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CALCULUS
REANIMATES ITSELF - HOW DOES CALCULUS BEHAVE? DRAFT
According to Dimensions of Dental
Hygiene in "Using
Files in Periodontal Therapy" - "Research studies also
conclude that, despite our best efforts, calculus
remains on tooth surfaces ranging from 17% to 64%
after closed scaling and root planing
and 7% to 24% after surgical intervention and open
instrumentation by experienced operators."
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= = =
WHAT ABOUT THE DEAD PERIODONTAL
MEMBRANE?? - How about if you worry about the calculus
first. How about that? Then when you get everything
perfectly clean and shiny and happy except for that
lingering problem of the deep nectrotic periodontal
ligament then you can start to worry about it. How about
that? But meanwhile will tell you it is very difficult,
it takes a long time and the best instrument I have
found to work the dead membrane is the Furcator. Plus
the O'Herirs. Also you won't find much information
about it. But it is critically important. Which fact was
readily recognized by 19th Century dentists. Who went on
and on about it.
= = =
Question being whether the cornflake has some type of intelligence. Or if indeed the entire composition of the calculus and flecks and blobs and biofilm does indeed form a community of like minded beings living in people's teeth. And indeed the answer is yes. Or alternately the infrastructure model is a good way to view the enemy. Destroy the infrastructure. Let everything heal. Then destroy the infrastructure again. Down the Doubling Curve - reduce by half, then again repeatedly until the infection is completely gone and the area heals. Yeah, like right. Alternately
the idea is to reduce the biofilm
and calculus infrastructure down to its remnants. Which
then reanimates itself and gets whacked again. Which
turns into a lifetime process. Also, once the deepest
calculus is eliminated, if you can clear the final edge,
which is extremely difficult, then even the bone will
come back at least a little. Like 2mm. Or in case of
miracles up to perhaps 4mm. Or maybe 1/10 of an inch.
Which does not seem like much. But can make all the
difference. Especially if the teeth get tighter too. So
object is to reduce the disease. Where you can imagine
that standard periodontal care might reduce the calculus
to say 10%. But where the DIY can systematically reduce
this amount to under 5%. Or in the case of a failing
tooth where so much of the calculus is so hard to reach
then the only alternatives are more and better SRP (Best
option), surgery or DIY. = = = BASE TWO GEOMETRIC SEQUENCE
Hudson:
Is this gonna be a standup
fight, sir, or another bughunt?
= = = NOTE ON
GRANULATION TISSUE - GIGANTIC BLOBS - I will try to be
honest with you for once in my life. I had no idea what
granulation tissue even was even when I was getting
bucketfulls of the stuff. I thought they were giant
blobs full of both themselves and nasty infection of
dubious lineage. Literally turning into some strange
alien creature somewhere down below. It was really quite
frightening will tell you. What if they escaped into the
interior of my body? What then?? Would I turn into a
giant blob too?? Of
course I sort of knew what granulation tissue was. That
it was my own tissue combined with infection. But I sort
of imagined it like the dog-xenomorph on Aliens. That it
was more xenomorph than dog. But truly I was just
letting my imagination get ahead of itself. And turning
a simple debridement into an epic battle. Which
strangely I still believe. Even though I know more about
the more realistic explanation. Since the blobs look so
bizarre. Then...
while chatting briefly with one of my periodontists
about the subject I was told that granulation tissue is
generally considered neutral within the dental
community. Even though it is also agreed it is
definitely infected. What is the justification? It is
only slightly infected. It is more less infected than it
is more more infected. It is in harmony with it's little
world. Peace and love. You
want to get rid of it? Knock yourself out. But
even so I still generally tend to get weirded out by the
stuff. And definitely don't want strange infected blobs
living inside of me. Even if they are supposedly benign.
Since they are still infected. What if they die? Then I
got a bunch of dead stuff inside my body? Yikes! Would
rather not. How does
granulation tissue survive?? Still haven't figured this
one out. If it is living then where is it's blood
supply? Now certainly I have seen a lot of the stuff.
