• Aside from this, the rough surface of dental calculus is

• usually covered with a layer of plaque biofilm. Αs such,

• calculus tends to "present" plaque to periodontal soft tissues
• and interfere vvith efforts to improve plaque control. The physical
• removal of dental calculus remains a critical component
• of mechanical periodontal inflammatory disease control.
• What Are the Risk Factors for Periodontal
• Diseases? What ls Meant by "Risk"?
• The expression risk in this context means that, in the presence
• of a given factor, injury to or loss of periodontal tissue is
• a possibility. Risk factors may be local or systemic in nature.
• Local contributing factors to the etiology of periodontal
• diseases fall into two general categories: Anatomic or iatrogenic.
• They share in common their ability to either facilitate
• bacterial plaque, and therefore calculus, accumuΙation/retention
• or their ability to interfere with plaque/calculus removal.
• Τhe loca| anatomic risk factors include:
• 1. Furcation anatomy. ln many instances, the entrance
• of bifurcations or trifurcations is restricted enough to
• limit access for mechanical root instrumentation.
• once access to the intrafurcaΙ space has been
• achieved, concavities in the furcal aspects of molar
• roots wiΙl limit instrumentation as well (see Figure 7).
• 2. lntermediate bifurcation ridges extending from the
• mesial furcation surfaοe of the distal root across the
• roof of the bifurcation to the distal sudace of the
• mesial root of mandibular molars. Τhese common
• anatomic deformities interfere with a patient's ability
• to effeοtively remove plaque biofilm.
• 3. Cervical enamel projections (CEP). CEPs are tooth
• developmental deformities of the CEJ found on
• molars. They are classified according to their involvement
• in tooth furcations. Α Grade l CEP presents with
• minimal projection of enamel tov/ard the entrance of
• the furcation. Α Grade ll οEP approximates the
• entrance of the furcation, and the tip of a Grade lll
• CEP is well within the furcation (see Figure 8).
• FlGURΕ 7. A maxiΙlary moΙar displaying a buccal to distal furcation invasion
• with a Nabers probe in place. The narrowness of the furcation entrances
• and the tortuousness of the furcation invasion mitigate against access for
• scaling and root planing. (Courtesy of Dr. Jeanne Salcetti)
• F|GURE 8. A human dried maxilla with a grade ll cervical enamel proiΘction
• (cEP) in the buccal furcation of the maxilΙary sΘcond molar. τhe cEP
• could have been partially responsible tor the furcation invasion and localized
• severe bone loss around the tooth.
• 4. Palato-gingival grooves (PGG). PGGs are tooth
• develοpmenta| deformities of maxilΙary central and
• lateral incisors. They begin in lingual piis and extend
• vertically onto root suιJaces. PGGs could, on rare
• occasions, extend to the root apex. PGGs are
• commonly associated with increased gingival inflammation,
• plaque aοcumulaiion, and probing depth (see
• Figure 9).
• CHAPτER 3
• FlGURE 9. A palatogingival groove on a maxillary lateral incisor. τhe gfoove
• couΙd have been partially responsible for the sΘvere attachment loss
• around the tοoth. Note that because of its loss of support, the lateral
• incisοr has undergone pathologic migration.
• 5. Open contacts and food impaction. Open contacts
• between teeth may be anatomical in origin, iatrogenic
• in origin, or be due to caries and pathologic migration
• of periodontally involved teeth. Food impaction is
• defined as the forceful wedging of food between
• teeth. Any other accumulation of food or food debris
• around teeth should be categorized as food retention
• and is probably less threatening to the periodontium.
• Food impaction and subsequent retention may
• contribute to root caries in individuals who do not
• perform proper oral hygiene interdentalΙy. open
• contacts by themselves probably do not contribute to
• periodontal pathology, but, in the presence of food
• impaction, open contacts have been associated with
• periodontal destruction. This may be particularly
• noticeable in periodontitis cases where the progress
• of disease is in its early stages or particularly obvious
• where periodontitis is isolated to sites of open
• contacts/food impaction.
• F|GURE 10. surgical exposure of an anomalous maxillary first moΙar. The
• palatal root is bifurcated and the distopalatal root curues into the mesial
• furcation of the second molar. on the bucca| aspect, the mesiobuccaΙ
• root of the second molar is in close approximation to the distobuccal root
• of the first molar. Access for effective scaling and root planing is
• extremely limited.
• 6. Other anatomic risk factors of potential etiologic
• importance are: The width of the space between
• teeth and root proximity (so-called "kissing roots").
• The iatrogenic risk factors are:
• 1. Overhanging dental restorations. Since dental
• restorations remain the mainstay of dental practice, it
• is not surprising that overhanging dental restorations
• are arguably the most common form of iatrogeny to
• affect marginaΙ periodontal health (see Figure 11).
• Overhanging and improperly placed dental restorations
• can be physicaΙly irritating' be pΙaque retentive,
• foster the growth of periodontal pathogens, alter the
• morphology of the interdental space, and violate the
• dentogingival junction (see 2 below). By virtue of their
• roughness and overall bulk, they may also interfere
• \ivith interdentaι plaque control.
• FI GURE
White spot lesions accumulates higher
concentration of Fluoride than sound enamel.

