Dental calculus &

Local Contributing Factors

Dr Saadou sami khalaf

Msc periodontology at
University of Khartoum
German Board of Oral Implantology
(GBOI)
 Dental Plaque
• Dental Plaque is an adherent intercellular matrix
consisting primarily of proliferating microorganisms,
along with a scattering of epithelial cells, leukocytes
and macrophages
TYPES OF DENTAL PLAQUE

• Based on its relationship to the gingival

margin, plaque is differentiated into
two categories,

• supragingival plaque
• subgingival plaque
•calculus
•It is an adherent calcified or calcifying mass
that forms on the surface of natural teeth and
dental appliances by mineralization of dental
plaque.
•It covered by vital ,tightly adherent
nonmineralized plaque
 calculus

Supragingival Subgingival
 Supragingival c. Subgingival c.
Location Coronal to the gingival margin. Below the crest of the marginal
gingiva.
Visibilit Visible in the oral cavity. Not visible.

y Color White or whitish yellow Dense, dark brown or greenish

Its color is affected by contact with black.
tobacco or food pigments.

Consisten Hard, clay like. Hard, flint like.

cy
It is easily detached from the tooth Firmly attached to the tooth
Attachme surface. Recur rapidly after removal surface
nt especially in lingual area of mandibular
incisors.

Occurs most frequently on buccal Either appears indepently or on

surfaces of maxillary molars opposite
Site (Stensen’s duct) and on lingual surface of
mandibular anterior teeth opposite to
(Wharton’s duct).
From saliva, so it is called (salivary
calculus).
Source of
areas where supragingival
calculus already presented.
From the blood serum or
gingival fluid, so it is called
(serumal calculus ).
• Supragingival calculus and subgingival calculus
may be seen on radiograph but detection of
them is low.
• Well calcified supragingival calculus is
detectable forming irregular contours on
the radiographic crown.
• Both supragingival and subgingival calculus are
easily detectable interproximally .They form
irregular shaped projections into the interdental
space.
Radiographic picture of calculus
 Supragingival calculus

Inorganic content organic content

70-90%
inorganic components(70-90%)
Calcium 39%
Phosphorus 19%
Carbon dioxide 1.9%
Magnesium 0.8%

Traces of sodium, zinc, bromine, copper ,iron

fluorine, strontium,tungesten, gold, aluminum,
and silicon .
2/3 of the inorganic content are crystalline in
structure
Crystal forms:
Hydroxyapatite 58%
Magnesium whitlockite 21%( in the posterior
area) Octacalcium phosphate
12%
Brushite 9% (in the mandibular anterior region)
The organic content
•Mixture of protein-polysaccharide complexes
desquamated epithelial cells, leukocytes and
various types of microorganisms.

•Salivary proteins account for 5.9%-8.2%of the

organic component of calculus and include most
amino acids.

•Lipids account for 0.2% in the form of neutral fats,

free fatty acids, cholesterol, cholesterol esters, and
phospholipids.
• Same hydroxyapatite content
• More magnesium whitlockite
• Less brushite and octacalcium phosphate.
• Higher ratio of calcium to phosphate.
• More sodium.
• No salivary proteins.
Five modes of attachment of calculus
to the tooth surface:

(1)Organic acquired pellicle:

This binds strongly to the tooth
surface and acts as adherent layer
for developing plaque and
calculus.
Pellicle attaches supragingival
calculus to enamel surface and
subgingival calculus to cementum
surface.

C
a
(2)Mechanical locking:
Into surface irregularities such as
{caries and resorped lacunae}.

(3) Close adaptation:

Of calculus under surface
depressions to sloping mounds of
cementum surface {cemental
defects}.
C
a
l
c
u
l
Under surface of u
calculus s
cementum
mounds in a
calculus t
(4)Penetration:
Of calculus bacteria into cementum
and dentin.

Calculus
embedded
within the

cementum Calculus embedded

beneath cementum
and penetrating to
the dentin
N.B:
Calculocementum :
Is calculus embedded deeply in
cementum and appears
morphologically similar to
cementum.
It differs:

*From Person to person.

* In different teeth.
* At different times in the same person.

Persons are classified as:

Calculus formers. Non calculus

formers.

Heavy Moderate Slight

• The rate of plaque and calculus accumulation depends
on many factors such as:
• Softness and stickiness of food: Enhances microbial growth as it
prolongs nutrient availability.