And some of it is darker and bluer. So that is
definitely the stuff that is underfed with oxygen. Then
some is more red. So they must be copping oxygen from
somewhere. But don't know how. Perhaps it is like a
placenta. So what
is the bottom line? In my opinion granulation tissue
should be debrided out. Plus it is usually quite willing
to leave the premises with just a little shaking of the
curette. So do your best to get rid of it. But again,
like the dentists say, don't know yourself out. If they
don't worry about it so much then why should you?
= = = LEAP-FROG ANALOGY - To imagine how the calculus travels down the tooth to the root. To start realize that biofilm has an energy transport mechanism. So it can transfer chemical energy from the sugary upper layers bathed by the saliva all the way down to the lowest layers. This enables the lower layers to infiltrate down the tooth. The process takes years. Like 10 to 20 to even 30 years. But then it has literally captured the tooth nerve!! What comes next? Or what has been happening all along? The bone has been retreating. Possibly abscesses have been forming. Possibly the nerve is trapped. This is called Apical Periodontitis. This means the tooth is toast!! Also I wouldn't believe all those stories about how calculus is supposed to be so benign and that it is the biofilm to worry about. To begin with the calculus is porous and can be filled with biofilm in all of it's nooks and crannies. Second the calculus is built of layers and is not some monolith. It has gaps, fissures, nooks and crannies and is perfectly capable of supporting large colonies of biofilm. Third realize that the biofilm has life cycles too. Young and fresh. Old and gnarly. Etc. Fourth, once much of the calculus is removed the latent bacteria in the calculus left behind will reanimate itself and exert authority. So just don't believe those tales about benign calculus. Or if you want to believe then think of the calculus like housing for the bacteria. So you don't care exactly what it does. But it provides aid and comfort to the biofilm so it has to go. Oh... also realize that the bacteria is undergoing many many lifecycles. Eventually it learns how to survive on blood. So it no longer needs any outside help and can just go after available body parts for sustenance. So with the housing analogy you won't have to worry about getting into arguments with dentists. With the vampire analogy you can explain that you are still leery about all this deep down calculus and am not completely convinced it is so harmless - trust me it isn't harmless - it is quite dangerous - forget about what anybody says otherwise. = = = So, as you can see the biofilm and calculus built itself up over the years. But if the hygienist can remove 50% of all the biofilm per treatment, then after seven treatments the remaining biofilm and calculus will be less than 1% of the original amount. Or if they can remove 75% per treatment then after the second treatment only 6% of the original amount will be left. And after the third treatment only 1 1/2% of the original will be left. All of
this suggests that instead of getting just one
legitimate SRP you should get two. Even if it costs
another $1200. Presuming it is legitimate. Issue being
depth and speed. If the stuff is deep and the hygienist
doesn't get to it then it doesn't matter how many times
they go back. Same goes for surgery. If the periodontist has a quick and
dirty attitude you can guarantee the disease will
continue interupted. And
you will be blamed. Probably for not flossing enough.
And it is unlikely the periodontist
will want to consider that maybe just maybe there is
something in there real deep that maybe just maybe they
can get to with the curette. But what do you know?
And how many years did you go to dental school? = = = WHAT IS THIS CORNFLAKE-LIKE MOTHER LODE? - WHAT DOES IT WANT FROM US? First notice the cornflake is flake-like. Which is a common shape for primitive life-forms. The shape enables the organism to get nourishment from both sides. So you can quite easily imagine how the flake behaves. It is like an energy black-hole for it's surrounding area. At the center is the flake itself. Plus it could even have another flake hidden inside itself! But realistically that is enough. It then surrounds itself with layers of bloody biofilm that transport energy and other resources to the flake. Including the blood released by the body to attack the cornflake and the bodies of the dead bacteria killed by the blood. Then
comes more layers of biofilm
that is not so bloody but more like serum. But can
clearly see how the cornflake has life set up nicely for
itself at the expense of destroying the teeth. So it is
always good to get rid of the bloody blobs. And many
don't even need a curette. Oftentimes a well placed
toothpick or brush-pick or the aspiration-irrigation