2
furcation invasion and localized
severe bone loss around the tooth.
4. Palato-gingival grooves (PGG). PGGs are
tooth
develοpmenta| deformities of maxilΙary central
and
lateral incisors. They begin in lingual piis and
extend
vertically onto root suιJaces. PGGs could, on
rare
occasions, extend to the root apex. PGGs are
commonly associated with increased gingival
inflammation,
plaque aοcumulaiion, and probing depth (see
Figure 9).
CHAPτER 3
FlGURE 9. A palatogingival groove on a
maxillary lateral incisor. τhe gfoove
couΙd have been partially responsible for the
sΘvere attachment loss
around the tοoth. Note that because of its loss
of support, the lateral
incisοr has undergone pathologic migration.
5. Open contacts and food impaction. Open
contacts
furcation invasion and localized
severe bone loss around the tooth.
4. Palato-gingival grooves (PGG). PGGs are
tooth
develοpmenta| deformities of maxilΙary central
and
lateral incisors. They begin in lingual piis and
extend
vertically onto root suιJaces. PGGs could, on
rare
occasions, extend to the root apex. PGGs are
commonly associated with increased gingival
inflammation,
plaque aοcumulaiion, and probing depth (see
Figure 9).
CHAPτER 3
FlGURE 9. A palatogingival groove on a
maxillary lateral incisor. τhe gfoove
couΙd have been partially responsible for the
sΘvere attachment loss
around the tοoth. Note that because of its loss
of support, the lateral
incisοr has undergone pathologic migration.
5. Open contacts and food impaction. Open
contacts
calculus (>6
months), the major crystalline structure is
hydroxyapatite
(Ca16[PO4]6(OH)r) with lesser amounts of
octacalcium phosphate
(Cas[HPOa]a), whitlockite (Ca3[POo]r), and
brushite
(Ca[HPOo]2HrO). ln younger deposits (<3
months), brushite
predominates, but with progressive aging,
octacalcium phosphate,
whitlockite, and finally hydroxyapatite become
more
abundant.
FlGURE 4. A heavy deposit of suρragingival,
salivary calculus on the buccal
and occlusal surfaces of nonfunctional
maxillary premolar and molar
teeth.
Calculus deposits have also been desοribed as
radiographically
apparent. The radiographiο detection of
calculus is positively
influenced by the thickness of the deposit, the
amount
calculus (>6
months), the major crystalline structure is
hydroxyapatite
(Ca16[PO4]6(OH)r) with lesser amounts of
octacalcium phosphate
(Cas[HPOa]a), whitlockite (Ca3[POo]r), and
brushite
(Ca[HPOo]2HrO). ln younger deposits (<3
months), brushite
predominates, but with progressive aging,
octacalcium phosphate,
whitlockite, and finally hydroxyapatite become
more
abundant.
FlGURE 4. A heavy deposit of suρragingival,
salivary calculus on the buccal
and occlusal surfaces of nonfunctional
maxillary premolar and molar
teeth.
Calculus deposits have also been desοribed as
radiographically
apparent. The radiographiο detection of
calculus is positively
influenced by the thickness of the deposit, the
amount
calculus (>6
months), the major crystalline structure is
hydroxyapatite
(Ca16[PO4]6(OH)r) with lesser amounts of
octacalcium phosphate
(Cas[HPOa]a), whitlockite (Ca3[POo]r), and
brushite
(Ca[HPOo]2HrO). ln younger deposits (<3
months), brushite
predominates, but with progressive aging,
octacalcium phosphate,
whitlockite, and finally hydroxyapatite become
more
abundant.
FlGURE 4. A heavy deposit of suρragingival,
salivary calculus on the buccal
and occlusal surfaces of nonfunctional
maxillary premolar and molar
teeth.
Calculus deposits have also been desοribed as
radiographically
apparent. The radiographiο detection of
calculus is positively
influenced by the thickness of the deposit, the
amount
MECHANISM OF ACTION OF FLUORIDES

• Reaction with enamel : less dissolution

• Effect on bacterial metabolism and plaque

• Reducing the tendency of enamel surface to

absorb proteins

• Ateration of the tooth morphology

8
 Void theory
• Kay, Young and Posner1964
• At concentration < 100ppm
• Fluorhydroxyapatite or fluorapatite formation
takes place
• This replacement takes place by Void theory

9
• Calcium triangle
• H of the OH ion,
face each other
• Insufficient
room
• OH missing-
void
• Fluoride ion
enters this void
10