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Pellicle

clear, insoluble, appears thin and pale pink with disclosing solution-can take on extrinsic stains

Materia alba

White or cream colored, cheesy mass composed of food devis, mucin, and bacteria

Soft deposits include

Pellicle, dental biofilm, materia alba, food debris

Hard deposits

calculus

Calculus

mineralized dental biofilm, forms on natual teeth dentures and other dental prostheses, significant in the progession of inflammatory periodontal disease but not the causative factor itself

Calculus forms from what?

forms from the deposition of minerals primarily calcium and phosphate into th ebiofilm organic matrix

How does calculus form?

Pellicle forms first, biofilm formation, mineralization, pellicle layer forms immediately, bacterial colonies form in the pellicle, colonies grow together forming a cohesive biofilm layer, MINERALIZATION centers form within 24-72 hours, centers eventually grow and unite, filamentous microorganisms provide the matrix for the deposition of minerals, pellicle may also mineralize explaining the stregth of the bond to tooth surface, mineral source for supraginigival calculus is saliva, mineral source for subgingival calculus is the gingival sulcus fluid and inflammatory exudate

What are the mineral content of calculus?

calcium, phosphorus, parotid pyrophosphate

Heavy calculus formers have?

higher salivary levels of calcium and phosphorus

Light calculus formers have?

higher levels of parotid pyrophosphate which is an inhibitor of clacification

Pyrophosphate

is an ingredient in many tartar control dentifrices

Average time for calculus formations

is 12 days

MIneralization can begin

as early as 24-48 hours

Calculus formation time dependent on

individual tendency, roughness of the tooth surfaces, quality and character of home care efforts

Supragingival calculus

located on the clinical crown to the margin of the gingiva

Subgingival calculus

located on the clinical crown APICAL to the margin of the gingiva, extending nearly to the bottom of the pocket, on exposed root surfaces and dental implants

Pellicle attachment then calculus:

calculus attachment is superficial, occurs most frequently on enamel and newly scaled root surfaces, removed readily

Areas of attachment

irregularities on the tooth surface: cracks, lamellae, and carious defects, cemental irregularities, difficult to be certain removal is complete

Direct contact between calcified matix and the tooth sureface occurs by:

crystals interlock with mineralizing biofilm, difficult to discern between calculus and cementum

What are the components of calculus?

Inorganic-mostly crystalline hydroxyapatite: mainly calcium, phosphorus, carbonate, sodium, magnesium, postassium; trace elements; fluoride

Calcification levels of Enamel, Dentin, Cementum and bone, Calculus:

Enamel 96%
Dentin 65%
Cementum and bone 45-50%
Calculus 75-85%

Identification of Calculus depends on:

Kowledge of its appearance, consistency, and distribution

Color of supragingival calculus

white, creamy yellow, or gray; may be stained by tobacco, food or other pigments; slight deposits may not be seen until air dried

Color or subgingival calculus

light to dark brown, dark green, or black; stains derived from blood pigments from diseased pocket

Shape of supragingival calculus

amorphous, bulky; gross deposits may form interproximal bridges between adjacent teeth or extend over the margin of the gingiva

Shape of Supragingival calculus is determined by:

anatomy of the teeth
countour of the gingival margin
pressure of the tongue, lips, and cheeks

Shape of the subgingival calculus

flattened to conform with pressure from the pocket wall: crusty, spiny, or nodular; ledge or ringlike; thin, smooth veneers; finger-and fern like; individual calculus islands

Consistency and texture of supragingival calculus

moderately hard; newer deposits less dense and hard; porous surface covered with non-mineralized biofilm

Consistency and texture of subgingival calculus

brittle, flint like; harder and more dense than supragingival; newest deposists near bottom of pocket are less dense and hard; surface covered with dental biofilm

Size and Quantity of supragingival calculus

direct relationship to oral hygiene care; character of diet; increased amount in tobacco users

Size and Quantity of subgingival calculus

related to pocket depth; incerased amount related to age; related to diet, oral care; primarily related to the development and progression of periodontal disease