needle are enough to disrupt the mother lode and cause
it to liberate itself. Which then becomes a great day in
potential periodontal recovery. Presuming the goal is to
Get the Crud Out. = = = MORE ON XENOMORPH - OR FACEHUGGER - The simplest analogy for an infested periodontics is a city or ant colony. Biofilm are quite handy not only at consuming sugars and what-not, including other not so fortunate cohort - cannabilism - Plus making good use of the blood byproducts brought by attempts by the body to attack or isolate the infection - Plus making good use of any dead bacteria that just happened to get killed, such as through attempts to poison them, or die on their own. More or less what the biofilm does is separate very small spaces into layers upon layers of material. Quite literally you can imagine the biofilm like sheets hanging on a set of clothes lines. Or hanging up a row of T-shirts to dry on the shower rod. Where you will try to separate each shirt by a small layer of air. Now imagine open communications between all the different layers of biofilm. And self-defense abilities similar to clams. Where the calculus can just isolate itself from attack, even though it will sacrifice part of itself. Like it cares. Then later it gets to eat all the leftover byproducts. So on its own it survives very well, even under adverse conditions. Also to a degree Including mechanical disruption. = = = GEOLOGY ANALOGY Here imagine a swarm of biofilm living alongside your tooth. The biofilm is also clinging to the tooth. The biofilm live in an infrastructure of layers upon layers of biofilm. Both in competition and in cooperation with each other. At the outward surface of the biofilm life is rich and nutricious with sugar and blood for food. Any extra nutrition is then passed along to the deeper layers. But the intermediary biofilm is greedy. So not much is left for the biofilm clinging to the tooth. So gradually the deepest layers die and turn into calculus. Which some say is like rock. Which is it. But higher up is lots and lots of biofilm in intermediary states that is not necessarily clinging to tenaciously to the tooth. This biofilm-calculus can be disrupted and removed through general mechanical means. Such as proxy-brushes, brush-picks and tooth-picks. = = = DOZENS
UPON DOZENS OF LAYERS - RIGHT ON YOUR TOOTH Google - youtube diy periodontal calculus Basically there are much greater amounts of the different types of crud then a normal person could even imagine. For one face of one tooth I once counted hundreds upon hundreds of blobs, many up to 2 and even 5 mm. How could the tooth possibly hold so much crud? Likewise for one face of my lower left molar I counted dozens of pieces. But each of them was sized around 5 mm wide. So where could they come from. In this case think they were probably folded over and expanded once released. But some of them could have been layered on top of each other too. I do not know the answer. But it is basically the same phenomona you might experience when cleaning paint or rust or debris off of something. What will happen is that much more crud will seem to come off than was ever there in the first place. Other more obvious answer is that once you start disrupting the crud then the body will liberate blood that will then tend to conglamerate around the crud and make it appear to larger and more than what it really is. = = = WHAT DOES ALL THIS MEAN? WHAT IS THE DILEMMA? Basically the dilemma is that the calculus should NOT be removed in layers. But rather should be removed in chunks. This is one of the mantras of dental hygiene. WHY? Reason is that there are so many layers that if you try to peel them off one at a time it will take forever. Also the lower layers will just revive the infection and you haven't accomplished much except to reduce its depth. And also is the problem of - Whacking the Hornets Next - which means what? That in fact if all that you do is remove some of the upper layers and maybe even layers closer to the gumline then what will happen? Well, clearly if the lower and deeper layers have just had the upper layers of competition removed from them then they should thrive, shouldn't they? Yes, I would certainly think so. Which basically means that for any hygiene work the work should be thorough and shouldn't leave large amounts of latent infection around. Or at best the disease will come back well. And at worst you just gave the lower layers a chance to thrive even more. Since the food can reach them more directly and there is less competition for resources. = = = SO WHAT DOES ALL THIS MEAN? What it means is that you should have the hygienist break off the calculus in chunks, not layers. BUT ISN'T THIS HARD TO DO? Yes, it is very hard. And for big pieces of calculus it is close to impossible. What is it like? It is similar to peeling a layer off a container. If you can catch an edge or break the calculus into pieces