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KMCT DENTAL COLLEGE


MANASSERY P.O, MUKKAM

DEPARTMENT OF PERIODONTICS

SEMINAR ON
CALCULUS

SUBMITTED BY

PRIYADERSINI.Y.R

REG NO: 110020568

FINAL YEAR,PART I

1
CERTIFICATE

This is to certify that £R.N_aofR5LN_1 :J - -:-----------Reg No:-J LQ.Q


_ Q_ - - -------
has satisfactorily completed the seminar in Department of PERIODONTICS for the fourth year
part I BOS course during the year 2015-2016.

· Date: Q , I / Ji,

Lecturer in charge: ,,.


W

External Examiner:
..Mudef\f'et-1_,pa,m.ent
...r- ..-----·- -·-

o r,l>ewt,..of Periodontics
K M, M C-T,,Oental collegi, C Hl5t..

2
INDEX

SL.NO: CONTENTS PAGE NO:

I CONTENTS 3
2 INDRODUCTION ",
3 SUPRA GINGIVAL CALCULUS
4 SUBGINGIV AL CALCULUS 5
5 COMPOSTION 5
6 PRINCIPLE INORGANIC CONTENTS G·
7 ORGANIC CONTENTS 7
8 FORMATION 1
9 THEORIES OF MINERALISA TOIN : : \O
10 MECHANISM \o
11 PREDISPOSING FACTORS \I
12 REFERENCE \ (.

3
INTRODUCTION

, Calculus consist of mineralized bacterial plaque that forms on the surfaces of natural teeth and
dental prostheses

,. It is classified into supra gingival and sub gingival according to its relation to the gingival margins

SUPRA GINGIVAL CALCULUS

, lt is located coronal to the gingival margin and there for it is visible in the oral cavity

► It is usually white or whitish yellow in color hard with clay like consistency and easily detached
from the tooth surface

► After removal it may rapidly recur especially in the lingual area of the mandibular incisors
; The color is influenced by substances like tobacco and food pigments

, It may localize on a single tooth or group of teeth or it may generalized through out the mouth

,.. Two most important locations for supra gingival calculus to develop are buccal surfaces of the
maxillary molars and the lingual surfaces of mandibular anterior teeth

, Saliva from the parotid gland flows over the facial surfaces of upper molars through stensen's
duct

, Orifices of wharton's duct and bartholin's duct empty onto the lingual surfaces of the lower
incisors from the submaxillary and sublingual glands

, Calculus may form a bridge like structure over the interdental papilla of the adjacent teeth or cover
the occlusal surface of teeth

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SUPRA GINGIV AL CALCULUS

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SUBGINGIV AL CALCULUS

► Located below the crest of the marginal gingiva and is therefore not visible for the routine clinical
examination

► It is typically hard and dense and frequently appears dark brown or greenish black while being
firmly attached to the tooth surface

► It usually extends nearly to the base of the periodontal pockets in chronic periodontitis but does not
reach the junctional epithelium

► When the gingival tissue recede subgingival calculus become exposed and is there for reclassified
as supra gingival

► Supra gingival calculus can be composed of both supra gingival and previous subgingival calculus
► A reduction in gingival inflammation and probing depth and gain in clinical attachment can be
observed after the removal of subgingival plaque and calculus

COMPIOSITION

, INORGANIC CONTENTS

► 75.9% calcium phosphate


I

l ► 3.1% calcium carbonate
l ► Magnesium phosphate and other metals in trace amount
l s
[
PRINCIPAL INORGANIC CONTENTS

► Calcium 39%
► Phosphorous 19%
► Carbon dioxide 1.9%
► Magnesium .8%
► Trace amounts of sodium ,zinc,strontium,bromine,copper,manganese ,tungstone, gold,
aluminium,silicon,iron,flourine

MAIN CRYSTAL FORMS AND THEIR PERCENTAGES

► Hydroxyapatite 58%
► Magnesium whitlockite 21%
, Octacalcium phosphate 12%

► Brushite 9%

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ORGANIC CONTENTS

, Consists of mixture of protein polysaccharide complexes ,desquamated epithelial cells leukosits


various types of micro organisms

► Salivary proteins5 .9% - 8.2% of the organic component of the calculus and includes most amino
acids

► Lipids account for .2% in the fonn of neutral fats ,free fatty acids, cholesterol esters,cholesterol
and phospholipids

► Subgingival calculus has the same hydroxyapatite content, more magnesium whitlockitc and less
brushite and less octacalcium phosphate than supragingival calculus .

