DHE 101 QUIZ CHAPTERS 20 21

• Parts:Handle / shank / working end
• Types of mirror surface: Flat plane / concave magnifying  / double sided
• Handles * thicker = more ergonomic

• Indirect illumination
• Transillumination
• Retraction

use modified pen grasp with finger rest on a tooth surface wherever possible to provide stability and control and to assist in retraction of lips and cheek.

use a water-based lubricant on dry or cracked lips and corners of mouth. Adjust the mirror position so that the angles of the mouth are protected from undue pressure of the shank of the mirror. Insert and remove mirror carefully to avoid hitting the teeth because this can be very disturbing to the patient.

warm mirror with water, rub along buccal mucosa to coat mirror with thin transparent film of saliva, and request patient to breathe through the nose to prevent condensation of moisture on the mirror. Use a detergent or other means for keeping a clear surface. Discard scratched mirrors.

dismantle mirror and handle for sterilization. Examine carefully after ultrasonic cleaning prior to sterilization to ensure removal of debris around back, shank, and rim of reflecting surface. Handle carefully during sterilization procedures to prevent other instruments from scratching the reflecting surface. Consult manufacturer’s specifications for sterilizing or disinfecting procedures that may cloud the mirror, particularly the front surface type.

• Improve/facilitate exam procedures; Removal / control
• Improve visibility during treatment; Non-slippage
• Prepare teeth and/or gingiva for procedures; Application of medicaments / caries preventitives,e tc.

Standard and automated

• Assess periodontal status; gingivitis or periodontitis, Bone loss / BOP
• Make sulcus/pocket survey; shape, topography, and dimensions
• Determine clinical attachment level (CAL);(+ OR -)
• Make a mucogingival examination; relationship of gingival margin, attachment level, mucogingival junction, and frena
• Make gingival determinations; Baseline data / BOP / recession / consistency
• Evaluate success of treatment; posttreatment tissue response
• Evaluate at maintenance appointments; Pt. recall / re-care & or referrals

a slender instrument with a smooth, rounded tip designed for examination of the depth and topography of a gingival sulcus or periodontal pocket.

the handle, the angled shank, and the working end, which is the probe itself.

Materials: stainless steel. Plastic: for screenings and titanium implant probing.

 Adaptability. The probe needs to be adaptable around the complete circumference of each tooth, both posterior and anterior, so that no millimeter of probing depth can be neglected. Flat probes require more attention to adaptation and are useful primarily on facial and lingual surfaces. Markings. Markings need to be easy to read so that probing depth can be readily identified and measured, and no disease area is overlooked. Color coding contributes to readability.

• (A)Williams (1-1-1-2-2-1-1-1)
• (B) Williams, color-coded (1-1-1-2-2-1-1-1)
• (C) Goldman-Fox (1-1-1-2-2-1-1-1)
• (D) Michigan O (3-3-2)
• (E) Hu-Friedy or Marquis color-coded (3-3-3-3 or 3-3-2-3)
• (F) Hu-Friedy PCPUNC 15 (each millimeter to 15), color-coded at 5-10-15

• a diseased gingival sulcus
• use of a probe is the only accurate assessment tool

• level of attached tissue varies
• gingival margin varies

• the col area  the most
• Therefore - Probing depth may be deepest directly under the contact area because of crater formation in the alveolar bone

• B. Shallow pocket (2 mm) with the attachment near the CEJ
• A. Deep periodontal pocket (7 mm) 
• Apical migration of attachment
• PDL detachment
• Alveolar bone-loss

• Severity and extent of periodontal disease:
• Diseased tissue offers less resistance, so that with increased severity of inflammation, the probe inserts to a deeper level. Average levels show that the probe is stopped as follows: Normal healthy tissue. The probe is at the base of the sulcus or crevice, at the coronal end of the junctional epithelium.
• Gingivitis and early periodontitis. The probe tip is within the junctional epithelium.
• Advanced periodontitis. The probe tip passes through the junctional epithelium to reach attached connective tissue fibers

• Calibration. Must be accurately marked; otherwise, readings cannot be accurate.
• Thickness. A thinner probe slips through a narrow pocket more readily.
• Readability. Aided by the markings and color-coding.

