CSA clinical aspects of calculus Flashcards
What is calculus?
Mineralised plaque, calcified deposits attached to surfaces of teeth or other solid structures in oral cavity
What is supragingival calculus ?
• coronal (above) gingival margin
• distributed adjacent to salivary duct openings
o Lingual of lower anteriors / buccal of upper molars (where parotid duct opens)
What is subgingval calculus
- apical (below) gingival margin
* Distributed anywhere in the mouth
How is calculus formed?
- Plaque before calculus formation & provides organic matrix for mineralisation
- Ca & phos. miner. from saliva (supragingival calculus) or GCF (Subgingival calculus)
What are the supragingival crystals?
o Hydroxyapatite
o Octacalcium phosphate
o Brushite
What is a subgingival calculus crystal?
magnesium whitlockite
What are supragingival calculus crystals like?
small needle shaped/large ribbon-shaped
What are subgingival calculus crystals like?
small crystals
How does calcification work ?
small crystals in intermicrobial matrix & matrix between microorganisms become calcified & bacteria become mineralised
What is mineralisation thought to be reovled around ?
o Epitactic >Nucleation or crystal seeding of matric
o Booster > (Inc. pH & saturation of calcium/phosphorus)
o growth of crystal
When is supragingival calculus formed?
when localised plaque had a higher pH than that of saliva
Where is main source of inorganic ions for supragingival calculus?
from saliva
Where is main source of inorganic ions for subgingival calculus?
GCF
What is mineral content in supragingival calculus like?
• Ca, Mg, F, Sr, Zn < than in subgingival calculus
• Carbonate & Mn > than in subgingival calculus
F distrib. more regular than in subgingiv.
what are microorg. like in non calcified areas in supragingival calculus?
o more filamentous
o grow faster
o Calculus can regrow within days
Is there fewer non calcified microorg. in sub gingival calc?
yes and less filamentous types too
what is growth of subgingival calculus like?
SLOWER than supra
What is the appearance of supragingival calculus?
creamy white/yellow may be stained in smokers
What is the appearance of subgingival calculus?
darker and may be brownish/black
What is morphology of supragingival calc.. like?
o Amorphous (Not a clearly defined shape) o Large deposits can be present
What is subgingival calc. morphology?
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
What is the diagnosis of supragingival cal?
- Location
- Colour
- Feels rough >Calculus will feel lot rougher than plaque
- Air drying will give chalky appearance
What is the diagnosis of subgingival cal?
- 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
What is papillae like for subgingival calculus?
dark red/purple when subgingival calculus is found interdentally
What is WHO probe used for on subgingival calculus?
used with its ball end to check for deposits
o WHO probe detect for calculus interdentally , probe should jump over calculus when its present
What happens when rings of subgingival calculus are visible at CEJ?
Loss of attachment due to perio disease & subgingival calculus became supra
When can subgingival cal. become visible?
apical migration during agress. perio
What will happen when WHO probe detects subgingival cal?
jump and ping dragging off the calculus
• Subgingival calculus feels rougher than enamel & cementum
What probing force with WHO probe?
20-25g
How to detect subgin cal?
RADIOGRAPH
What is clinical significance of supragingival calculus?
o Poor aesthetics , stained
o Feels rough on tongue/ lingual surface of anteriors
o Predisposes /associated with gingival recession
What is clinical significance of subgingival cals?
Associated with loss of attachment
What can both supra and sub act as?
PRF
What does amelogenesis imperfecta predispose you to?
accumulation of plaque and calculus
- incr. recession and inflammation around anterior
What does perio therapy and scaling do?
•Scaling removes soft calculus & allows soft tissues to heal
o good OH for tissues to heal
What is RSD?
• Vision curettes, hoes, ultrasonic scalers used to remove subgingival calculus from root surface
Why is diagnosis important as well as systematic RSD?
to allow soft tissues to heal
What indices helpful in seeing>?
if treatment has been successful
