can collect on pontic, restorations, crown. most frequent on ling mand anterior, facial max posterior, teeth out of occlusion. . other names: supramarginal, extramarginal, coronal, salivary.
use direct examinatio and compressed air
on anything below the ging margin. can be generalized/localized. usually starts interproximal of post teeth 1st. or other equallh hard to get.
examination: dark edge, deflect margin with air, transillumination. ging tissue color change. tacile exam with probe and explorer. RGs and perioscopy.
other names: submarginal, serumal.
mature calc has 70-90% inorganic= calciums phosphous, carbonate, sodium, magnesium, potassium. trace elements of metals. fluoride in calculus depends on pts exposure to fl.
crystals is 2/3 inorganic matter is crystalline, predominantly hydroxyapatite.
organic: non vital micros, desquamated epithelial cells, leukocytes, mucin from saliva.
1- pellicle formation...2- bf formation
3- mineralization: within 24-72 hrs after bf has occured mineralization foci form in intermicrobial matrix provided by filamentous micros. centers will eventally coalesce. as deposits ages,mineral occurs withint the bacteria too.
sources kof minerals: supra= saliva. sub=sulcular fluid and imflammatory exudates. asinflamm increases, so does concentration of minerals.
4- crysstal formation: mineralization is crystal formaiton beginning in the intercellular matrix then the surface of bacteria and finally within bacteria. mechanism of mineralization isnt completely understood. same for supra and sub. heavy formers have higher levels of ca and phosphate. high formers have higher levels of parotid pyrophosphates. pyrophosphates inhibits calcification and is used in anit tartar toothpaste
structure of calc
parellel to surface of tooth. seperated by layers of pellicle. rough and detected with explorer. outer layer=only paritally calcified with thick, matlike soft layer of bf. subging is it in contact wiht disease pocket epithelium.
12-average. 10-rapid formers. 20-slow formers. can begin 24-48 hrs. will appear as graininess.
attachment of calc
ease/difficulty of removal depends on means of attachment. attaches differently to smooth, hard, enamel v rough porous cementum/dentin.
modes of calc attachment
acquire pellicle: easily removed, more on newly scaled surfaces and enamel.
minute irregularities in tooth surface: mechanical locking into undercuts, difficult to remove and know when removed.
direct contact: calcified intercellular matrix and tooth surface. hard to remove and know when removed.
cycle of destruction
bf collect o surface, irritates lining that brings in more fluid with more minerals increasing amoutn of calc. pt can remove bf off of smooth surface but once calc has formed no matter how good they are with bf removeal the sliver is still there rpoviding a harbor for bacteria.
location and extent of deposit....light moderate heavy. diagnosis of case type. tx planning, reference during instrumentaiton.
anitcalc dentfrice and mouthrinse
objective: aim to inhibit calc crystal gorwn but does not have an effect on existing calc on decrease formation of new supraging calc.
chemotherapeutic anit-calc agnets: pyrophosphates, zinc citrate, triclosan.
contraindications: soft tissue irritaion and dentinal hypersensativity.