Lec. 6 ‫صادق الصالحي‬.

‫د‬

Dental calculus :

Is a calcified deposit on the teeth and other solid structures in the

oral cavity.
It is either supragingival calculus
when it’s located coronal to the gingival
margin, the visible clinical crown, or
subgingival, when the calculus is present
apical to the gingival margin in the gingival
sulcus or periodontal pocket.

Clinical appearance and distribution of calculus:

Supragingival calculus (Sup.g.c.) is whitish- yellowish deposit,
usually present along the gingival margins of the teeth. However, the
color of which may be changed to brown
due to secondary staining from tobacco
and food pigments.
The distribution of supra.g.c. does
not follow that of supragingival dental
plaque.
The largest amounts are found
near the opening of salivary glands ducts;
so that the calculus is found on the buccal surfaces of the upper molars
near the opening of the parotid gland duct and on the lingual surfaces of
lower anterior teeth near the opening of the ducts of sublingual and
submandibular glands.
Subgingival calculus is
brown to greenish black in color
and it’s located below the crest of
marginal gingiva, detection of
sub.g.c. requires careful
examination with an explorer. It is
usually firmly attached to the tooth
surface. Sup.g.c. and sub.g.c.
generally occur together, but one
may be present without the other.

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 The primary effect of calculus is not due to mechanical irritation
( as was originally thought), but is related to its always being covered
by bacteria and play a major role in maintaining and accentuating
P.D.disease by keeping the plaque in close contact with the gingival
tissue and creating areas where plaque removal is impossible.

Composition of calculus:

Inorganic content:
Sup.g.c. consists of inorganic (70%-90%) and organic components.
The inorganic portion consists of mainly of :

 Calcium phosphate as Ca(PO4)2 (75.9%).

 Calcium carbonate CaCO3 (3.1%).
 Traces of magnesium phosphate Mg3(PO4)2 and other metals.
At least two thirds of the inorganic component is crystalline in
structure. The four main crystal forms and their
percentages are:
1) Hydroxyapatite, approximately 58%.
2) Magnesium whitlockite, approximately
21%.
3) Octacalcium phosphate, approximately
21%.
4) Brushite, approximately 9%.
Generally two or more crystal forms occur
in a calculus sample, with hydroxyapatite and
Octacalcium phosphate being the most common.
Brushite is more common in the mandibular
anterior region and magnesium whitlockite in the posterior areas.

Organic contents:
The organic component of calculus consists of a mixture of
the followings:
 Protein-polysaccharide complexes.
 Desquamated epithelial cells.
 Leukocytes.
 Various types of microorganisms.
2%-9% of organic component is carbohydrate which is derived
mainly from saliva.
Salivary proteins account for about 6% - 8% of the organic
components of calculus .

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 Lipids account for 0.2% of the organic contents of calculus.
Differences between the composition of sub.& sup.g.c.:
The composition of sub.g.c. is similar to that of sup.g.c. with some
differences.
It has the same hydroxyapatite content, more magnesium
whitlockite, and less Brushite and Octacalcium phosphate.
The ratio of Ca. to phosphate is higher Subgingivally and sodium
content increases with the depth of periodontal pocket. Salivary proteins
present in sup.g.c. are not found Subgingivally.

Attachment to the tooth surface:

There are 4 modes of attachment of calculus to the tooth surface:
1) Attachment by means of an organic pellicle which is also
calcified.
2) Penetration of calculus bacteria into cementum (this mode is not
accepted by some investigators).
3) Mechanical locking into surface irregularities, such as resorption
lacunae and caries.
4) Close adaptation of calculus undersurface depressions to the
gently sloping mounds of the cementum surface.

Formation of calculus:
 The soft plaque is hardened by precipitation of mineral salts,
which is usually starts between the first and the 14th day of
plaque formation;

 Calcification has been reported to occur in 4-8 hours. Calcifying

plaques may become 50% mineralized in 2 days and 60% - 90%
mineralized in 12 days.

 Microorganisms are not always essential in calculus formation,

because the calculus occurs in germ-free rodents. Saliva is the
mineral source of sup.g.c., and the gingival fluid provides the
minerals for sub.g.c.

 Calcification entails the binding of calcium ions to the

carbohydrate- protein complexes of the organic matrix and the
precipitation of crystalline calcium phosphate salts.

 Crystals form initially in the intercellular matrix and on the

bacterial surfaces and, finally within the bacteria.

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  Calcification begins along the inner surface of the sup.g.p.
adjacent to the tooth.

Rate of formation and accumulation:

 The starting time and rates of calcification and accumulation of
calculus vary from person to person, in different teeth and at
different times in the same person.

 Persons may be classified as heavy, moderate or slight calculus

former.

 Calculus formation continues until it reaches as a maximum, after

which it may be reduced in amount.

 The time required to reach the maximal level has been reported as
10 weeks, 18 weeks and 6 months.

 The decline from the maximal accumulation may be explained by

the susceptibility of bulky calculus to mechanical wear from food
and from cheeks, lips and tongue.

Theoies of mineralizationof calculus:

There are no general agreement on the factors responsible for the
deposition of inorganic salts in plaque attached to the tooth surface.
Various hypotheses have been emphasized the following;
1. Metabolism and degeneration of plaque bacteria.
2. Loss of carbon dioxide from saliva at the time of its secretion.
3. Epitaxis.

1. Bacterial theory:
The role of bacteria in the formation of calculus may include
microbial metabolic products ,which produce local changes leading to
the deposition of Ca. salts.
Mineralization of plaque starts extracellularly around both g+ve
and g-ve organisms ,it may also start intracellularly.
Filamentous organisms ,diphtheroids,and bacterionema and
veillonella species have the ability to form intracellular apatite

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Crystals – Calculus formation spreads until the matrix and bacteria are
calcified.

2. CO2 theory:
Saliva in the major salivary ducts is secreted at a high CO2
tension , about 54 to 65 mm Hg , whereas the CO2 pressure in
atmospheric air is only about 0.3 mm Hg.
Saliva emerging from the salivary ducts is believed to lose CO2 to
the atmosphere as a result of this large difference in CO2 tension , the
pH in saliva will increase when CO2 escapes , the concentration of
less soluble secondary and tertiary phosphate ions increases .
This increase in phosphate ions presumably leads to a situation in
which the solubility product of calcium phosphate is exceeded and
crystals form.

3. Epitaxis theory:
Seeding agents induce small foci of calcification that enlarge and
coalesce to form a calcified mass .This concept has been referred to as
the epilactic concept.The seeding agents in calculus formation are
unknown, but it is suspected that intercellular matrix of plaque plays
an active role.
The carbohydrate-protein complexes may initiate calcification by
removing calcium from the saliva (chelation) and binding with it to
form nuclei that induce subsequent deposition of minerals.
Plaque bacteria have also been implicated as possible seeding
agents.