► The ratio of calcium to phosphate is higher sub gingivaly and sodium content incraeses with the
depth of the periodontal pockets

► Salivary proteins present in supra gingival calculus are not found in sub gingival calculus
TYPES OF ATTACHMENT

► Attachment by means of a organic pellicle on enamel


► Mechanical locking in to surface irregularities such as resorption lacunae
, Close adaptation of calculus under surface depressions to the gently sloping mounds of the
unaltered cementum surface

► Penetration of the calculus bacteria in to cementum

l
l 7
lL,
SCALING A ND ROOT PLA ·N1 G

' Calculus embedded deeply in the cementum may appear m rph Q}gically sin ilar t ccrn'-'ll un ;;inti.
thus has been termed cakulocementum

FORMATION

, Calculus is dental plaque that has undergone mineralization

, Soft plaque is hardent by the precipitation of mineml salts which usu:illy tans bet\\'- th' fin-t
and fourteenth days of plaque formation

, Calcification has been reported to occur \\ithin -t to 8-hours

, Calcifying plaques may become 50%mineralised in two daYS and 60 - 9(P min 1li in,g. in 12
days

, All plaques does not necessarily undergo calcification

, Early plaque contains small amount of inorganic material '' hich increase as the plaqu \.k, ·d )J in

to calculus

, Plaque that does not develop in to calculus reaches a plateau of maximal mincml C\'tlretlt within

two days

, Saliva is a source of mineralization of supm gingi\'al calculus

► Gingival crevicular tluid furnishes the minerals for sub gingival cakulus
► Calcification entails the binding of calcium ions to the carbohydrnk pn.)tcin ,1.., mpl 'xcs '-'f th..:-
organic matrix and the precipitation of crystalline calcium phosphak s llts

8
II
L
,, crystals fom1 initia lly in th e intercdlular matrix and 011 the bacterial surfaces and finally within
. the bactcri a

,,. Calcification begins along the inner surfaces of the supra gingival plaque and 111 the attached
component of the sub gingival plaque adjacent to the tooth surface

, Time required to reach the maximal level has been reported as IO weeks and six months

,, Decline from maximal calculus accumulation referred to as reversal phenomenon

► Separate foci of calcification increases in size and coalesce to form solid masses of calculus
► As calcification progress the number of filamentous bacteria increase
;, The foci of calcification change from basophilic to eosinophilic

► Calculus is fonned in layers


;, Calculus accumulation vary from person to person ,for different teeth,and at different times in the
same person

, On the basis of these differences person may be classified as heavy ,moderate ,or slight calculus
fonners or non calculus formers

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TJIEORIES OF MINERALISATION

,, Mineral precipitation results from a loca1. nse. 111 the degree of saturation of calcium and phosphate

ions.

MECHANISM
, An. .i ncr.ease in the ph of saliva causes Prec·1·p1ta·t10n of ca.lcium phosphate salts by lowering the

prec1p1tat1on constant

, The ph may be elevated by the loss 0 f carbon d1.0·x1de and the formation of ammonia by dental
plaque bacteria or by protein degradation by stagnation. ·

► Colloidal proteinsm saliva bind calcium and phosphate 10ns and maintain a supersaturated

solution with respect to calcium phosphate salts

► With stagnation of saliva colloid settle out and super saturated state is no longerma in ta in e d

leading to precipitation of calcium phosphate salts

; Seeding agents induce small foci of calcification that enlargec,o a lesce to forma calcified mass

', • This concept has been referred to as epitactic concept/heterogenous nucleation

; Phosphatase liberated from dental plaque, desquamated epithelial cells or bacteria precipitates
calcium phosphate by hydrolyzing organic phosphates in saliva thus increasing the concentration

of free phosphate ions


Esterase another enzyme initiate calcification by hydrolyzing fatty esters into free fatty acids

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fa tt Y acids fonn soaps w ith calcium and magnesiu m that arc later con verte d in to the lses soluble
r
calcium phosphate salts
.
ROLE OF MICROBES

► M in eral ization of plaque starts extracellularly around both Gram positive and negative organisms

,. Filamentous orgamsm, diphtheroids,bacterio nema ,veillonella species has the ability to form
intracellular apatite crystals

► Calculus fonnation continues until the matrix and bacteria are calcified
ETIOLOGICAL SIGNIFICANS

► Although the bacterial plaque that coat the teeth is the ain etiological factor in the development
of periodontal disease the removal of sub gingival plaque and the calculus constitutes the comer
stone of periodontal therapy

MATERIA ALBA

► It is a concentration of micro organism, cell debris, leucocytes and a mixture of salivary proteins
and lipids with few or no food particles

OTHER PREDISPOSING FACTORS

IATROGENIC FACTORS

► Deficiencies in the quality of dental restorations or prosthesis are contributing factors to gingival
inflammation and periodontal destruction

► Inadequate dental procedures that contribute to the deterioration of the periodontal tissues are
referred to as iatrogenic factors

► Characteristics of dental restorations or prosthesis and removable partial dentures that are
important to the maintenance of periodontal health include
'.,
' . The location of gingival margin for the restoration

