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Calculus

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Section 1

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Tobacco use

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Calculus Math

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Last updated

1 year ago

Date created

Mar 14, 2020

Cards (35)

Section 1

(35 cards)

Tobacco use

Front

•The use of all tobacco products, cigarette smoking, cigar smoking, and smokeless tobacco have been strongly identified as risk factors for periodontal disease •Studies have shown that smoking is associated with deeper pockets and more clinical attachment loss •In addition, increased amounts of calculus and dental stains and the development of acute aggressive forms of periodontal disease are more common in those individuals who smoke. •Toxic effects of tobacco use occur, regardless of the form of tobacco Tobacco-induced changes include: •Epithelial cells of the gingiva show increased keratinization, and the buccal mucosa demonstrates altered oxygen consumption. •Vasoconstriction of the gingival tissues occurs. •Nicotine metabolites are found in saliva and gingival crevicular fluid. •Polymorphonuclear leukocytes have a reduced ability to phagocytize substances, and the vascular reaction to inflammation is reduced. •Tissue destruction is observed in the gingiva and bone underlying the location where smokeless tobacco rests in the mouths of users •Smoking has a negative effect on healing during periodontal therapy; pocket reduction and gain in clinical attachment are greatly reduced

Back

Characteristics related to an increased formation

Front

Include: •Elevated salivary pH •Concentration of calcium in saliva •Concentration of salivary bacterial protein and lipid •Low individual inhibitory factors •Higher salivary urea and protein from the submandibular glands •Higher total salivary lipid levels

Back

Calcium phosphate (inorganic)

Front

76%

Back

Formation and components of subgingival calculus

Front

•Calculus formation rates vary •Mineralization can occur in 1 to 14 days, but it can occur as quickly as in 4 hours •Heavy calculus formers have higher levels of calcium & phosphorus (from the saliva) in the plaque •In addition, differences in diet and in the composition of the microbiota may contribute to formation rates. •The mineral content is derived from crevicular fluid rather than from saliva, differentiating it from supragingival calculus •The organic components of subgingival calculus are similar to those of supragingival calculus, but subgingival calculus contains more calcium, magnesium, and fluoride because of the higher concentrations of these minerals in crevicular fluid •No salivary protein is present in subgingival calculus and the sodium content of subgingival calculus increases with the depth of the periodontal pockets.

Back

Octacalcium phosphate (inorganic)

Front

12%

Back

Iatrogenic crown contours and margins

Front

•Over-contoured crowns, bridges, and other cast and ceramic restorations have been associated with gingival inflammation and periodontal disease Subgingival placement of fixed restorations enhances plaque biofilm formation for a variety of reasons: •Greater surface roughness of the materials •Fit of the margin to the remaining tooth structure •Contour of the restoration The poorer the fit of the subgingival cast restoration margin, the more extreme the gingival reaction is likely to be •The contour of crown restorations is also significant •Bulbous, rounded crowns can impinge on the embrasure space, making plaque control difficult and resulting in increased inflammation of the associated tissues

Back

Partial dentures

Front

•Complete dentures, and all other removable appliances can collect supragingival calculus •The dental hygienist should remove this calculus during the hygiene appointment by using powered or hand scalers and polishing. •Wearers of partial dentures should also be instructed to clean the appliance daily at home with an accepted denture cleaner, denture brush, and clasp brush •Natural teeth in function with removable partial dentures tend to have more periodontal pockets and deeper pockets •Increased susceptibility to caries is also associated with abutment teeth for partial dentures

Back

Habits and self inflicted injuries

Front

•Oral piercing •Toothbrush trauma

Back

Inorganic (composition)

Front

Inorganic: •Makes up approx 80% of supragingival calculus Primarily the minerals are: •Calcium phosphate (76%) •Calcium carbonate (3%) •Traces of magnesium, sodium & potassium •Trace elements of fluoride, zinc, & strontium •At least 2/3 of inorganic component is crystalline in structure The main crystal types in calculus are: •58% hydroxyapatite (Ca10[PO4 ]6 [OH]2) •21% magnesium whitlockite •12% octacalcium phosphate •9% brushite

Back

Iatrogenic dental restorations

Front

•Marginal discrepancies between the edges of restorations and the tooth surface, particularly subgingivally, are associated with detrimental periodontal changes

