus formers  High levels of parotid pyrophosphate  Pyrophosphate is anti- calculus ingredient found in dentifrice  Pyrophosphate is a crystal growth inhibitor  Factors affecting the amount of calculus in a population  oral hygiene habits  access to professional care  Diet  Age  ethnic origin  time since last dental cleaning  systemic disease  use of prescription medications  Plaque Retention Factors  Orthodontic Appliances  Partial Dentures  Malocclusions  Faulty Restorations  Calculus  Deep Pockets  Mouth Breathing  Tobacco Use  Certain Medications Hard Deposits  Relationship to disease  Calculus is a plaque haven  Calculus is the result (NOT the cause) of pocket formation  Plaque forming on top of calculus is nearly impossible to remove (rough surface harbors plaque; tears floss)  If calculus is removed, the smooth tooth surface makes plaque removal effective  Calculus holds toxic by-products of plaque in contact with gingival tissues Supragingival calculus Supra +subgingival calculus Outer surface of calculus  Covered in a rough, dense furry plaque layer  This plaque attracts more plaque forming microorganisms  Subgingivally the microorganisms are pressed against inner  Location of calculus Supragingival Where saliva pools  Lingual of mandibular anteriors  Buccal of maxillary 1st and 2nd molars  Malposed or non- functioning teeth  Where patients don’t clean Location of subgingival calculus  Heaviest interproximally  May occur on any root surface  Where patients don’t clean  Clinical appearance Supragingival calculus  Whitish yellow  DRY TEETH TO EXPOSE IT  Can pick up stain  Forms bridge across many teeth  Hard  like plaster Clinical appearance Subgingival calculus  Darker than supra  green, brown, black  Stained from sulcular fluids including blood  Tissue may appear dark /blue due to underlying deposits & erythema/cyanosis  Hard ( like cement)  USE AIR TO DEFLECT MARGINAL GINGIVA  Removal of calculus  Supra easier to remove  Careful, thorough root planing by hand and power driven scalers  Subgingival comes off in layers (like flint)  Must be removed to base layer of cementum  Smoothed but not removed calculus is called burnished  VERY TOUGH TO REMOVE!  Results from improper angulation of the blade, use of dull instruments, not enough lateral pressure, choice of the Burnished calculus  How to check for removal  Dry the teeth  Careful exploration. (Use a light grasp)  Overlapping strokes Re-Evaluate Quads previously treated Tips on maneuvering around calculus  When probing move probe around the obstruction to get deeper reading  When exploring readapt under calculus to determine surfaces covered  Small Calculus Deposits  You will feel a gritty sensation as the explorer passes over the small calculus deposit.  “Inline skating over a few pieces of gravel”  Fewer than picture Minute and isolated deposits are called spicules  Large Ledge of Calculus  You will feel the tip move out and around the raised bump and return back to the tooth surface.  Can be on B L M D  “Skating over a speed bump in a parking lot” Runs parallel with gingival margin, if it encircles the tooth it’s a RING What to decide when you explore  Quantity of deposits  Shape of deposits  Tenacity of deposits  Describing calculus  Generalized Localized (1 or 2 teeth)  Slight Moderate Heavy  Inter-proximal Facial Lingual  Supra-gingival Subgingival “Generalized moderate inter-proximal subgingival calculus” Located in your program manuel The following slides will give you an example of different degrees of calculus build up:  Concentration  needed for a clinician to determine what he or she is feeling when the explorer tip vibrates as it encounters something on the root surface.