Physiology and pathology of dental deposit formation
Understanding the patient's hygienic status requires knowledge of the structures that form on the tooth surfaces. Initially, the tooth is covered by the cuticle (cuticula dentis) and pellicle (pellicula dentis). Subsequently, dental plaque (plaque) begins to form on them.
The process of plaque formation goes through certain phases, with initial accumulation occurring in specific areas—the so-called retention sites. Dental plaque can also spread subgingivally, forming specific distribution zones of subgingival plaque. Over time, soft accumulations transform into hard dental calculus (calculus dentalis).
The presence of dental deposits is directly related to the development of periodontal diseases. Primarily, we are talking about nosological forms such as gingivitis (gingivitis) and periodontitis (periodontitis). A set of preventive measures is used to prevent their formation.
Disclosure of deposits and cleaning quality control
Special agents and disclosure methods are used in clinical practice to detect dental deposits. They are divided into:
- Visual (oral examination).
- Instrumental.
- Chemical (use of special markers).
After completing all stages of professional calculus removal, cleaning quality control is mandatory. The thoroughness of removal is checked using visual inspection, explorers (probes), and radiography.
Periodontal instruments
Specialized instruments are used to remove dental deposits, the choice of which depends on the location of the calculus. Scalers (scalers) are used to remove supragingival calculus. Periodontal curettes (curettes) are used for subgingival work, as their rounded tip prevents trauma to the mucosa.
Curettes are divided into two main types depending on the structure of the working part:
| Characteristic | Universal curette | Gracey curette |
|---|---|---|
| Number of cutting edges | Two cutting edges | One working edge (the second is blunt) |
| Angle (face / shank) | 90° | 70° |
| Cross-sectional shape | Semicircle with a flat surface | Semicircle with a beveled surface |
Methods for dental calculus removal
Deposit removal can be carried out in several ways, which are often combined to achieve an optimal result.
Mechanical method Performed with hand instruments. The biomechanics of movements includes scraping and lever-like movements. When performing the latter, stable teeth on the opposite side of the jaw serve as a fulcrum for the instrument. The tooth surfaces are treated in a strict sequence: first the vestibular surface, then the contact (approximal) surfaces, and finally the oral surface.
Physical method Based on acoustic systems (ultrasonic, sonic, and electromagnetic vibrations). For example, a hardware combination of Air-Flow and a piezoelectric scaler (Piezon) is used. Ultrasonic power must be strictly regulated, as exceeding it threatens damage to the enamel, root cementum, gingiva, as well as damage to artificial crowns and light-cured fillings. Small remnants of calculus after ultrasound are removed manually.
Hardware ultra-dispersed impact Consists of the directed supply of a reactive aerosol stream (water + abrasive). Sodium bicarbonate or aluminum alpha-oxide is used as abrasive substances.
Chemical method Used only in combination with mechanical removal. Special agents contain low-concentration acids that soften hard deposits. However, acids can adversely affect tooth tissues and the gingiva, so the method requires caution.
Stages of professional hygiene and drug therapy
The tooth cleaning procedure is strictly regulated and consists of the following steps:
- Preparatory stage: irrigation of the oral cavity with mild antiseptics, removal of soft deposits, and adequate anesthesia (topical or injection).
- Removal of supragingival calculus: by mechanical or physical means.
- Removal of subgingival calculus: performed with curettes strictly after the removal of supragingival deposits.
- Surface polishing (final stage): polishing pastes, brushes, rubber/silicone cups and points, discs, and fine-coated abrasive strips are used.
After cleaning, medical treatment of the gingiva is carried out. Preparations must have anti-inflammatory, antiseptic, antimicrobial, and epithelizing properties.
Application technique:
- Preliminary isolation of the gingiva from saliva with cotton rolls.
- Application of the drug (in the form of a gel, paste, soluble film, or turunda moistened in a solution).
- According to indications — application of hardening dressings with an antibacterial effect.
Briefly: answers to topical questions
What dental indices are used to assess oral hygiene?
Special hygiene indices are used for objective diagnostics and assessment of the amount of dental deposits. The main ones are:
- Fedorov-Volodkina index — one of the most common methods, using a 5-point scoring system.
- Simplified Oral Hygiene Index (OHI-s, Green-Vermillion) — evaluates the vestibular and oral surfaces of the teeth.
- Oral Hygiene Performance Index — proposed by Podshadley and Haley.
What specific dyes and preparations are used for chemical dental plaque disclosure?
Special dyes are used for chemical dental plaque disclosure and evaluation of the hygienic state. The main preparations used include:
- Schiller-Pisarev solution — contains crystalline iodine, potassium iodide, and distilled water.
- Fuchsin — used for qualitative and quantitative assessment of the hygiene level.
- Methylene blue — used for staining dental deposits.
- Erythrosin — used to detect dental plaque and biofilm.
In the presence of plaque or inflammation, tissue staining occurs, which allows for an objective assessment.
Class and exam questions
Can the chemical method of calculus removal be used independently?
No, the chemical method is always used exclusively in combination with mechanical methods due to the risk of negative acid effects on the tooth and surrounding tissues.
What is the main feature of the Gracey curette?
Unlike the universal curette, the Gracey instrument has only one working cutting edge and an angle between the face and the shank of 70°.
What is the sequence of tooth surface instrumentation during mechanical removal?
Work begins with the vestibular surface, then proceeds to the contact (approximal) surfaces, and completes the cleaning on the oral surface.
What else to study on this topic
- Anatomical structure of the periodontium: groups of periodontal fibers and the gingival sulcus (sulcus gingivalis).
- Detailed phases and stages of dental plaque formation.
- Retention sites of teeth prone to primary deposit formation.
- Clinical characteristics and differences between gingivitis and periodontitis.
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Other topics in "Chapter 13. Dental Deposits"
The entire section "Chapter 13. Dental Deposits"Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.