Back

Pathogenesis of calculus

Front

•Supragingival calculus is porous and rough and provides a lattice on which plaque can grow •Supragingival calculus assists in maintaining the bacterial colonies close to the tissue, interfering with oral self-cleansing mechanisms and making plaque biofilm removal more difficult for patients. •Subgingival calculus is associated with the chronic nature and progression of periodontal diseases. Periodontal pockets most often contain subgingival calculus, even if in microscopic amounts •Calculus provides a reservoir for bacteria and endotoxins that are related to the disease process •In addition, subgingival calculus is covered by bacterial plaque biofilm that is associated with greater disease progression than plaque alone

Back

Hydroxyapatite (inorganic)

Front

Ca₁₀(PO₄)₆(OH)₂ 58%

Back

Malocclusion

Front

•Poorly aligned teeth can change embrasure spaces and make dental hygiene care more challenging •Anterior open bite-due to tongue thrusting places lateral pressure resulting in spreading or tilting of teeth

Back

Distribution of calculus

Front

Light calculus formers have higher levels of parotid pyrophosphate, similar to the chemical found in tartar control toothpastes

Back

Magnesium whitlockite (inorganic)

Front

21%

Back

Anatomic anomalies

Front

•Variations of normal tooth anatomy need to be identified to ensure that the correct instrumentation and plaque biofilm control can be applied •The lingual groove on a maxillary lateral incisor, highlighted in this figure, show the difficulties of cleaning root surfaces in deep pockets

Back

Tobacco and alcohol Use

Front

•Both tobacco and alcohol use, singly and in combination, have been related to the amount and severity of periodontal disease •Smoking and excessive alcohol use frequently occur together, and the combination greatly increases the risk of esophageal, throat, and other oral cancers

Back

Subgingival calculus

Front

•Forms on crowns and root surfaces below the gingival margin and extends into pockets. •Subgingival calculus can become supragingival calculus with healing and/or recession •Although it goes to base of pocket it will not reach the junctional epithelium •It can be tenacious and is typically dark green or black as a result of the organic matrix products of the subgingival plaque •This matrix contains blood products that give subgingival calculus the dark pigment •This matrix differs from supragingival calculus, in which the organic matrix components come primarily from saliva, not blood •The location of subgingival calculus is not specific to a site. •Subgingival calculus is found anywhere throughout the mouth. Subgingival calculus is deposited in rings or ledges on root surfaces, but it may also appear as veneers. •Both radiographic examination and explorer detection are required to evaluate the extent and location of deposits. •Radiographic images alone tend to show mesial and distal deposits and underestimate the amount of calculus present. •Explorer detection provides the dental hygienist with buccal and lingual estimates of deposits, along with proximal estimates, but its accuracy is also subject to the individual technique

Back

Calculus

Front

•Calculus removal is important in dental hygiene care; its presence tends to accelerate the progression of disease. •Calculus is a modifiable factor associated with improved periodontal health Removal of calculus results in: •Improvement of tissue tone & color •Reduced inflammation & tissue shrinkage •Calculus is not a benign substance unrelated to the pathogenesis of gingival & periodontal disease •It plays a significantly smaller role in these diseases than bacterial plaque biofilms •Calculus serves as a reservoir for bacterial plaque biofilm

Back

Amalgam overhangs

Front

•Contribute to pathologic conditions, such as gingival inflammation. They are a source of plaque biofilm retention and can complicate plaque control for patients

Back

Definition of calculus

Front

Is defined by its location relative to the gingival margin: •Supragingival •Subgingival •Dental hygienists commonly describe patients as those who form light, moderate, or heavy amounts calculus, depending on the amount of supragingival calculus that forms between recall visits. •Although useful in terms of estimating treatment time, this distinction has little value.

Back

Intro

Front

•Calculus removal is important in dental hygiene care; its presence tends to accelerate the progression of disease •Calculus is a modifiable factor associated with improved periodontal health. Removal of calculus results in: •Tissue tone & color improvement •Reduced inflammation & tissue shrinkage •Calculus is not a benign substance unrelated to the pathogenesis of gingival & periodontal disease •It plays a significantly smaller role in these diseases than do bacterial plaque biofilms •Calculus serves as a reservoir for bacterial plaque biofilm •"Tartar" is the common name often used by patients for dental calculus.

