Lecture 13, 14, and 15 Flashcards
TF? Tartar is another name for plaque.
F. tartar = calculus
TF? Dental plaque can form in the absence of bacteria.
T
What is dental calculus?
mineralized bacterial plaque
Where can dental calculus form?
teeth, restorations, prostheses
What can dental calculus absorb, leading to damage of the gingiva?
endotoxin and other toxins
TF? Toxins are located within root surfaces.
F. on, not within
TF? Extensive removal of cementum is not necessary to remove dental calculus.
T
a heat-stable toxin associated with the outer membranes of certain gram-negative bacteria, including Brucella, Neisseria, and Vibrio species:
endotoxin
2 classifications of dental calculus:
supra- or subgingival
TF? Supragingival dental calculus is easily detached.
T.
TF? Supragingival dental calculus recurs slowly.
F. rapidly
Supragingival dental calculus recurs rapidly, esp around these teeth.
Lingual mandibular incisors
Extremely heavy calculus buildup can lead to the formation of a calculus:
bridge
What color is supragingival calculus?
White or whitish yellow
Most common location of supragingival dental calculus:
lingual of mandibular anterior teeth
Wharton’s duct is the ___ gland
submandibular
Bartholin’s duct is the ___ gland.
sublingual
2nd Most common location of supragingival dental calculus:
buccal maxillary molars
Stensen’s duct is __ gland
parotid
TF? Subgingival dental calculus is usually visible.
F.
What color is subgingival dental calculus?
dark brown or greenish black
TF? Subgingival dental calculus is easy to remove.
F. Firmly attached, tough to remove
How far apically does subgingival calculus typically extend?
nearly to bottom of periodontal pocket but not to JE
What will happen to a pt with heavy subgingival dental calculus after initial scaling and wo effective subgingival scaling?
gingival “shrinkage” and very visible, dark calculus that was previously below the gingiva
What is calculus?
mineralized dental plaque,calculus: minerals, caries: bacteria
Calculus formation occurs days ___-___ of plaque formation.
1-14 (ask, what about after?)
Minerals for supragingival calculus come from:
saliva
Why does calculus form more near salivary gland ducts?
saliva and plaque fluid supersaturated with calcium phosphates
Where do the minerals for subgingival calculus come from?
gingival crevicular fluid, serum transudate, esp. inflamed gingiva
TF? All plaque becomes calculus.
F.
What is calculus always covered by?
plaque
What causes gingival inflammation?
plaque covering calculus, not calculus itself
Evidence demonstrating that calculus does not cause inflammation:
autoclave calculus, no inflammation
Can calculus form in the absence of microorganisms?
Yes, (ask, how -> You were getting calculus confused with caries!. All calculus needs to form is minerals from saliva)
2 theories as to how plaque mineralizes:
Saliva supersaturated with calcium and phosphate ions AND heterogeneous nucleation
What happen to pH, CO2, and ammonia formation if saliva becomes supersaturated with calcium and phosphate ions?
increase pH (these minerals are basic), decrease CO2 and increase ammonia formation by plaque bacteria
What does phosphatase precipitate?
calcium phosphate, increases phosphate ions (possible therapeutic target?)
Explain Heterogeneous Nucleation:
Seeding agents induce small foci of calcification that enlarge and coalesce to form a calcified mass
Composition of Calculus:
70%–90% Inorganic, similar to calcified tissues - bone, dentin cementum
The inorganic portion of calculus is mainly:
calcium phosphate (76%) - Ca3(PO4) some calcium carbonate - CaCO3 - and magnesium phosphate - Mg3(PO4)2
What are the main crystals in calculus?
hydroxyapatite, octacalcium phosphate
What determines ease / difficulty in removal of caclulus?
How it attaches to teeth (I asssume this is why calculus is harder to remove subgingivally)
4 ways Calculus Attaches to Teeth:
Enamel: pellicle, Cementum: mechanical locking, close adaptation, or penetration of calculus
Is calculus attachment to enamel via pellicle easy or difficult to remove with scalers and curettes?
easy
Is calculus interlocked to cementum easy or difficult to remove?
difficult
What type of calculus adherence necessitates SRP?