► The space between the margin of the restoration and the unprepared tooth
► ·Contour of restorations
' Occlusion
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. ,, rvtat rials used in the restoration

, · ' Restorati\'e procedures

,, Design of the removable partial denture

RADIAnoN THERAPY

, Periodontal attachment loss and tooth loss where greater on the radiated side in cancer patients
treated with high doss unilateral radiation

t 1nia which occurs aft .d ·


, ,X
. eros 0 er ra tahon therapy results in greater plaque accumulation

TOBACCO

• Smokers have greater attachment loss and bone loss ,an increased no of deep pockets and an
increased amount of calculus fonnation

• Smokers demonstrate varied levels of plaque and inflammation with a tendency towards
decreased inflammation

• Smokers were more likely to be infected with A.actinomycetumcomitans,po rphyromonas


gingivalis ,bacteroides forsythus than non smokers

COMPLICATIONS ASSOCIATED WITH ORTHODONTIC THERAPY

• Orthodontic therapy may affect the periodontium by favoring plaque retention by directly
injuring the gingiva as a result of over extended bands and by creating excessive forces on the
tooth and the supporting structures

• Orthodontic appliance not only tend to retain bacterial plaque and food debris ,resulting m
gingivitis but also are capable of modifying gingival ecosystem

• An increase in prevotella melaninogenica ,prevotella intennedia and actinomyces odontolyticus


and a decrease in the proportion of facultative microorganism

• Orthodontic bands should not be forcefully placed beyond the level of attachment because it will
detach the gingiva from the tooth and result in apical proliferation of the junctional epithelium with
an increased incidents of gingival inflammation

• Excessive force will result in necrosis of periodontal ligament

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cAL IRRITATION
- c\-\Etvf1
• In. d,sc·r1111inatc use of strong mouth waslle·s ,t op1· caI app-11cat·ion of co1Tos1. vc drugs such as asp·m·n
.coca1·11e •'-U1d accidental contact with cl1·ug-s sueh as pI1enol or s·ilver n·itrates are common examples
of chetnicals that cause irritation of the gingiva

rooTH BRUSH TRAUMA,TRAUMA ASSOCIATED WITH ORAL JEWELRY

• Incidence of lingual recession with pocket fonnation and radiographic evidence of bone loss
common with this
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B ITS AND SELF INFLITED INJURIES
t HA - -
I
• Improper use of tooth brush ,wedging of tooth picks between the teeth ,application of finger nail
pressure against the gingiva

. MALOCCLUSION also leads to plaque accumulation

t RESTORATIVE MATERIALS
l • The composition of plaque formed on all types of restorative material is similar with exception of
l that fanned on silicate
I
• Under surface of pontics in fixed bridges _should barely touch the mucosa.acces for oral hygiene is
impaired by excessive pontic to tissue contact.there by contributing to plaque accumulation
\
\ DESIGN OF REMOVABLE PARTIAL DENTURES

t • Partial dentures favor the accumulation of plaque


!i • Particularly if they cover the gingival tissue.partial dentures that are worn during both night and

day induce more plaque fonnation than those worn only during tehday

i l CONTOURS AND OPEN CONTACTS


- • Over contoured crowns and restorations tend to accumulate plaque and possibly prevent self
l
i
f
cleaning mechanism of adjacent cheek,lipsa nd tongue
l
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'l

13
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TICALCULUS AGENTS
Materials used :
a. Pyrophosphates
b. Zinc citrate
c. Zinc chloride
d. Gantrez acid (a copolymer of methyl vinyl ether and maleic anhydride)

Functions :
Anti calculus agents are mostly designed to inhibit the mineralization of
plaque. They are also known as crystal growth inhibitors.

• Pyrophosphates
In tooth paste and dental floss ,tetra sodium pyrophosphate act as
a tartar control agent ,serving to remove calcium and magnesium from saliva and thus
preventing them from being deposited on teeth. It is used in commercial dental rinses
before brushing to aid in plaque reduction
• Zinc citrate
Mineralization of plaque leads to tartar formation- . Zinc citrate helps
prevent tartar formation by preventing plaque from hardening. It
prevents bacterial accumulation on mouth
--

CONCLUSION
While the bacte al plaque that coats the teeth is the main etiologic factor in the development
0 f eriodontal disease, the removal of subgingival plaque and calculus constitute the comer
st :e of periodontal therapy. Calculus plays an important role in maintaining and
aoccentutain g pe·nod onta1 d"isease b Y k eep·mg plaque in close contact with the gin. giva1 . tissue
d creating areas where plaque removal is impossible. Therefore the clinician must not only
panossess the clinica.l sk.ill tobremove the calculus and other irritants that attach to the teeth but
also be very conscientious a out performing this task.
/

REFERENCE

cARJlANZA'S CLINICAL PERIOOONTOLOGY


-10TH edition

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