Back

Plaque retention factors

Front

Includes: •Iatrogenic factors: ➔Dental Restorations ➔Amalgam overhangs ➔Overcontoured crowns •Removable partial dentures •Orthodontic appliances •Malocclusion •Loss of the first molars, esp. in children •Mouth breathing •Anatomic anomalies •Habits and self inflicted injuries •Tobacco and alcohol use

Back

Orthodontic appliances

Front

•Are associated with increased plaque accumulation, gingivitis, and caries susceptibility in children and adolescents. •Molar bands are more highly associated with gingival inflammation than bonded brackets •Excessive force may produce •Necrosis of periodontal ligament and alveolar bone •Resorption of root

Back

Formation and components of supragingival calculus

Front

•Mineralization in plaque can begin within 4 to 8 hours •50% mineralized in 2 days •90% mineralized after 12 days •Plaque occurs more rapidly in some individuals & more slowly in others •Supragingival calculus can form on occlusal tooth surfaces when the teeth are out of occlusion or in cross bite, as well as on both fixed & removable prosthetic devices.

Back

Supragingival calculus

Front

•Found on the clinical crowns of the teeth above the margin of the gingiva •Although supragingival calculus is visible as a yellowish-white accumulation, it may darken with age or other staining factors •Supragingival calculus is tightly adherent to the teeth, and it may occur on any tooth in the mouth •Supragingival calculus is most abundant on tooth surfaces near the openings of the salivary ducts •Lingual surfaces of mandibular anterior teeth •Buccal surfaces of the maxillary molars

Back

Anticalculus agents

Front

•A number of agents, including dentifrices and mouthwashes, can reduce supragingival calculus formation •They work through the inhibition of hydroxyapatite crystal growth by pyrophosphates •Studies have found that these pyrophosphate-containing agents are safe and well tolerated by the oral soft tissues •Anticalculus toothpastes with fluoride have no negative effects on tooth remineralization and do not interfere with caries inhibition by fluorides •Educating patients about the realistic effects of these preparations is an important goal for the dental hygienist •Anticalculus agents do not reduce the quantity of calculus already present in the mouth •Their effectiveness is limited to reducing the formation of new supragingival calculus; these agents have no measurable effects on subgingival calculus

Back

1st molar loss

Front

•1st molar loss, other malocclusions, and migrations are associated with gingival inflammation and pocket formation The loss of the permanent first molar follows certain events: 1. Second and third molars drift mesially and tilt, which causes a loss of the vertical dimension. 2. Mandibular premolars drift distally and can tilt. 3. Maxillary first molar extrudes into the space on the mandibular arch. 4. Anterior overbite is increased, causing the lower anterior teeth to strike the maxillary incisors on or near the gingiva •Lower anterior teeth drift lingually, and the increased pressure results in splaying or spreading of the maxillary anterior teeth

Back

Missing teeth

Front

•Create occlusal pressure on the remaining teeth and contribute to migration •Migration usually occurs in a mesial direction •Migrating teeth create spaces that affect plaque control

Back

Brushite (inorganic)

Front

9%

Back

Alcohol use

Front

•Alcohol use is a contributing factor to the severity of periodontal disease. •In a recent study, the consumption of 3.5 drinks or more per week was associated with greater pocket depths. •Adjustment was made for smoking and plaque control. •In addition, patients consuming five or more drinks per week were 65% more likely to have gingival bleeding and 36% more likely to have severe attachment loss

Back

Mouth breathing

Front

•Leads to localized gingival inflammation that is usually confined to the labial gingiva of the maxillary anterior teeth •The tissue becomes reddened, swollen, and shiny and bleeds easily •Mouth breathing is also associated with higher levels of plaque and gingivitis •The inflammation does not respond to therapy •Inflammation persists, despite dental hygiene care and plaque biofilm control •The inflammation is thought to occur because of the constant drying of the tissues and the interference with the natural protective factors in saliva •Palliative care includes placing petroleum jelly over the tissue or using a saliva substitute product.

Back

Tartar

Front

•Tartar is the common name often used by patients for dental calculus •Products referred to as "tartar control" toothpaste and rinses are popular and reinforce the use of this common name.

Back

Calcium carbonate (inorganic)

Front

3%

Back

Organic (composition)

Front

•Approximately 15% to 20% Components include: •Protein •Carbohydrates •Lipids •Desquamated epithelial cells •Leukocytes

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