Calculus interlocked to cementum
Scaling is the removal of ____ from teeth.
deposits
Root Planing is aka:
root debridement
What is being removed during root debridement?
cementum or dentin that is rough, contaminated, or permeated with calculus
How to remove cementum or dentin that is rough, contaminated, or permeated with calculus:
hand, sonic and/or ultrasonic instruments
Goal of root planing:
Create a glasslike feel to the surface
This is one of the most difficult clinical skills to master:
Root planing
% of calculus removed in pockets less than 5mm:
90%
% of calculus removed in pockets greater than 6mm:
65%
Is calculus removal more difficult on multirooted or single rooted teeth?
multirooted
This surgery facilitates calculus removal:
flap, open vs closed procedure
TF? Flap surgery is a closed procedure.
F. open
Supragingival calculus detection:
visual, dry tooth surface, “chalky” appearance
Subgingival calculus detection:
dark shadow at the gingival margin, feel roughness with an explorer
Appearance of calculus on RG:
radiodense spicules
Explorer used primarily for calculus detection:
11/12, (board exam)
Does subgingival calculus reach the junctional epithelium?
no, but nearly to the bottom of the pocket
Where is there a zone free of calculus in sulcus?
base of pocket
Which type of calculus can you see on a RG?
both supra- and subgingival
Main type of calculus visible on RG’s:
interproximal
TF? The location of calculus indicates the bottom of the periodontal pocket.
F.
Is the sensitivity of RG calculus high or low?
low
Why is the Sensitivity of Radiographs for the Detection of Calculus Low?
only interproximal calculus visible
Additional methods for calculus detection:
(A, E, L, O, U) Fiberoptic endoscopy, spectro-optical technology, ultrasound, autofluorescence, laser and autofluorescence
Device used for fiberoptic endoscopy:
perioscopy
Device used for spectro-optical technology:
detectar
Device used for autofluorescence:
diagnodent
Device used for ultrasound:
perioscan
Device used for laser and autofluorescence:
Keylaser3
Is calculus a primary or secondary factor for PD?
secondary etiology
plaque accumulation leads to:
Inflammation, difficulty in plaque removal
Can tissue healing occurs in the presence of calculus?
as long as plaque is removed
Basis for all periodontal therapy:
plaque and calculus removal
Increased difficulty of calculus removal with:
Deeper pockets, tooth anatomy (furcations), less operator experience
Common ingredients in anti-tartar dentrifice formulations:
zinc citrate, sodium, phosphate, fluoride, pyrophosphate, triclosan,
% of ppl bwb 9-18 with calculus:
37%-70%
TF? Prevalence of calculus increases with age.
T
% of ppl with calculus after the age of 40:
86-100%
90% of all calculus is found here:
mandibular anteriors
4 Types of Calculus Formers:
non, low, mod, heavy
Why Different Calculus Formers?
Differences in pyrophosphate concentration in plaque. Non-formers had high concentrations
How Does Pyrophosphate Decrease Calculus Formation?
prevents calcification
Components of Pyrophosphate:
sodium, tetrasodium, tetrapotassium
Pyrophosphate is a structural analog of:
orthophosphate
Pyrophosphate inhibits:
calcium phosphate crystal growth, conversion of calcium phosphate to hydroxyapatite, bacterial growth (lower concentrations)
How Does Pyrophosphate Decrease Calculus Formation?
binds to Ca2+ ions in hydroxyapeptite
Agents to Control Calculus:
Plaque or crystal growth inhibitors
Ex of Plaque inhibitor:
triclosan
What type of agent is triclosan?
broad-spectrum antimicrobial
Fxn of triclosan:
destroys bacterial cell membrane (cidal then, R?)
Examples of Crystal growth inhibitors:
pyrophosphate, zinc salts, bisphosphonates
TF? Crystal growth inhibitors inhibit the formation of new calculus.
T
TF? Crystal growth inhibitors reduce existing calculus.
F
TF? Pockets resolve after calculus removal.
T
Pyrophosphates inhibits:
plaque mineralization
Should X-rays be reviewed before or after charting?
Before
This should be continuous with lamina dura of adjacent teeth:
interdental crestal bone
What to look for in healthy bone:
normal trabeculation and density
Where should the alveolar crest be?
1-2mmm from CEJ and roughly parallel to a line bw CEJ’s
Healthy features of interdental crestal bone margins in anterior region:
thin, even, pointed
Healthy features of interdental crestal bone margins in posterior region:
thin, smooth, evenly corticated, sharp angle bw crestal bone and lamina dura
Features of healthy perio ligament space:
thin even width
Factors that can result in the absence of ‘normal features’ of bone:
technique error, overexposure, normal variation in alveolar bone shape and density
Why is the cortication at the crest not always evident?
small amt of bone, beam angulation
What might be visible in RG’s following perio therapy?
healthy perio tissues with earlier bone loss
TF? RG bone loss alone is an indicator of current periodontal inflammation.