• Held by thumb (T), index finger (1) & the second, or “middle,” finger (2), which also provides support
• Third, or “ring,” finger (3) serves as the finger rest
• “little,” finger (4) is positioned beside the ring finger to supplement the finger rest.

maintain the probe in the sulcus or pocket of each tooth as the probe is moved in a walking stroke as shown on the next slide. It is not necessary to remove the probe and reinsert it to make individual readings. Use a continuous probing to avoid missing a deep pocket area. Repeated withdrawal and reinsertion cause unnecessary trauma to the gingival margin and hence increase posttreatment discomfort

• Molars/premolars; Initial Orientation: distal line angle for both facial and lingual
• Anterior teeth; Initial Orientation: distal line angle
• Proximal surfaces : Walking stroke around each line angle, Continue the strokes under the contact area, 10°probe angulation out of Col area

• 6 total for each tooth
• 3 on buccal aspect / 3 on lingual aspect

• Furcation involvement
• Mucogingival involvement

• Rationale = loss of attachment = disease / habit
• junctional epithelium migrates toward the apex
• Revealing cemental surface

• CEJ is clinically visible
• Measure from the CEJ to the attachment
• CAL is greater than the probing depth when there is visible recession

• Feel CEJ with inserted probe
• Measure from gingival crest to CEJ
• This will be a (+) overgrowth of gingiva reading

probing depth equals the CAL when the free gingival margin is level with the CEJ.

(teeth with two roots).

(teeth with three roots).

. (A) Measure the total gingiva by laying the probe over the surface of the gingiva and measuring from the free margin to the mucogingival junction. (B) Measure the probing depth. Dotted line represents the base of the pocket. Subtract the probing depth (B) from the total gingiva (A) to obtain the width of attached gingiva. The area illustrated shows 2 mm of attached gingiva.

• Detect, by tactile sense, the texture and character of the tooth surfaces. For calculus, defects or irregularities in the surfaces and margins of restorations, and other irregularities that are not apparent to direct observation. An explorer is used to confirm direct observation. Do not use an explorer on remineralizing potentially dental carious legions.
• Define the extent of instrumentation needed and guide techniques: for scaling and root planing and removing an overhanging filling.
• Evaluate the completeness of treatment: for periodontal nonsurgical treatment as shown by the smooth tooth surface and for removal of an overhanging filling by the smooth margins of the restoration.

Tooth structure. The smooth surface of enamel and root surface that has been planed; anatomic configurations, such as cingula, furcations. Restored surfaces. Smooth surfaces of metal (gold, amalgam) and the softer feeling of plastic; smooth margin of a restoration.

• increases or elevations in tooth surface: Deposits. Calculus. Anomalies. Enamel pearl. Restorations. Overcontoured, irregular margins (overhangs).
• Irregularities: depressions, grooves. Tooth surface. Demineralized or carious lesion, abrasion, erosion, pits such as those caused by enamel hypoplasia, areas of cemental resorption on the root surface. Restorations. Deficient margin, rough surface.

• N = normal, physiologic
• 1 = slight mobility, greater than normal
• 2 = moderate mobility, greater than 1 mm displacement
• 3 = severe mobility, may move in all directions, vertical as well as horizontal

No tooth has zero mobility except in a condition,  in which there is no periodontal ligament.

• means palpable vibration or movement. In dentistry fremitus refers to the vibratory patterns of the teeth. A tooth with fremitus has excess contact, possibly related to a premature contact. Usually, the tooth also demonstrates some degree of mobility because the excess contact forces the tooth to move. The test is used in conjunction with occlusal analysis and adjustment. Because fremitus depends on tooth contact, determination is made only on the maxillary teeth.
• N = normal (without vibration or movement).
• + = One-degree fremitus; only slight vibration can be felt.
• + + = Two-degree fremitus; the tooth is clearly palpable but movement is barely visible.
• + + + = Three-degree fremitus; movement is clearly observed visually.

