Quiz 3. Hard Deposits Calculus

Question 1

What is calculus

Answer 1

Hard calcified plaque. It’s always covered with dental plaque

Question 2

Where does calculus occur?

Answer 2

Teeth, implants, dentures and other appliances. Not on gingiva

Question 3

Calculus can be defined as:

Answer 3

calcified, mineralized, dental plaque. Contains everything found in plaque w/ addition of calcifying salts

Question 4

Calculus Significance

Answer 4

It doesn’t initiate perio disease. Facilitates more plaque accumulation since it’s rough. Can’t brush off calculus

Question 5

Classification of Calculus

Answer 5

Classified by location on tooth surface related to gingival margin. (Supra or Sub)

Question 6

Other names for Supragingival

Answer 6

Supramarginal, Extragingival, Coronal indicating that it’s on crown

Question 7

Supragingival Calculus Location

Answer 7

Most abundant near opening of major salivary glands.
Buccal of maxillary molars
Lingual of mandibular anteriors
Varies person to person and tooth to tooth

Question 8

Supragingival Calculus Consistency

Answer 8

Moderately hard, dense, porous, surface covered in plaque.

Question 9

Supragingival Calculus Color

Answer 9

White/Creamy yellow or grey. May be stained by tobacco, food, and look dark brown

Question 10

Supragingival Calculus elements are from

Answer 10

Saliva

Question 11

Supragingival Calculus Clinical Appearance

Answer 11

Thin layer may be missed if wet. Dry and able to see calculus chalky, rough and catchy. Large deposits seen easily.

Question 12

Subgingival Calculus

Answer 12

Attachment on the root surface that is unseen. AKA know as submarginal

Question 13

Serumal

Answer 13

Indicating source of minerals in blood serum. (subgingival)

Question 14

Subgingival Calculus is typically

Answer 14

Dark due to blood pigmentation.

Question 15

Subgingival occurs due to:

Answer 15

lack of flossing. It’s more dense than supra, harder to remove

Question 16

Subgingival Calculus Consistency

Answer 16

Brittle, harder and dense than supra, Newest deposit nearer to base of pockets (less dense here)

Question 17

Subgingival Calculus Color

Answer 17

Brown or black. Stains from blood pigment

Question 18

Subgingival Distribution

Answer 18

Wider distribution than supra. More prominent on proximal and lingual. Adheres hard to tooth.

Question 19

Subgingival Examination

Answer 19

Visual exam (blow air)
Gingival tissue color change (inflammed)
Tactile Examination- Probe/Explorer
Radiographic Exam
Perioscopy

Question 20

Types of Subgingival Calculus

Answer 20

Spicules, Ledge, Ring, Veneer

Question 21

Composition of Calculus

Answer 21

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.

Question 22

Composition percentage varies

Answer 22

depending on the age and hardness of a deposit and location

Question 23

Calculus, Inorganic components

Answer 23

70-90% Main: Calcium, P, Carbonate, Sodium, MG and K. Flouride is in calculus

Question 24

Calculus, Organic Content

Answer 24

10-30% Non-vital organisms

Calculus isn’t the problem, it’s bacteria on top of it

Question 25

Formation of Calculus

Answer 25

Patient unaware. Mineralization is slow 3-4 days up to 2 weeks Asymptomatic, Painless, Sometimes bleeding

Question 26

Radiographic appearance of calculus

Answer 26

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

Question 27

Steps of Calculus Formation

Answer 27

Pellicle Formation Biofilm Maturation Mineralization

Question 28

Pellicle Formation

Answer 28

Glycoproteins in saliva

Question 29

Biofilm maturation

Answer 29

Bacterial plaque development over plaque

Question 30

Mineralization/ Calculus Formation

Answer 30

Source of minerals- Supra is saliva and Sub is gingival sulcus fluid. 72+ hours early calculus. Avg is 12 days to mineralize

Question 31

Theories

Answer 31

Mineralization CO2 (Doesn't hold) Ammonia (Doesn't hold)

Question 32

Mineralization Theory

Answer 32

Saliva is saturated w/ salts and able to support crystal growth, helps mineralize it all.

Question 33

Structure of Calculus

Answer 33

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

Question 34

In what amount of time is Calculus Formed

Answer 34

3-4 days in heavy calculus formers Wilkins 10-20 days to form Subgingival 60% mineralized Supragingival 30% mineralized

Question 35

Mineralization begins in

Answer 35

intercellular plaque matrix then bacterial cells

Question 36

Modes of Calculus Attachment

Answer 36

``` Acquire pellicle (not as common) Minute irregularities in tooth surface Direct contact (most common) ```

Question 37

Reasons for Calculus

Answer 37

``` Medications Alkaline pH Calcium in saliva Tube feed Dialysis Swimmers Calculus ```

Question 38

Usually if someone creates a lot of calculus they don't...

Answer 38

have a lot of decay

Question 39

Ease of Calculus removal

Answer 39

Acquired pellicle- Easy to remove Mechanical Locking- Hard to remove Direct Contact- Have to remove cementum and dentin to assure complete removal

Question 40

Location

Answer 40

Areas closest to salivary duct | Protected, less cleansable area

Question 41

Protected, less cleansable areas

Answer 41

``` Interproximal Malpositioned teeth Sulcus, pockets Distals of last tooth Rough surface Rough restorations Prosthesis Age- most kids have supra ```

Question 42

Effect of Calculus on Perio tissues

Answer 42

Calculus by itself is harmless to perio tissues | Dental plaque is always on calculus

Question 43

Tenacity

Answer 43

Length of time present Attachment mechanism Sub is more difficult to remove Depends on individual

Question 44

Prevention of Calculus

Answer 44

Personal dental biofilm control | Avoid it by homecare

Question 45

Significance of Radiographs

Answer 45

Aids in detection Guide during scaling Patient Education "Road Map"

Question 46

Anticalculus Dentrifrice and mouthrinse

Answer 46

inhibit calculus growth Pyrophosphates (anti-tarter) Zinc chloride (Antimicrobial)

Question 47

Factors to teach the patient

Answer 47

``` Personal oral hygiene What's calculus and how it's formed Effect on perio Expectations for use of anticalculus ADA Seal of Approval ```

Question 48

Hints for Calculus Detection

Answer 48

Use air-blow dry Use transillumination (more for caries) Feel w/ explorer or probe

Question 49

Time required for supragingival calculus formation is:

Answer 49

3-20 days, first evidency may occur after 12 hours. Composition characteristic of old calculus requires months or years