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

5
(No Transcript)
6
(No Transcript)
7
Hard Deposits

• Location
• Supragingival
• Subgingival

8
Hard Deposits

• Identification
• Supragingival calculus
• Subgingival calculus

9
(No Transcript)
10
Hard Deposits

• Calculus formation
• Pellicle --gt (colonization) --gt Plaque --gt
  (mineralization) --gt 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
Hard Deposits

• Hardness of calculus
• inorganic substance
• 96 enamel
• 75-85 calculus
• 65 dentin
• 45-50 cementum/bone
• the higher the inorganic , the greater the
  degree of calcification

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

14
(No Transcript)
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

18
(No Transcript)
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
• Shepards 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

24
(No Transcript)
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

27
(No Transcript)
28
Exploring

• Practicing exploring techniques
• Posterior techniques

29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
The following slides will give you an example of
different degrees of calculus build up
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)