• 1 to 1.5 mm from the CEJ

• more than 1 to 1.5 mm from the CEJ
• When bone loss is horizontal, the crest of the alveolar bone is parallel with a line between the cementoenamel junctions of adjacent teeth. Note early furcation involvement in the second molar and moderate furcation involvement in the first molar.

• Localized horizontal bone loss
• 2nd molar mesial drift
• level of the crestal bone is parallel with a line between
• the CEL’s of the second premolar and the tipped second molar

mesial of the first molar. The level of the crestal bone between the second premolar and the first molar is not parallel with a line between the cementoenamel junctions of the same teeth

• Normal =radiopaque /
• Disease = radiolucent / non-distinct

• Normal = radiolucent;Fine black line
• Disease = radiolucent;Widening or thickening, not consistent, Triangulation

• Earliest signs: NOT evident in a radiograph, BOP
• Initial bone destruction, Interproximal  pathway , Horizontal most common
• Radiographic evidence
• crestal lamina dura may appear slightly irregular, fuzzy, and radiolucent
• Angular thickening of the periodontal ligament space (triangulation)

calculus is mineralized dental biofilm that is filled with crystals of various calcium phosphates. It is covered with a layer of nonmineralized dental biofilm containing viable, active bacteria. The hard, tenacious mass forms on the clinical crowns of the natural teeth and dental implants, dentures, and other dental prostheses.

• Nonsurgical periodontal therapy
• Clinical care
• Patient learning
• Classification and distribution of calculus

Dental calculus. (A) Supragingival calculus on cervical third of a mandibular anterior tooth extends slightly subgingivally. (B) Supragingival calculus over crown, exposed root surface, and the margin of the gingiva. (C) Subgingival calculus along root to the bottom of a periodontal pocket. (x) Bottom of pocket.

• Location: on the clinical crown coronal to the margin of the gingiva. On implants, complete and partial dentures.
• Distribution: Most frequent sites. On the lingual surfaces of mandibular anterior teeth and the facial surfaces of maxillary first and second molars, opposite the openings of the ducts of the salivary glands. On the crowns of teeth out of occlusion; nonfunctioning teeth; or teeth that are neglected during daily biofilm removal (toothbrushing, flossing, or other personal care). On surfaces of dentures, dental prostheses, and tongue piercing barbells.

Other names for supragingival calculus: Supramarginal. Extragingival. Coronal, indicating that the calculus is on the anatomic crown. Salivary, a term indicating that the source of the minerals is the saliva.

Location: on the clinical crown apical to the margin of the gingiva and extending nearly to the clinical attachment on the root surface. On dental implants.

Distribution: may be generalized or localized on single teeth or a group of teeth. Heaviest deposits are related to areas most difficult for the patient to access during personal oral biofilm removal procedures.

• is made up of inorganic and organic components and water.
• Mature calculus usually contains between 70% and 90% inorganic components; the rest is organic components and water.

calculus results from the deposition of minerals into a biofilm organic matrix. Calculus formation occurs in three basic steps: pellicle formation, biofilm formation, and mineralization. Mineralization of supragingival and subgingival calculus is essentially the same, although the source of the elements for mineralization is not the same.

the pellicle, or cuticle, is composed of mucoproteins from the saliva and is an acellular material. The pellicle begins to form within minutes after all deposits have been removed from the tooth surface.

microorganisms settle in the pellicle layer. Colonies are formed. In early calculus the colonies consist primarily of cocci and rod-shaped organisms. By the fifth day, the biofilm is mostly made up of filamentous organisms. The colonies grow together to form a cohesive biofilm layer.

mineralization foci (centers) form. Undisturbed, within 24 to 72 hours, more and more mineralization centers develop close to the underlying tooth surface. Eventually, the centers grow large enough to touch and unite. Mineralization first occurs within the intermicrobial matrix. The filamentous microorganisms provide the matrix for the deposition of minerals. As the deposit ages, mineralization within the bodies of the bacteria occurs.

