Quiz 3. Hard Deposits Calculus Flashcards
What is calculus
Hard calcified plaque. It’s always covered with dental plaque
Where does calculus occur?
Teeth, implants, dentures and other appliances. Not on gingiva
Calculus can be defined as:
calcified, mineralized, dental plaque. Contains everything found in plaque w/ addition of calcifying salts
Calculus Significance
It doesn’t initiate perio disease. Facilitates more plaque accumulation since it’s rough. Can’t brush off calculus
Classification of Calculus
Classified by location on tooth surface related to gingival margin. (Supra or Sub)
Other names for Supragingival
Supramarginal, Extragingival, Coronal indicating that it’s on crown
Supragingival Calculus Location
Most abundant near opening of major salivary glands.
Buccal of maxillary molars
Lingual of mandibular anteriors
Varies person to person and tooth to tooth
Supragingival Calculus Consistency
Moderately hard, dense, porous, surface covered in plaque.
Supragingival Calculus Color
White/Creamy yellow or grey. May be stained by tobacco, food, and look dark brown
Supragingival Calculus elements are from
Saliva
Supragingival Calculus Clinical Appearance
Thin layer may be missed if wet. Dry and able to see calculus chalky, rough and catchy. Large deposits seen easily.
Subgingival Calculus
Attachment on the root surface that is unseen. AKA know as submarginal
Serumal
Indicating source of minerals in blood serum. (subgingival)
Subgingival Calculus is typically
Dark due to blood pigmentation.
Subgingival occurs due to:
lack of flossing. It’s more dense than supra, harder to remove
Subgingival Calculus Consistency
Brittle, harder and dense than supra, Newest deposit nearer to base of pockets (less dense here)
Subgingival Calculus Color
Brown or black. Stains from blood pigment
Subgingival Distribution
Wider distribution than supra. More prominent on proximal and lingual. Adheres hard to tooth.
Subgingival Examination
Visual exam (blow air) Gingival tissue color change (inflammed) Tactile Examination- Probe/Explorer Radiographic Exam Perioscopy
Types of Subgingival Calculus
Spicules, Ledge, Ring, Veneer
Composition of Calculus
Made of inorganic/organic components and water
Chemical component of supra and sub are similiar although source of elements for mineralization aren’t the same.
Composition percentage varies
depending on the age and hardness of a deposit and location
Calculus, Inorganic components
70-90% Main: Calcium, P, Carbonate, Sodium, MG and K. Flouride is in calculus
Calculus, Organic Content
10-30% Non-vital organisms
Calculus isn’t the problem, it’s bacteria on top of it
Formation of Calculus
Patient unaware.
Mineralization is slow 3-4 days up to 2 weeks
Asymptomatic, Painless, Sometimes bleeding
Radiographic appearance of calculus
Radiopaque- White
Interproximal- Spurs or lumps
Calculus can be present w/o seeing on radiographs, most heavy to be seen
Can look like hazy ring around tooth
Steps of Calculus Formation
Pellicle Formation
Biofilm Maturation
Mineralization
Pellicle Formation
Glycoproteins in saliva
Biofilm maturation
Bacterial plaque development over plaque
Mineralization/ Calculus Formation
Source of minerals- Supra is saliva and Sub is gingival sulcus fluid. 72+ hours early calculus. Avg is 12 days to mineralize
Theories
Mineralization
CO2 (Doesn’t hold)
Ammonia (Doesn’t hold)
Mineralization Theory
Saliva is saturated w/ salts and able to support crystal growth, helps mineralize it all.
Structure of Calculus
Layers: More/less parallel to tooth. Separated by a line that appears to be pellicle that was deposited over previously formed calculus. Evidence that calculus grows in layers
Rough Surface
Outer layer- partly calcified- on surface thick, soft layer of dental biolfilm
In what amount of time is Calculus Formed
3-4 days in heavy calculus formers
Wilkins 10-20 days to form
Subgingival 60% mineralized
Supragingival 30% mineralized
Mineralization begins in
intercellular plaque matrix then bacterial cells
Modes of Calculus Attachment
Acquire pellicle (not as common) Minute irregularities in tooth surface Direct contact (most common)
Reasons for Calculus
Medications Alkaline pH Calcium in saliva Tube feed Dialysis Swimmers Calculus
Usually if someone creates a lot of calculus they don’t…
have a lot of decay
Ease of Calculus removal
Acquired pellicle- Easy to remove
Mechanical Locking- Hard to remove
Direct Contact- Have to remove cementum and dentin to assure complete removal
Location
Areas closest to salivary duct
Protected, less cleansable area
Protected, less cleansable areas
Interproximal Malpositioned teeth Sulcus, pockets Distals of last tooth Rough surface Rough restorations Prosthesis Age- most kids have supra
Effect of Calculus on Perio tissues
Calculus by itself is harmless to perio tissues
Dental plaque is always on calculus
Tenacity
Length of time present
Attachment mechanism
Sub is more difficult to remove
Depends on individual
Prevention of Calculus
Personal dental biofilm control
Avoid it by homecare
Significance of Radiographs
Aids in detection
Guide during scaling
Patient Education
“Road Map”
Anticalculus Dentrifrice and mouthrinse
inhibit calculus growth
Pyrophosphates (anti-tarter)
Zinc chloride (Antimicrobial)
Factors to teach the patient
Personal oral hygiene What's calculus and how it's formed Effect on perio Expectations for use of anticalculus ADA Seal of Approval
Hints for Calculus Detection
Use air-blow dry
Use transillumination (more for caries)
Feel w/ explorer or probe
Time required for supragingival calculus formation is:
3-20 days, first evidency may occur after 12 hours. Composition characteristic of old calculus requires months or years
