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

U15/30 – large blade

Jacquette – usually 1, 2, 3, are having medium sized blade.
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.
 Instrument Adaptation
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 of bladed
instrument
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

Basic strokes may be activated by:

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 adjacent
to the working area
The blade is adapted with an angulation of 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