•Sucrose content of food: Enhances the growth of mutans type

streptococci that produce a sticky glucan matrix using
glucosyltransferase enzyme.

• Calcium content of food and saliva enhances the

mineralization of
plaque into calculus.

•Alkalinity of foods and saliva enhances the mineralization of plaque

into calculus.
• Salivary flow enhances calculus formation by supplying additional
calcium ions.

• Soft tissue movement and occlusion prevent plaque accumulation.

•Frequency and effectiveness of oral hygiene methods that remove

plaque.

•Frequency and effectiveness of professional tooth cleaning that

removes surface deposits.

•Local anatomic and restorative factors such as malpositioned teeth,

root concavities, enamel defects, bulky restorations, and orthodontic
appliances create niches for plaque growth.
• Calculus is nothing but dental plaque that
has undergone mineralization .
• Calculus is formed by the precipitation of
mineral salts which can starts between 1st
and 14th day of plaque formation
• Plaque undergoes mineralization in 4-8
hours.
• 50% of plaque is mineralized in 2 days
• 60-90% of plaque is mineralized in12
days
• Calcification starts as a separate foci on
the inner surface of the plaque .

• These foci of mineralization gradually

increase in size and coalesce to form a
solid mass of calculus
• Before 1960 the belief was that calculus
was the principle etiologic factor in
periodontal disease

• The current view is that the initial damage

to gingival margin in periodontal disease is
due to the pathogenic effects of
microorganisms in plaque
• However the effect could be more
pronounced by calculus accumulation
because it further provides retention for
more plaque organisms
• So calculus can :

1. Bring the bacterial deposits more closely to

the supporting structure
2. Interfere with the local self cleansing defene
mechanims
3. Make it difficult to the patient to perform
proper oral hygiene methods
4. It acts as a physical barrier between gingiva
and tooth surface so prevents gingival
repair or healing
Local Contributing Etiological
Factors
• factors that contribute to periodontal
diseases but are not themselves etiologic
factors.

• These factors tend to accelerate the

progression of disease ,often in a localized
area, and sometimes in a dentition
minimally affected by periodontitis.
• For the clinician, the most important step is to
recognize the presence of a contributing
factor and to understand its effect on
diagnosis, prognosis, and treatment.

• the presence of a contributing factor that is

difficult or impossible to modify may cause
the prognosis of a tooth to be downgraded or
may change the treatment recommendation
from periodontal surgery to extraction
• To provide the best possible treatment for
patients, it is important that all factors
affecting the outcome of treatment be
recognized and appropriately considered
in formulating a treatment plan.
 Local Contributing Factors
• ANATOMIC CONTRIBUTING FACTORS

• RESTORATIVE CONTRIBUTING
FACTORS
• ANATOMIC CONTRIBUTING FACTORS

• Proximal Contact Relation

• Cervical Enamel Projections and Enamel Pearls
• Root Anatomy
Palatogingival groove

Root trunk length

Cemental Tears

Accessory Canals

cervical root resorption

 Proximal Contact Relation
• Open interproximal contacts or uneven
marginal ridge relations are factors that may
predispose to food impaction.
• Food impaction is defined as the forceful
wedging of food into the interproximal space by
occlusal forces.
• It can lead to inflammation, bone loss,
and attachment loss.
• Interproximal areas with wide open
contacts that are easily cleansable may be
as healthy as those with a proper contact
relation.
• Loose contacts, in contrast, are most likely
to result in food impaction
• Food impaction can be prevented by
establishing proper contact and marginal
ridge relations when interproximal areas
require a restoration.

• If open contacts and uneven marginal

ridges are widespread in the mouth,
orthodontic therapy may be considered
• When the papilla is absent pressure from
the tongue and facial soft tissues direct
food into these spaces It is called
lateral food impaction rather than
forceful wedging
 Cervical Enamel Projections and Enamel Pearls
• Cervical enamel projections (CEPs) occur primarily on
molars where amelogenesis has failed to stop before
root formation.

• They appear as narrow wedge-shaped extensions of

enamel pointing from the cementoenamel junction
(CEJ) toward the furcation area

• These projections occur most frequently on

mandibular molars, approximately 30% of the time,
and are found on maxillary molars with about half that
frequency.
• Enamel pearls are most common in the furcation
region, particularly on third molars.

• They range in size from very small to large

• When small, they may be removed as a part of

periodontal therapy.

• However, larger enamel pearls have underlying

dentin and even possible pulpal extensions and
should be removed cautiously.