The source is saliva

Gingival sulcus fluid and inflammatory exudate (Because the amount of sulcus fluid and exudate increases with increases in inflammation, more minerals are available for mineralization of subgingival biofilm.)

• hydroxyapatite, octocalcium phosphate, whitlockite, and brushite, each with a characteristic developmental pattern.
• The crystals form in the intercellular matrix and on the surface of bacteria, and finally within the bacteria

• same for both supragingival and subgingival calculus
• Heavy calculus formers have higher salivary levels of calcium and phosphorus than do light calculus formers
• Light calculus formers have higher levels of parotid pyrophosphate
• Pyrophosphate is an inhibitor of calcification and is used in anticalculus dentifrices
• The process by which minerals become incorporated from the saliva or gingival sulcus fluid into the biofilm matrix is still not completely understood.
• Research studies point to the probability that calcification of calculus may involve the same phenomena as those of other ectopic calcifications (such as urinary or renal calculi) and may be similar to normal calcification of bone, cartilage, enamel, or dentin.

calculus forms in layers that are more or less parallel with the tooth surface. The layers are separated by a line that appears to be a pellicle that was deposited over the previously formed calculus, and as mineralization progressed, the pellicle became imbedded. The lines between the layers of calculus can be called incremental lines. They form around the tooth in supragingival calculus, but they form irregularly from crown to apex on the root surface in subgingival calculus. The lines are evidence that calculus grows or increases by apposition of new layers.

the surface of a calculus mass is rough and can be detected by use of an explorer or probe

the outer layer of subgingival calculus is partly calcified. On the surface is a thick, mat-like, soft layer of dental biofilm. The outer surface of the biofilm on the subgingival calculus is in contact with the diseased pocket epithelium.

means the average number of days required for the primary soft deposit to change to the mature mineralized stage.

The average time is about 12 days, within a range from 10 days for rapid calculus formers to 20 days for slow calculus formers. Mineralization can begin as early as 24 to 48 hours when a patient’s personal daily oral hygiene is neglected.

Formation time depends on individual tendency, but it is strongly influenced by the roughness of the tooth surface and the care and character of personal biofilm control measures.

Bacterial mass

always

depends on knowledge of its appearance, consistency, and distribution.

Selection of instruments, techniques depend o understanding the texture, morphology, and mode of attachment of calculus.

Direct examination. Supragingival deposits may be seen directly or indirectly, using a mouth mirror. Use of compressed air. Small amounts of calculus may be invisible when they are wet with saliva. With light and drying with air, small deposits usually can be seen.

• Visual examination:
• Dark edge of calculus may be seen
• Gentle air blast can deflect the margin
• Using transillumination
• Gingival tissue color change: dark calculus may reflect through a thin margin
• Tactile examination:

Probe. = a rough subgingival tooth surface can be felt when calculus is present.

• Explorer. = adapted close to the root surface all the way to the bottom of a pocket
• Radiographic examination: radiographic examination is not useful for calculus detection because of highly mineralized tooth structure superimposed over calculus deposits. Thick, highly mineralized calculus may be detected on proximal tooth surfaces except when there is overlapping.jQuery110105320488308667279_1510200500327jQuery110109546054228424707_1510206465108??????
• Perioscopy: the use of dental endoscopy in deep pockets and furcations can show otherwise undetectable calculus, especially burnished calculus.

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• Patients at risk for calculus formation need personalized counseling.
• Risk factors related to calculus formation are similar to those for dental biofilm formation and relate to biofilm removal during the patient’s personal daily oral care.
• Coping Methods: patient instruction and daily care and NSPT/ nonsurgical periodontal therapy.
• Personal dental biofilm control:
• Objective. Removal of dental biofilm by appropriately selected brushing, flossing, and supplementary methods
• Instruction. = patient’s successes and reteach as necessary.
• Regular professional supervision. Professional maintenance appointments on a regular basis can supplement the personal care

is an inhibitor of calcification and is used in “tartar control” dentifrices and is also in the parotid saliva