Your role in recognizing
and healing supervised
neglect related to
BY TAMI WANLESS, RDH, MED
you examine your patient to determine if burnished deposits are present.
Before you pick up a scaler:
1. Carefully view the color and consistency
of the gingival tissues, paying close attention
to interproximal areas and line angles (where
the tooth curves and you need to pivot on your
fulcrum while rolling your instrument to adapt).
Look for red or blue shades as well as swelling.
The body’s first line of defense from any foreign
object is to send in the white blood cells to
cause tissue to become angry red and
2. Use a generous amount of air and blow
toward the cervical tissue at a 45-degree angle.
Allow the tissue to distend while you view the
sulcus. Many times, I have noticed undetected
burnished deposits when I’m using the air
polishing unit. Try polishing prior to scaling
Dictionary: Edition 2, 2007).
A diligent clinician would never deliberately
leave calculus, let alone burnished calculus.
But what if you learned today that you were
leaving deposits, contributing to chronic gingival disease? Are you unintentionally practicing supervised neglect? Whether you’re a new
graduate or a seasoned professional, there are
things you need to know to start making positive changes in your next patient.
WHAT IS BURNISHED
When describing calculus attachment to my
patients, I like to use the analogy that the
calculus attaches to the tooth like a barnacle
attaches to a boat. Barnacles produce cement
that is released through the tips of their antennules to attach themselves (Grunbaum,
2010). Calculus attaches by mechanically interlocking to the crystals of the tooth, using
the acquired pellicle (Roberts-Harry EA, 2000
; 28). Burnished calculus is a subgingival deposit that has had its outermost layer shaved
off—but not fully removed—so that the surface
is smooth yet still attached to the tooth surface, contributing to disease (Pattison, 2011).
When clinicians do not recognize or remove
burnished calculus, they are practicing super-
vised neglect. One wouldn’t “plane away” a
barnacle off a boat, nor
should you “shave
away” calculus from a
tooth; in either scenario,
you will leave the source of
These areas of burnished deposits will contribute to persistent gingival
inflammation and bleeding, in addition to
providing a constant food source for more
bacteria. This vicious cycle will continue until
you completely remove all calculus. We set our
patients up for failure when, every six months,
we tell them to brush and floss to reduce recurrent bleeding while we leave burnished
Recognizing burnished calculus can be
challenging, even for the skilled clinician. Isolated areas of tissue color change, slight inflammation, or bleeding upon probing in a
patient who effectively brushes and flosses
regularly may be signs of areas where burnished
calculus is present. These areas will not heal
until the irritant is removed. Change the way
Photo courtesy of
Charles M. Cobb,
DDS, MS, PhD