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# DENTAL CALCULUS

## What is Calculus or Tartar?

◼ Calculus, is plaque that has hardened on your teeth.
This can also form at and underneath the gingival
margin or gumline and can irritate gingiva.
◼ Calculus gives plaque more surface area on which to
grow and a much stickier surface to adhere, which
can lead to more serious conditions, such as dental
caries and periodontal disease.
Periodontal disease is a disease of the tissues
that support the teeth in the mouth. It occurs
when the body’s immune system cannot clear
the mouth of the bacteria and toxins.
If plaque is not removed, it will eventually
accumulate and harden into dental calculus (or
tartar). Periodontal disease will develop if these
are not removed.
Calculus or tartar does not only threaten the
health of our teeth and gums, it is also a cosmetic
problem, because it is more porous, and absorbs
stains easily.
So if the patient is a coffee or tea drinker, or if
he smokes, it is really important to prevent
calculus or tartar buildup.
How do we know if we have Calculus or
Tartar Buildup?
◼ Unlike plaque, which is a colorless film of bacteria
and can be removed by tooth brushing, calculus or
tartar is a mineralized dental plaque that cannot be
removed by simple brushing.
◼ Clinically, calculus is a yellow or brown color on
cervical areas of our teeth and in severe cases this
covers gingiva.
Severe Gingivitis
Scaling and Polishing

## Scaling- is the process by which plaque and calculus

are removed from both supragingival and subgingival
tooth surfaces. There is no deliberate attempt to
remove tooth substance along with the calculus.

## Root Planing – is the process by which residual

embedded calculus and portion of cementum are
removed from the roots to produce a smooth hard
clean surface.
Two Types of Calcular Deposits
◼ Supragingival (above the gumline) calculus is the
visible deposit that forms on the surface of the teeth.
◼ Subgingival (below the gumline) calculus forms in
pockets between teeth and gums.
▫ Subgingival calculus is more harmful as it facilitates
faster growth of plaque.
Primary Objective of Scaling and Polishing and Root
Planing:

## To restore gingival health by completely removing

from tooth surface elements that provoke gingival
inflammation like plaque, calculus, and altered cementum.

## Scaling and Root Planing are not separate procedure.

All principles of scaling apply equally to root planning. The
difference between the two is only a matter of degree that is
the nature of the tooth surface determine the degree to
which the surface must be scaled or planed.
Instruments used to Remove Calcular Deposits
Sickle scalers
Curettes
Ultrasonic Instruments
Hoe,
Chisels and
Files
Sickle scalers- are heavy instrument primarily used to
remove supragingival calculus. They have flat surface and
two cutting edges that converge in a sharp pointed tip. The
arch shape of the instrument makes the tip strong so that it
will not break off during use.

## Because of the design of this instrument, it is difficult to

insert the blade under the gingival without damaging the
surrounding gingival tissues.

## This is inserted under the ledges no more than 1mm

below the gingival. It is used with a pull stroke.
Types of Sickle Scalers

Jacquette – usually 1, 2, 3, are having medium
Morse sickle – have small blade (0,00) is useful
in mandibular anterior area if there is little
interproximal space. The blade is replaceable
and can be obtained in various sizes 0, 00.
Curettes – are fine instrument used for subgingival
scaling, root planning and removing the soft tissue
lining the pocket.
They have spoon-shaped blade rounded tip.

## Ultrasonic instrument – are used for scaling and

cleaning tooth surfaces and curetting the soft tissue
walls of the periodontal pocket.

## Hoe, Chisel and File – are used to remove

tenacious subgingival calculus and necrotic
cementum. Their use is limited compared with that of
curette.
INSTRUMENTATION PRINCIPLES

Fundamental Pre-requisite:
Proper position of patient and operator
Illumination and retraction for optimum
visibility
Sharp instrument
Clinician should have acquired the following
knowledge:

## Tooth and root morphologic features

Condition of periodontal tissues
Knowledge of instrument design – so as to properly select
proper instrument for the procedure and the area in which
it will be performed.
Concept of grasp of instrument
Finger rest
Adaptation and angulation and stroke must be
understood.
Adaptation – refers to the manner in which the
working end is placed against tooth surface.
The objective of adaptation is to make the
working end of the instrument conform to the
contour of the tooth surface. Maintain precise
adaptation to avoid trauma to the soft tissues
and root surfaces.
Instrument Angulation

