Hard Deposits and Exploring

1. Hard Deposits and Exploring

2. Hard Deposits and Exploring • Objectives • Describe calculus and name the various surfaces on which it can form. • Describe the similarities and differences between supragingival and subgingival calculus deposits. • Name 3 methods for identification of supragingival calculus and 5 methods for identification of subgingival calculus. • Describe the process of calculus formation. • Compare the hardness of calculus to that of enamel, dentin, cementum, and bone.

3. Hard Deposits and ExploringObjectives Cont. • Discuss the relationship between calculus and dental disease. • Identify 3 modes for attachment of calculus to a tooth surface. • Describe the composition of calculus. • Identify 6 uses of a dental explorer. • Describe the design and use of the #17, #23, and ODU 11/12 explorers. • Demonstrate appropriate use of the #17, #23, and ODU 11/12 explorers on the dentoform.

4. Hard Deposits • Calculus • Calcified bacterial plaque • Hard, tenacious mass forming on teeth (primary or permanent), dentures, & other dental appliances

7. Hard Deposits • Location • Supragingival • Subgingival

8. Hard Deposits • Identification • Supragingival calculus • Subgingival calculus

10. Hard Deposits • Calculus formation • Pellicle --> (colonization) --> Plaque --> (mineralization) --> Calculus • Saliva provides elements for calcification of supragingival deposits • Gingival sulcus fluid provides elements for mineralization of subgingival deposits • Average time for plaque to mineralize into calculus is 12 days (Range= 10 to 20 days) • Mineralization of plaque may begin as soon as 12 to 24 hours • Forms in layers parallel with tooth surface • Incremental lines form between layers of calculus

11. Hardness of calculus % inorganicsubstance 96% enamel 75-85% calculus 65% dentin 45-50% cementum/bone **the higher the inorganic %, the greater the degree of calcification Hard Deposits

12. Hard Deposits • Relationship to disease • Calculus is a plaque haven • Calculus is the result (NOT the cause) of pocket formation • Plaque forming on top of calculus is nearly impossible to remove (rough surface harbors plaque; tears floss) • If calculus is removed, the smooth tooth surface makes plaque removal effective • Calculus holds toxic by-products of plaque in contact with gingival tissues

13. Hard Deposits • Modes of attachment • Acquired pellicle- easily removed because there is no mechanical interlock • Mechanical interlock- locked into irregularities (rough cementum, caries, enamel cracks). Difficult to remove and difficult to assess when complete • Direct contact between tooth and calculus matrix- difficult to remove

15. Hard Deposits • Composition • Mature calculus • 75-85% inorganic components (calcium, phosphate, trace elements, fluoride, hydroxyapatite crystals) • 15-25% water and organic components (microorganisms, desquamated epithelial cells, leukocytes)

16. Exploring • Uses of the explorer - Detection of:

17. Exploring • Design • Working end • flexible, wire-like • circular in cross-section • last 1-2mm is referred to as the TIP • tapers to a sharp POINT • single-ended or double-ended (paired or dissimilar ends) • Shank • straight or curved • very flexible

19. Exploring • #17 Explorer • Tip is at a right angle to the shank • Used supragingivally and subgingivally but NOT for caries detection in pits and fissures • Good for deep pockets and anterior teeth

20. Exploring • #23 Explorer • “Shepard’s hook” • Used primarily for caries detection (use is now controversial- some evidence that clinician may actually penetrate thin but sound enamel with explorer tip) • Does not adapt well subgingivally

21. Exploring • ODU 11/12 • Double ended with paired working ends • Works well in all segments with shallow sulcus depths

22. Exploring • Tactile sensitivity • Ability to distinguish relative degrees of roughness and smoothness • Takes a lot of time and effort to refine

23. Exploring • Technique • Light (no blanching), modified pen grasp • Intraoral fulcrum on same arch (except maxillary posterior where it may be impossible to fulcrum on same arch) • Carefully insert into sulcus at distal line angle • SIDE of tip should be against tooth • BACK will reach junctional epithelium • Do not direct POINT apically • Critical that explorer reaches the base of the sulcus

25. Exploring • Technique (cont.) • Adapt so TIP is flush against the tooth (Adaptation= placement of working end against tooth) • Use an exploratory stroke (feeling) • Pull motion from base of sulcus to marginal gingiva • “Bump” over large pieces of calculus; “drag” over smaller pieces; “fall” into large areas of decay; bump over or fall into defective restorative margins; smooth tooth surface

26. Exploring • Stroke direction • Vertical and oblique strokes should be used. This directs the explorer at a right angle to the deposit. • Horizontal strokes should be avoided. They may cause the explorer to run parallel to the deposit so it will not be detected. Point is directed toward JE- very dangerous! • Extend strokes at least 1/2 way across the interproximal surfaces. • Roll the explorer in your fingers to maintain adaptation • Use wrist action, NOT finger action

28. Exploring • Practicing exploring techniques • Posterior techniques

32. The following slides will give you an example of different degrees of calculus build up: