CSA clinical aspects of calculus

Question 1

What is calculus?

Answer 1

Mineralised plaque, calcified deposits attached to surfaces of teeth or other solid structures in oral cavity

Question 2

What is supragingival calculus ?

Answer 2

• coronal (above) gingival margin
• distributed adjacent to salivary duct openings
o Lingual of lower anteriors / buccal of upper molars (where parotid duct opens)

Question 3

What is subgingval calculus

Answer 3

• apical (below) gingival margin

* Distributed anywhere in the mouth

Question 4

How is calculus formed?

Answer 4

• Plaque before calculus formation & provides organic matrix for mineralisation
• Ca & phos. miner. from saliva (supragingival calculus) or GCF (Subgingival calculus)

Question 5

What are the supragingival crystals?

Answer 5

o Hydroxyapatite
o Octacalcium phosphate
o Brushite

Question 6

What is a subgingival calculus crystal?

Answer 6

magnesium whitlockite

Question 7

What are supragingival calculus crystals like?

Answer 7

small needle shaped/large ribbon-shaped

Question 8

What are subgingival calculus crystals like?

Answer 8

small crystals

Question 9

How does calcification work ?

Answer 9

small crystals in intermicrobial matrix & matrix between microorganisms become calcified & bacteria become mineralised

Question 10

What is mineralisation thought to be reovled around ?

Answer 10

o Epitactic >Nucleation or crystal seeding of matric
o Booster > (Inc. pH & saturation of calcium/phosphorus)
o growth of crystal

Question 11

When is supragingival calculus formed?

Answer 11

when localised plaque had a higher pH than that of saliva

Question 12

Where is main source of inorganic ions for supragingival calculus?

Answer 12

from saliva

Question 13

Where is main source of inorganic ions for subgingival calculus?

Answer 13

GCF

Question 14

What is mineral content in supragingival calculus like?

Answer 14

• Ca, Mg, F, Sr, Zn < than in subgingival calculus
• Carbonate & Mn > than in subgingival calculus
F distrib. more regular than in subgingiv.

Question 15

what are microorg. like in non calcified areas in supragingival calculus?

Answer 15

o more filamentous
o grow faster
o Calculus can regrow within days

Question 16

Is there fewer non calcified microorg. in sub gingival calc?

Answer 16

yes and less filamentous types too

Question 17

what is growth of subgingival calculus like?

Answer 17

SLOWER than supra

Question 18

What is the appearance of supragingival calculus?

Answer 18

creamy white/yellow may be stained in smokers

Question 19

What is the appearance of subgingival calculus?

Answer 19

darker and may be brownish/black

Question 20

What is morphology of supragingival calc.. like?

Answer 20

o	Amorphous (Not a clearly defined shape)
o	Large deposits can be present

Question 21

What is subgingival calc. morphology?

Answer 21

o Crusty, Spiny, Nodular deposits
o Ledge or ring formation 
o Thin, smooth veneers
o Finger & fern-like formations
o Islands or spots
o Supragingival calc.  can form on top of subgingival

Question 22

What is the diagnosis of supragingival cal?

Answer 22

• Location
• Colour
• Feels rough >Calculus will feel lot rougher than plaque
• Air drying will give chalky appearance

Question 23

What is the diagnosis of subgingival cal?

Answer 23

• Root surfaces of teeth at any site on any tooth of te mouth
• Darker more brown black than supragingival
• Visible= gingival margin of tooth following recession/attachment loss

Question 24

What is papillae like for subgingival calculus?

Answer 24

dark red/purple when subgingival calculus is found interdentally

Question 25

What is WHO probe used for on subgingival calculus?

Answer 25

used with its ball end to check for deposits

o WHO probe detect for calculus interdentally , probe should jump over calculus when its present

Question 26

What happens when rings of subgingival calculus are visible at CEJ?

Answer 26

Loss of attachment due to perio disease & subgingival calculus became supra

Question 27

When can subgingival cal. become visible?

Answer 27

apical migration during agress. perio

Question 28

What will happen when WHO probe detects subgingival cal?

Answer 28

jump and ping dragging off the calculus

• Subgingival calculus feels rougher than enamel & cementum

Question 29

What probing force with WHO probe?

Answer 29

20-25g

Question 30

How to detect subgin cal?

Answer 30

RADIOGRAPH

Question 31

What is clinical significance of supragingival calculus?

Answer 31

o Poor aesthetics , stained
o Feels rough on tongue/ lingual surface of anteriors
o Predisposes /associated with gingival recession

Question 32

What is clinical significance of subgingival cals?

Answer 32

Associated with loss of attachment

Question 33

What can both supra and sub act as?

Answer 33

PRF

Question 34

What does amelogenesis imperfecta predispose you to?

Answer 34

accumulation of plaque and calculus

- incr. recession and inflammation around anterior

Question 35

What does perio therapy and scaling do?

Answer 35

•Scaling removes soft calculus & allows soft tissues to heal
o good OH for tissues to heal

Question 36

What is RSD?

Answer 36

• Vision curettes, hoes, ultrasonic scalers used to remove subgingival calculus from root surface

Question 37

Why is diagnosis important as well as systematic RSD?

Answer 37

to allow soft tissues to heal

Question 38

What indices helpful in seeing>?

Answer 38

if treatment has been successful