Calculus- a clinical perspective

Question 1

Define calculus

Answer 1

Mineralised plaque

alcifying or calcified deposits attached to the surfaces of teeth or other solid structures in the oral cavity

Question 2

What are the 2 main categories calculus I split into?

Answer 2

1. Supragingival calculus

2. Subgingival calculus

Question 3

Where is supra gingival calculus found?

Answer 3

Located coronal to the gingival margin

Question 4

Where is supra gingival calculus mainly distributed?

Answer 4

Distributed adjacent to salivary duct openings

Question 5

Where ares salivary duct openings found?

Answer 5

Lingual of lower anteriors

Buccal upper molar

Question 6

Where is sub gingival plaque found?

Answer 6

Located apical to the gingival margin

Question 7

Where is subgingival plaque mainly distributed?

Answer 7

It can be distributed anywhere in the mouth

Question 8

Where d the calcium and phosphate minerals that calcify calculus come from?

Answer 8

They come from:

1. Saliva (supragingival calculus)
2. GCF (Subgingival calculus)

Question 9

What type of crystals are found in supra gingival calculus?

Answer 9

1. Hydroxyapatite
2. Octacalcium phosphate
3. brushite (new supra)

Question 10

What type of crystals are found in sub gingival calculus?

Answer 10

magnesium whitlockite

Question 11

Describe the crystals fond in supra gingival calculus

Answer 11

Small needle shaped or large ribbon shaped crystals

Question 12

Describe the crystals fond in sub gingival calculus

Answer 12

Small crystals

Question 13

Name the 2 mechanisms by which calcification can occur

Answer 13

1. Epitactic

2. Booster

Question 14

Where is does the mineral content for supra gingival calculus come from?

Answer 14

37% Minerals come from saliva by volume

Question 15

Which minerals are found more in subgingival calculus than supra gingival?

Answer 15

Ca
Mg
F
Sr
Zn

Question 16

Which minerals are found more in supragingival calculus than sub gingival?

Answer 16

Carbonate and Mg

Question 17

Following a scale and polish how long may I take for supra gingival calculus to reform?

Answer 17

Can reform within days

Question 18

Where is does the mineral content for sub gingival calculus come from?

Answer 18

58% mineral comes from GCF by volume

Question 19

Describe the crystal growth within subgingival calculus

Answer 19

Tends to be heterogeneous nucleation and crystal growth

Question 20

Following a scale and polish how long may I take for supra gingival calculus to reform?

Answer 20

Theres slower growth as there’s fewer non calcified micro organisms

Question 21

Why can supra gingival calculus being to reform within days of a scale and polish in comparison to subginigval calculus?

Answer 21

As supra gingival calculus has more non caclcifie micro organisms and more filamentous

Question 22

What did Roberts-Harry’s study show in regards to mineral composition in Indo-Pakistani adults?

Answer 22

Showed they had lower levels of sodium in apical than coral subgingical calculus
They also had lower levels of sodium ad magnesium in apical samples in comparison to Caucasian samples

Question 23

What hypothesis did Roberts-Harry reach following their findings regarding ethnic variation in mineral composition

Answer 23

That decrease substitution go M fo calcium in Indo-pakistani adults. This will reduce the dissolution of Mg and make subgingival calculus more tenacious and difficult to remove

Question 24

Describe the appearance of supra gingival calculus

Answer 24

Creamy white colour

May be satin in smoker

Question 25

Describe the appearance of subgingival calculus

Answer 25

Darker may be brownish or black in colour

Question 26

Describe the morphology of supra gingival calculus

Answer 26

It is amorphous

Question 27

Describe the morphology of subgingival calculus

Answer 27

Can be in the form of:

1. Crusty, spy, noodle deposits
2. Ledge or ring formation
3. Thin, smooth venners
4. Finger and fern like formations
5. Islands of spots

Question 28

List the 4 ways supragingival calculus can be diagnosed

Answer 28

1. Deposits will be LOCATED above the gingival margin and around the openings of the salary ducts
2. Look at the COLUR of the deposits
3. Calculus will feel rougher in comparison to plaque
4. If you air dry the area calculus will give a chalky appearance

Question 29

List the ways we can diagnose subginigval calculus

Answer 29

1. Check the location (under the gingival margins)
   2, deposit will be darker colour
   3.Use a WHO probe
2. Sometimes you can seee subgingival calculus at gingival mrgins following recession loss
3. Ma be ablate see subgingival calculus in pocket s
4. The papilla may be dark re (check using WHO probe)
5. See if there is a shadow under the gingiva (check with a WHO probe)
   7 Can use radiograph (but only visible if calculus has extended a to

Question 30

Name the WHO probe we use to check for calculus

Answer 30

The WHO 621 probe

Question 31

Describe the WHO 621 probe

Answer 31

It has a spherical ball end (0.5mm)

Question 32

What probing force should we apply when using WO 621 probe?

Answer 32

20-25g

Question 33

What is the clinical significance of supraginigval calculus?

Answer 33

Poor aesthetics especially if stained

Question 34

What do sub and supra gingival calculus act as?

Answer 34

Plaque retention factors

Question 35

Why do supra and sub gingival calculus act as plaque retention factors?

Answer 35

Due to the rough surface

Question 36

What is subgingival calculus associated with?

Answer 36

Loss of attachment

Question 37

Why is supra gingival calculus clinically significant?

Answer 37

It is predisposed to gingival recession

Question 38

What I we use a WHO 521 probe for?

Answer 38

To aid detection of sub and supra gingival calculus

Question 39

Nam some periodontal therapy we can use to remove calculus

Answer 39

1. Root surface debridement

2. Scaling