F
RG features of chronic PD:
Loss of corticated interdental crestal margin (irregular or blunted), bone in furcation areas (from widening of PDL space in furcation to large areas of bone loss), hori or vert bone loss (loss or formation of complex bony defects), widening of interdental PLS’s, widened perio lig spaces at crestal margin, normally sharp angle bw crestal bone and lamina dura bcm rounded or irregular
order of tissues from cementum out:
cementum, PDL, then lamina dura
Are the categorizations of mild, moderate and severe bone loss based on distance from where it should be or based on percent loss in relation to length of roots?
ask, same with furcation involvement
How do we quantify bone loss?
as a percentage
What affects the relative height of alveolar crest in RG’s?
beam angulation
If the beam is angled in this manner, the alveolar crest will appear more coronal than it is:
angled from above (think more coronal) patient at a down angle
How to get X-ray of severe bone loss:
vertical placement of film
Etiology of vertical bone loss:
Local factors, endo/perio lesions, localized aggresive PD, immunosuppression
Local factors that can cause vertical bone loss:
open contact, overhanging restorations, cracked tooth (post and core restorations)
This is important in determining prognosis and in prosthetic tx plans:
RG crown to root ratio (clinical crown? Anatomical crown? Area of tooth not covered with bone?)
Overhanging restos can lead to:
loss of LD at alveolar crest and hori bone loss
Other factors in local bone levels:
root and sinus proximity
Factor in treatment planning of teeth with bone loss:
number of osseous walls
Example of 1-wall osseous defect:
hori bone loss (check)
Example of 2-wall osseous defect:
Oseous crater
What is the most common type of osseous defect in PD?
2-wall
Limitations of standard RG’s:
don’t show perio pockets, early bone loss, early furcation involvement, all calculus, tooth mobility, widened PDL, detailed morphology of osseous defects
Supragingival, usually use:
McCall’s instrument
These are instruments to reach root surfaces in deep pockets without trauma:
Gracey curettes
Blade in relation to the shank, Gracey curettes:
offset, face beveled at 60d angle to shank
TF? Gracey curettes are site-specific.
T
In how many planes are Gracey curettes curved?
2, up and to the side
These Gracey curettes are used for all surfaces of anterior teeth only:
Gracey 1-4
These Gracey curettes are used for all surfaces of anterior teeth, all surface of premolars, and all surfaces of molars except distals:
Gracey 5 and 6
lower numbers work well on:
B,L, and M
Gracey’s 13, 14, 15:
posterior teeth and distals of posteriors (check)
These Gracey curettes are used for all surfaces of anteriors, all surface of premolars, and facial and lingual of posteriors:
Gracey 7 - 10
These Gracey curettes are used for all surfaces of all teeth except distals of posteriors:
Gracey 11 and 12
These Gracey curettes are used for all surfaces of all teeth except mesials of posteriors:
Gracey 13 and 14
Gracey 5 and 6 are never for:
distal surfaces
Angle of blade face to lower shank for sickle scaler:
90d
How should site specific curettes be held in relation to the tooth surface?
parallel to root surface
If an instruments lower shank is perpendicular to the flor, where is the workign-end?
the lower edge is the cutting edge
What are the 1st, 2nd, and 3rd strokes in scaling?
vertical, oblique, then hori
For which stroke is the lower shank parallel (to the long axis of tooth?)?
mainly for vertical stroke
Which instruments are thinnest in Xsection?
curettes
Where should finger rest be for scaling mandibular premolars?
mandibular anteriors
Where should finger rest be for scaling distal mandibular posteriors?
cross arch, from upper arch (finger rest in different arch?)
Where should finger rest be for scaling maxillary molars?
mandibular premolars or double finger rest on the maxillary arch
What is the least stable finger rest?
chin rest
TF? Distal curettes can also be used on B and L.
F. Mesial curettes can be (check)
Angulation for calculus removal should be bw:
45 and 90d
Ideal angulation for calculus removal should be bw:
60-80d
What will happen if you use a 90d angle in calculus removal?
jump over caclulus, missing a lot and cutting gingival of pt
