Calculus and ultra sonics.

Question 1

What initiates periodontal disease?

Answer 1

Plaque initiates the immune response of the patient.

Question 2

what is dental plaque and how do we try and reduce it?

Answer 2

Plaque is the biofilm of bacteria that live in the mouth.
We try to deliver OHI and oral hygiene procedures (brushing, flossing teeth and TP ).

Question 3

What does periodontal treatment aim to do?

Answer 3

To reduce the level of pathogens in the sub gingival biofilm to a level where healing can occur. (dependent on the patients susceptibility levels of plaque).

Question 4

what is Calculus and name 2 sights where it is the most common on?

Answer 4

inert deposit of plaque bacteria supra/sub gingivally.

1) Near the buccal of the upper 6 - parotid gland outlet.
2) lower 3-3 due to sublingual salivary gland

Question 5

when would it be okay to level calculus?

Answer 5

When the patient’s susceptibility to periodontal disease is low and no LoA.

Question 6

why do we clean plaque name 2 things?

Answer 6

It creates a rough surface which attracts further plaque to accumulate and makes it hard for patient to clean around.

Question 7

what is the difference between plaque and calculus?

Answer 7

dental plaque is soft and can be removed easy whereas dental plaque is hard and cannot be removed by patients.

Question 8

how can we identify sub-gingival calculus (rare) and what is the reason for this discolouration?

Answer 8

Dark green/black in appearance but it is hard to see because it is sub gingival. This is caused by chromogenic bacteria metabolising blood based products.

Question 9

what differentiates sub gingival calculus to supra gingival calculus (location)?

Answer 9

Supra gingival calculus is usually located near the saliva glands/ ducts where is sub gingival calculus is all over the mouth.

Question 10

how do we detect Supra gingival calculus and what is its appearance?

Answer 10

Dry the tooth/ well lit as well.
It appearance is matt coming out of the tooth rather than a “frosty” appearance within the tooth (Demineralised).

Question 11

how do we detect sub gingival calculus

Answer 11

Using 3in1 air into pockets trying to Get a dry tooth as well as see the root surface.
Then using the BPE probe (ball ended ) it will catch on rough surfaces and the CP 12 probe

Question 12

what is the diameter of the CP12 probe

Answer 12

3mm banding for narrow pockets

Question 13

what probe can be used for detecting sub gingival calculus other than the CP12/ who probe?

how would you detect calculus using the probe?

Answer 13

Cross calculus probe.

Question 14

Identify and give a reason to where the Calculus is present in the radiograph

Answer 14

On the image on the left the the over hang is not calculus but the restoration as it hsa the same radiolucency.

Image on the right has side the little trianlge which is coming off the mesial surface of the 6 is the calculus. We know this as it has different radiolucency as wellk as the trigangle shape.

Question 15

1. Identify the surfaces which calculus is present on?
2. what might be the reason for the calculus not being removed by the clinician.
3. Comment on the bone levels and give a reason why for your answer.
   4.

Answer 15

1. Distal surface of the Upper premolars and molars.
2. Hard for the clinicain to remove as the angles are very tight on the distal surfaces of the molars and permolars as the teeth are right as the back of the mouth.
3. bone levels around the 7/8 are low as the patient is susceptible to periodontitus.

Question 16

Comment on the photo below mentioning the key points.

hints are below for each thing which needs to be mentioned.

1. papilla
2. 3 major signs
3. greyness suggests?
4. patient care
5. creamy colour

Answer 16

1. Central incisors the papilla is purplish which is not a good sign.
2. upper left 1 and 2 the papilla has inflammation (Puffy/loss of stippling/ no knife edge margian) suggesting there is something wrong
3. inbetween the teeh there is greyness suggesting calculus has sub gingivally.
4. Lower left/ right lateral incisors has a grey rim suggesting there is high levels of calculus being laid down which the patient cannot clean.
5. upper left 6 has a more creamy calculus which is supra gigival.

Question 17

what is the main obstical when trying to use a ultrasonic scaler and the the patient has has loss of attachment.

what can we do to alleviate this problem

Answer 17

loss of attachment can cause root surface being exposed which can create hyper sensativity as root surfaces has many tubules. Dentinal sensativity.

we can use hand instruments or give LA.

Question 18

ultrasonic and sonic scalers are power scalers but how do they differ?

is there disadvantage to using sonic scalers?

Answer 18

ultrasonic generate their motion from peizo-electricty (uses crystals to convert mechanical enegry to eletrical energy and vise versa) OR magnetistriction.

Sonic scalers generate from passge of compressed air.

Sonic can cause micro abrrasion to the root surface making it more rough which can lead to plaque build up.

Question 20

what is the frequency at which the ultrasonic scale and the sonic scale oscillate at?

Answer 20

Ultrasonic- 25-42 kHz

Sonic scaler 6-8kHz

Question 21

what is the main purpose of caviationa and microstreaming when trying to scale

Answer 21

Within the pocket this will remove the biofilm as thet affeect the permeability of the bacterial cell membrane which leads to lysis.,

Question 22

when to use power scalers and when do we avoid them?

Answer 22

useful for hard deposits/ narrow pockets and furcations

not useful for soft plaque as they create a big mush- Can you interdental brushes/floss

Question 23

What teeth would we avoid in the picture and why?

Answer 23

avoide the lower right premolar because that is carious dentin and the power scaler will remove this.

Question 24

when would we not use the ultrasonic scalers?

Answer 24

1. when a patient has a device put in such as a Pacemaker or any other device hearing aid.
2. avoid in TB/ Repsiratory problem patients
3. avoid with patients who cannot tolerate high volumes of aspirations

Question 25

why do we have to be careful when using ultrasonics name 3 reasons?

Answer 25

1. can cause thermal damage tooth
2. damage to the tooth surface when angualtion is incorrect
3. have to take care on decalcifiation of enamle areas as they can cavitate lesion.

Question 26

What do we need to be mindful of when we use ultra sonics in the mouth

Answer 26

Ceramics are highly scrathable and can be chipped.

crowns / bridges /direct restorations.