it will come out in chunks. But if you try to dislodge a big piece of calculus that is stuck fast to the tooth then it won't readily break off at all. Then what are you going to do? And the answer here is to find the side of the calculus piece that lets you leverage the curette against the open side of the calculus. So the end will break off. Then repeat. This exercise is sort of like slicing salami. BUT WHAT IF ALL YOU CAN HOPE TO ACCOMPLISH IS TO BREAK OFF THE CALCULUS IN LAYERS? If this is the best you can do then that is too bad. But if you want to do a good job can guarantee it will take hours and hours for just one small area. Where if you could have broken off the calculus in chunks instead of layers then it would go much faster and the results would be much cleaner and better. = = = WHAT IS THE TRICK? AND DON'T TOOTH AND BONE GET CONFUSING? - WARNING !! - ALWAYS WORK FROM AN EDGE THAT YOU ARE 100% SURE IS TOOTH - AND WORK ALONG THE EDGE OF THE SUSPECTED AREA UNTIL YOU ARE 100% SURE IT IS CALCULUS - THROUGH VARIOUS LOGICAL PROCESSES THAT YOU KNOW MEANS IT IS CALCULUS AND NOT BONE!! Bottom-line to not get teeth and bone confused is to always start from tooth. Never Never start in the middle of somewhere. Numerous times I have thought it was calculus, but maybe not, and it ended up being bone instead. Yes, one of the primary issues is that if you find yourself swimming about with the curette in deep pockets with the tooth and bone mixed in together then how can you tell if you are pulling on calculus on the tooth and are not pulling on bone instead. This is a major problem. Bone will oftentimes feel what I call "stalky." Like sharp weeds. Other times it will feel like a rough tooth. So how do you know you are pulling on tooth and not bone? NOTE - To further confuse this issue teeth do have self-awareness, like most of the external body. But it is difficult to figure out the exact spot. And to top it off the imagination quickly steps in to fill the gaps of sensory knowledge. The result is that nobody can truly say where on the teeth they really are. Unless they have some sort of sensory "proof" and logic to confirm their location. Also the teeth will feed the person false information based on the person's expectations. So if I imagine I am on one particular part of a particular tooth then in fact I could be somewhere else but my brain will convince me that what I think is true is in fact true. When it isn't. Meaning it is a bad idea to pull on anything unless you know exactly what it is you are pulling on and there is no possible way you could be fooling yourself. = = = WHAT IS THE BOTTOM LINE ISSUE HERE? Think the bottom line issue here relates to large calculus ledges. Deep down. How is one to tell for sure it is a calculus ledge and not bone? Good question. And I will confess that I have always been afraid of this possibility and still am. But think I could be completely wrong. Meaning I don't have to be so wimpy. So what
do I do? I almost always only attack a calculus ledge
if: With this information I then declare the piece to be a piece of calculus and try to remove it. But oftentimes the piece is too big to remove in one piece. So I break it off in chunks. Or I am not having much luck breaking it off in chunks and so have to break it off in layers. Which I don't like to do. And which even seems foolish. But once I get the area clean and realize I didn't shirk from removing the calculus then I am happy. = = = BUT SHOULDN'T YOU BE ABLE TO DO THE ANALYSIS A LITTLE LESS RIGOROUSLY? Would certainly think so. And which I have also tried. And also to take a more patient approach for any ledges that are obviously quite large. Here I will work my way around the piece of calculus and try to crack it but not follow through.Then after awhile what happens is the piece starts to get floppy. So I continue the process as patiently as I can and eventually the piece will just fall out. And since I was mellow and didn't start screaming after I started tugging on the thing then it had to be calculus and couldn't have possibly been bone. Right? I would say so. It had to be calculus and couldn't have possibly been bone. Yessiree. The logic of meatball surgery. Raised to a much higher and more delicate and dangerous level. Which can only be justified if not only did you only do what you had to do - but that your opinion was correct too - and how can you possibly justify that? What do you know about dental hygiene and why can't you just let the hygienist do it and forget about it DIY? = = = IF YOU KEEP TUGGING AT THE LEDGE AND SOMEHOW MANAGE TO BREAK OFF SMALL PARTS DOES IT GET EASIER AFTER AWHILE? YES - As highly simplified example you can imagine trying to dig a hole into hard ground. Certainly the ground will resist you. OR rather you just don't have the upper hand over the hard ground. So your effort plus leverage is just not enough to effect