## refers to the angle between the face of a bladed instrument

and tooth surface or called tooth-blade relationship
optimal angulation during scaling is between 45- 90
degrees
on heavy tenacious calculus, angulation should be less
than 90 degrees so that the cutting edge “bites” into the
calculus. With angulation less than 45 degrees tha cutting
edge will not bite into or engage the calculus properly,
instead it will slide over the calculus, smoothing or
burnishing it. If the angulation is more than 90 degrees the
lateral surface of the blade rather than the cutting edge is
against the tooth and the calculus is not removed.
Lateral Pressure
refers to the pressure created when force is applied
against the surface of the tooth with the cutting edge
the exact amount of pressure must be varied
according to the nature of calculus and according to
whether the stroke is intended for initial scaling to
remove calculus or for root planing to smooth root
surface.
The nature of lateral pressure may be firm, moderate
or light
Repeated application of heavy strokes will nick or
gouge the root surface, so it is necessary to apply
careful and varied controlled amount of lateral
pressure
Strokes
Three Basic Types of strokes used during
instrumentation
Exploratory stroke
Scaling stroke
Root-planing stroke

Push
Pull

## Basic strokes may be directed in different direction:

Vertical direction
Oblique direction
Horizontal
Exploratory stroke
Is a light ‘feeling stroke” that is used with
probes and explorer to evaluate the dimension
of the pocket (if any) and detect calculus and
irregularities of tooth
Scaling stroke
Is a short powerful pull stroke that is used with
bladed instrument for removal of both supragingival
and subgingival calculus
Muscles of hand and fingers are tensed to establish a
secure grasp and lateral pressure is firmly applied
against the tooth surface.
The cutting edge engages the apical border of the
calculus and dislodges it with a firm movement in a
coronal direction (pull-cut method)
Some advocate push scaling motion (push-cut
method) where the instrument engages the lateral or
coronal border of calculus and the fingers provide a
thrust motion that dislodges the deposit. Not usually
recommended.
Root Planing stroke
Is a moderate to light pull stroke that is used for
final smoothing and planing of root surface.
SUPRAGINGIVAL SCALING TECHNIQUE

## Most commonly used instrument for

supragingival scaling: sickle, curette, ultrasonic
instrument
Hold the scaler with a modified pen grasp and
firm finger rest is established on the tooth and
slightly 90 degrees to the surface being scaled
The cutting edge should engage the apical margin of the
calculus while short, powerful overlapping strokes are
activated coronally in a vertical in a vertical or oblique
direction
There should be careful adaptation of instrument,
otherwise, the sharp pointed tip of the sickle can easily
lacerate marginal tissues or gouge exposed root surface.
Continue instrumentation until the surface is visually and
tactilely free of deposits
If the gingiva is retractable enough to allow easy insertion
of the blade then the scaler may be used slightly below the
free gingival margin. If you do this then final scaling and
root planning with curette always follows.
Cleansing and Polishing Instruments
◼ Rubber Cup – consists of rubber shell with or without
webbed configuration in the hollow interior. They are
used in the handpiece with a special prophylaxis
angle.
▫ Usually used with cleansing and polishing paste which
should be kept moist to minimize frictional heat as the
cup revolves. Aggressive use of rubber cup may remove
the layer of cementum which is thin at the cervical area.
◼ Portepolisher - is a hand instrument constructed to
hold a wooden point with which polishing paste is
applied to the tooth with a firm burnishing action.
▫ The ivory straight portepolisher with a wood point set
at an angle of 45 degrees to the handle fulfills most
needs
▫ A contrangled portepolisher, angulated at 60 degrees for
use in the posterior part of the mouth, is also available.
▫ This is convenient to use when engine-driven polishing
system are not available such as homebound patients or
in mobile clinics
◼ Bristle brushes –are available in wheel and cup
shapes. The brush is used in the handpiece with a
polishing paste. Because the bristles are stiff, use of
brush should be confined to the crown to avoid
injury to cementum.
◼ Dental tape – with polishing paste used for polishing
proximal surfaces inaccessible to other polishing
instrument
▫ The tape is passed interproximally at right angle to the
long axis of the tooth and activated with firm
labiolingual motion and care not to injure the gingiva.

## ▫ * All areas should be cleansed with warm water to

remove all remnants of paste.
Prophlaxis Paste
◼ Why do we have to polish the surfaces of the teeth
after scaling?
▫ To remove exogenous stains, pellicle, materia alba, and
oral debri
◼ Requisite of Prophy Paste
▫ Sufficiently abrasive to effectively remove all types of
accumulation from the tooth surface without imparting
undue abrasion to enamel, dentin and cementum.
Components of Prophy Paste
Abrasives – produce the cleansing action and these maybe:
Pumice – most abrasive especially the coarse one
Quartz – have higher cleansing value but greater
abrasion
Zirconium silicate – effective cleansing and polishing
agent but is influenced by the distribution of particle sizes of the
material
Sodium fluoride or stannous fluoride
THE END