Dental Calculus

 Formed when minerals deposit in organic framework

 Abnormal stone formed in body tissues by an accumulation of mineral salts.

A. Mineralized plaque (hardened)

 hard, tenacious mass that forms on crowns and roots of teeth.
B. Classification
 Supragingival -- must come from saliva. Above the gumline
 Subgingival -- if tissues are inflamed, gums bleed.
 Exudate (pus) Gingival sulcus fluid provides minerals for this formation. Below the gumline.
C. Occurrence
 Can occur at any age. Increases with age. Kids do get it but it occurs more in older mouths. Harder.
D. Composition
 Inorganic -- Calcium phosphate, magnesium phosphate, calcium carbonate. Trace elements of:
 sodium, copper, chlorine, zinc, fluorine, iron, strontium.
 2/3 is crystalline in structure. Makes up 75-85%.
 comes from saliva
E. Formation time
 varies accoring to individuals
 average soft forms to hard is 12 days
o reason why it varies
1. Chemical formation of person's body
2. oral hygiene
3. Diet
4. Smoking -- indirectly

Structure of Calculus
 Formed in layers
1. pellicle
2. plaque
3. calculus
a. outer layer less dense than inner layer
b. related to inner lining of gingiva.

Supragingival
 lingual surface -- most cervical part of tooth
o cervical third
o whole surface
o bridge of calculus

Most common areas are buccals of maxillary molars and mandibular lingual anteriors due to salivary glands.

Subgingival
 finger-like projection -- pretty broad but flat
 spicules - off mesial and distal surfaces
 ledge or ring around circumference of entire tooth.

burnished calculus -- partially removed calculus

* harder to find and remove
* causes inflammation
* best indicator is the condition of the tissue
* Always check previously scaled areas.
II. See p. 274 in Wilkens Table 17-2

III. Calculus detection

Visual -- if large enough. Big deposits can be seen easily. Dry tooth with air (dehydrates area), makes more
visible. Deflect tissue with little spurts of air to see into calculus.
Tactile Sensitivity - using the explorer. (Best one to use; feels rough, bumpy, hard, grainy)
Radiographic: must be dense to see
If don't see, doesn't mean that calculus isn't there.

IV. Mode of attachment to tooth surface

By means of the pellicle→very superficial attachment→very easy to remove

Minute irregularities to the surface of the tooth→very difficult to remove→might remove some cementum
Direct contact between the matrix of the calculus and the matrix of the tooth→very difficult to remove

V. Relationship of calculus to plaque and periodontal pocket formation

 Calculus is mineralized plaque
 Plaque forms on top of a layer of plaque of calculus
 Plaque bacteria and toxins they produce cause inflammation which causes periodontal pocket formation
 Pocket comes first, then calculus
 Calculus is a rough surface and attracts more plaque.
 Traps and holds bacteria to the tooth.
 Acts as a reservoir for plaque and microbes
 Calculus does not cause disease, toxic biproducts of plaque bacteria do.
 Looks unsightly and can't perform good oral hygiene procedures

IV. Controlling calculus formation

Has a definite role in disease process
Antimicrobial rinses
Good oral hygiene (brushing and flossing)
**Interdental brush
**Stimulants
**Waterpik
**Rubber tip
Nutritional counseling
Frequent visits to the dentist
Tartar control toothpaste, chemical interferes with the mineralization process -- Calcium phosphate. Can reduce
above the gumline
Soft scale -- breaks bond between tooth and calculus. Soft gel