Distribution of supragingival calculus

coronal to the marginal gingiva; may cover a large portion of the crown or form a thin line at the margin; sysmmetrical except when affected by malposed teeth, poor oral hygiene, abrasion from food; occurs with or without sub deposits; related to location of salivary gland ducts

Distribution of subgingival calculus

apical to the gingival margin; extends to the bottom of the pocket and follows the contour of the attachment; heaviest on proximal surfaces, lightest on facial surfaces; occurs with or without associated supragingival deposits

Ways to detect supragingival calculus

can be seen directly or indirectly with the mouth mirror; visual detection must be accompanied by air and exploring; with the use of light through the anterior teeth during transillumination, calculus can be seen as an opaque shadow

Ways to detect subgingival calculus

may be seen just beneath the gingival margin because of loosely adapted, inflammed marginal tissues; may also reflect through thin marginal tissues; air can also aid in deflecting tissue; must use mirror, light and explorer

Subgingival biofilm causes:

inflammation and destruction of gingival tissues and loss of attachment

Inflammation causes:

creation of more sulcus fluids producing more subgingival calculus

Calculus acts as a

reservior for endotoxins and tissue breadwon products

Calculus is a predisposing factor

in pocket development providing a haven for the collection of bacterial masses on its rough and porous surface

What is a denta stain?

a discolored spot or area on a tooth or restoration; significance is primarily cosmetic; only detrimental affect is related to the biofilm or calculus in which the stain occurs

Where can dental stains occur?

may adhere directly to the tooth surface or restoration; contained within calculus and soft deposits; incorporated within the tooth structure or restorative material

What are the ways to classify a stain by location?

extinsic
intrisic

Extrinsic

occuring on the external surface of the tooth and are removable

Intrinsic

occuring within the tooth substance and cannot be removed by scaling or polishing

What are the ways to classify a stain by source?

exogenous
endogenous

Exogenous

develop from sources outside the tooth (extrinsic or intrinsic)

Endogenous

develop from within the tooth (ALWAYS intrinsic and usually discolorations of the dentin reflecting through the enamel)

How can you identify the source of stains?

HHx review: developmental complication, medication, use of tobacco, fluoride history
Diet: stains from foods, liquids, supplements
Oral Hygiene Habits: frequency of plaque removal

What are the most common extrinsic stain colors?

yellow, gree, black line stain, light brown to black

What are the less common extrinsic stain colors?

brown, orance & red, metallic

A yellow stain indicates

discoloration of biofilm
usually form food pigments

A green stain indicates

embedded in the biofilm
poor oral hygiene, chromogenic bacteria, and gingival hemmorrhage found primarily in children, may be demineralized underneath

A black line stain indicates

calculus like stain
occurs along the gingival 1/3 continuous line
occurs more often in children and mostly females
frequently found in clean mouths

A light brown to black stain indicates

tobacco
can be incorporated into calculus

A brown stain indicates

stannous floouride; food stuff such as tea, coffee, soy sauce; chlorhexidine rinse; betal leaf in eastern cultures

A metallic stain indicates

industrial exposure (copper, nickel, cadmium)
medications/supplements (iron, maganese)

Exogenous Intrinsic stains

restorative materials such as amalgam may impart a gray or black discoloration;
endodontic therapy and materials can cause yellow, brown, black, or a combination;
stain in dentin form a carious lesion

Endogenous stains include

pulpless teeth
tetracycline stain
hereditary: ie. amelogensis imperfecta or dentinogenesis imperfecta, enamel hypoplasia
denta fluorosis
other systemic sources: blood borne pigment

Pulpless teeth color

range form light yellow, to brown, gray, reddish brown, bluish-black, orange or green (color changes form pulp tissue breakdown)

Tetracycline stain

occuring when mother has taken it during pregnancy or administered to child during infancy or earyl childhood (color may be light green to dark yellow to grayish brown)

Dental fluorosis

from ingeston of excessive fluoride (teeth may be cracked or pitted as well as discolored with white spots or areas that become stained will appear light or dark brown)

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