much change. BUT... once you get started and start to get a reasonable hole then you can break off the edges more easily. Also note that going down still takes a lot of effort. The easy part is breaking stuff above the bottom level. Also, fairly narrow penetration can create better penetration than along a broad front. And that once you have achieved the penetration you can expand the field to widen the area you are opening up. My general experience is that I get very little positive debridement at first. But once I manage to break off a few small pieces that it becomes easier to break off big pieces. WHAT IS THE BEST WAY TO FINISH UP? - MAXIM IS - FINISH WHAT YOU STARTED - GET THE LAST READILY AVAILABLE BIG CHUNK - This is a basic debridement principle. Keep going as long as you can without causing too much trauma. Go for the last readily available big chunk. But don't keep going if you are not getting results except for only a few small pieces. IS THERE MORE? ARE THERE DEEPER LAYERS? - This is a great mystery. My general experience for deep areas is that I debride until I stop. Then let it heal. For severe enough trauma and general trauma for at least two weeks ie two healing cycles. In practical terms though I may not be so eager to go back and may revisit places a few months later. Or in one case I did not go back in time and got an abscess and lost the tooth #30. Lower right first molar. FORTRESSES INSIDE OF FORTRESSES? - OR STIMULATING THE INFECTION AT THE LOWER LAYERS? - ie SLIDING DOWN THE DINOSAUR - Which is it? This is the great dilemma. If you debride the upper layers but don't debride the lower layers in time then will the lower levels thrive? Likely yes. NOTE- XYLITOL MIGHT HELP HERE TO SUPPRESS THE LOWER LAYERS OF BACTERIA. But what if you don't debride at all? Are the lower layers likely to thrive anyway. Answer here seems to be yes. Since the lower layers can survive on blood. Even though they would prefer sugar. BUT AREN'T YOU MAKING AN EXCUSE FOR YOURSELF? Yes - Paramount to the entire strategy of debridement is the premise that the damage caused is less than the damage the disease would have caused anyway. It is akin to trying to save somebody and then having your rescue technique result in injury or death. Is it then your fault? Did you in fact cause the negative consequences? For a hopeless tooth the answer here would seem to be easy. I didn't do it. The periodontal disease did it. FORTRESSES INSIDE OF FORTRESSES - WHAT IS THE APPARENT REALITY - Once the moral issues about causing damage and various imaginations are resolved the issue becomes what does the situation appear like? Huh? APPARENT REALITY? wtf? - PRESUMED REALITY - VISUALIZED REALITY - This is a strange concept. It is aking to wandering around in a gigantic museum or maze where rooms lead into other rooms and you really do not know what is what. FORTRESSES INSIDE OF FORTRESSES - GET TO THE BOTTOM - FINALLY - The reality is that a person will debride down to a level and then will stop getting blood and debris. And they will imagine they actually got to the bottom. Plus time, energy and trauma will tend to dictate to them to stop, finally. Then after the area heals and the person goes back then lo and behold there is more crud. Lots of it. Where did this crud come from? IS THE DEEPER CALCULUS BRAND NEW OR OLD? -- THE ANSWER IS OLD - The dental profession will tend to claim that fresh caches of calculus somehow managed to create themselves most recently. If somebody says this - DO NOT DISPUTE THEM - YOU WILL JUST BE WASTING YOUR BREATH - What is the realityland? The realityland is that this calculus is old. It somehow managed to infiltrate itself down the side of the tooth and there it is. WHAT IS THE ANSWER? The answer is understood by applying the analogy of digging the hole. The reason why you come to a stop, besides the trauma factors, is because in essence you have reached the borders of a deeper fortress of calculus. So naturally your yield will be close to zero to start. That is why it appears you have reached the bottom when in fact all you really reached was the gates of a deeper fortress. That is the answer. I am quite sure of that. 90% or more. DOES THE DENTAL HYGIENIST HAVE THE SAME PROBLEM OF FORTRESSES INSIDE OF FORTRESSES? I think the answer is yes. That explains why ledges can build up deep and the hygienist hardly even seems to notice them. Likewise why the claim by some that they can get things clean is false. THERE IS NO SUCH THING AS DEFINITIVE DEBRIDEMENT - ALL YOU CAN TAKE OUT IS A PORTION OF THE TOTAL INFECTION - = = = 2-4-8-16-32-64-128-256-512- ETC - The Doubling Process works in two directions. First for the growth of the periodontal colonial empire. Second for the destruction of the empire and its forced and voluntary removal from the dentition.
No
matter how long it takes. |
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