CALCULUS

Definitions:

A hard deposit that forms by mineralization of

dental plaque and is generally covered by a layer of
unmineralized plaque .

 Dental calculus is an adherent, calcified or

calcifying mass that forms on the surfaces of teeth
and dental appliances.
 Composition : ( Inorganic + Organic content)

Inorganic Content : (70% to 90%)

• 75.9% - calcium phosphate, Ca3(PO4)2,

• 3.1% - calcium carbonate, CaCO3 ;

• traces of - magnesium phosphate, Mg3(PO4)2 and other metals

Principal Inorganic Components Trace elements

magnesium , sodium, zinc,

strontium, bromine, copper,
Calcium, Phosphorus, Carbon dioxide manganese, tungsten, gold,
aluminium, silicon, iron, and
fluorine.
Two thirds of the inorganic component is crystalline in structure

The four main crystal forms and their

percentages are as follows ;

 Hydroxyapatite, 58%
97% to 100% of all
 Magnesium whitlockite, 21% supragingival calculus
( more common in posterior areas)
 Octacalcium phosphate, 12%

 Brushite, 9 %.
(more common in mandibular ant. areas)
Organic Content :

Mixture of ….protein polysaccharide complexes,

desquamated epithelial cells, leukocytes, and various types
of microorganisms.

Salivary proteins - 5.9% to 8.2%

Carbohydrate - between 1.9% and 9.1% ,

Lipids - 0.2%
Calculus is classified according to its relation to the
gingival margin

supragingival subgingival,
(supra marginal / extra gingival) (serumal / sub marginal )
 CLINICAL CHARACTERISTICS OF DENTAL CALCULUS

S. No Property Supragingival Subgingival

1. Color White or whitish yellow. Dark brown/genuine black.

2. Shape and Amorphous, bulky. Flattened to conform with

Size Shape of calculus is
determined by the anatomy of
teeth, contour of gingival
margin, and pressure of
tongue, lips or cheeks.
pressure from the pocket
wall. May be crusty, shiny,
thin, finger and fern like.

3. Consistency Moderately hard. Flint like, brittle.

4. Attachment Easily detached from tooth. Firmly attached to the tooth

surface.
 CLINICAL CHARACTERISTICS OF DENTAL CALCULUS

S. No Property Supragingival Subgingival

5. Location Coronal to gingival margin. Apical to the gingival margin.

6. Visibility Visible in the oral cavity. Not visible on routine clinical

examination.
7. Composition More brushite and Less brushite and octacalcium
octacalcium phosphate. phosphate.
Less magnesium More magnesium whitlockite.
whitlockite. Absence of salivary proteins.
Less sodium content. Sodium content increases with
the depth of pocket.
 CLINICAL CHARACTERISTICS OF DENTAL CALCULUS

S. No Property Supragingival Subgingival

8. Source Derived from salivary Formed from gingival exudates.

secretions.
9. Distribution Symmetrical arrangement Related to the depth of pocket.
of teeth, more on facial
surface of maxillary molars
and lingual surface of
mandibular anterior teeth
due to the openings of
salivary gland ducts.
SUPRAGINGIVAL
CALCULUS

SUBGINGIVAL CALCULUS
 Detection…

 Subgingival calculus is located

below the crest of the marginal
gingiva and therefore is not visible
on routine clinical examination.

 The location and extent of

subgingival calculus may be
evaluated by careful tactile
perception with a delicate dental
instrument such as an explorer.
 Detection…

 Both supragingival calculus and

subgingival calculus may be seen on
radiographs

 Highly calcified interproximal calculus deposits are readily

detectable as radio-opaque projections that protrude into the
interdental space.

 However, the sensitivity level of calculus detection by radiographs

is low.
 Detection…

Use of compressed air – Combination of retraction , light and

drying

Tactile + Auditory – Rough cementum / calculus is scratchy

or noisy .
Attachment to the Tooth Surface :

Four modes of attachment have been described;

 Attachment by means of an organic pellicle;

 Mechanical locking into surface irregularities such as resorption

lacunae and caries;

 Close adaptation of calculus undersurface depressions to the

gently sloping mounds of the unaltered cementum surface; and

 Penetration of calculus bacteria into cementum.

(Calculus embedded deeply in cementum may appear

morphologically similar to cementum and thus has been termed
calculocementum. )
 E

Calculus interlocked into the

irregularities of the enamel surface
Calculus embedded in
damaged cemental surface
Theories Regarding the Formation / Mineralization of Calculus :

Calculus is dental plaque that has undergone mineralization.

 PHYSIOCHEMICAL/BOOSTER THEORY

 EPITACTIC THEORY

 INHIBITON THEORY

 TRANSFORMATION THEORY
 PHYSIOCHEMICAL THEORY/ BOOSTER CONCEPT (Prinz 1928)

Mineral precipitation results from a local rise in the degree of

saturation of calcium and phosphate ions, which may be brought
about in several ways

 loss of carbon dioxide

 formation of ammonia by dental plaque bacteria

 protein degradation during stagnation

• Colloidal proteins in saliva bind calcium and phosphate ions and

maintain a supersaturated solution with respect to calcium phosphate
salts.

• With stagnation of saliva, colloids settle out and the supersaturated

state is no longer maintained, leading to precipitation of calcium
phosphate salts.
  Enzymatic concept

Phosphatase

 Esterase
EPITACTIC THEORY( CONCEPT) / HETEROGENOUS NUCLEATION /
SEEDING THEORY (Mandel et al 1957)

EPITACTIC = crystal formation of a compound through seeding

• 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.

• The seeding agents induce small foci of calcification

that enlarges and unites together to form calcified
mass – calculus.
 TRANSFORMATION THEORY ( Eanes 1970)

Non crystalline deposits Octacalcium Phosphate / HA

( Transformation)

RATE OF CALCULUS ACCUMULATION

Accumulation varies from person to person / tooth to tooth , in the same person

 Heavy,
 Moderate Based on rate of calculus formation
 slight calculus formers
 non-calculus formers.
 Maximal level - 10 weeks and 6 months.

Daily increment in calculus formers - 0.10% to 0.15% of dry weight

Reversal Phenomenon - decline from maximal calculus accumulation,

May be explained by the vulnerability of bulky calculus to

mechanical wear from food and from the cheeks, lips and tongue.
 Etiologic Significance :

1) Relation to plaque

Calculus has a rough surface – promotes plaque accumulation

2) Relation to pocket

 Subgingival calculus is always covered by plaque - in direct contact with

the pocket epithelium

 Subgingival calculus is a result of pocket formation, not the cause of pocket

formation

 Calculus More disease activity

More gingival sulcus fluid

3) Relation to disease control
Plaque over calculus difficult to remove by brushing / flossing

4) Drainage from pocket

Prevents drainage – gingival abcess may form
FIRST SECOND
ANTI-CALCULUS AGENTS GENERATION
GENERATION

DISSOLUTION- Acids, sodium INHIBITION OF CRYSTAL GROWTH

ricinoleate
PLAOUE INHIBITION – Antibiotics
(Nidamycin, Antiseptics (Chloramine –T)
MATRIX DISRUPTION – Enzyme
(Mucinase), Urea (30%) etc
PLAQUE ATTACHMENT – Silicones,
Ion –Exchange resins
Vitamin –C,
 pyrophosphates,
Diphosphonates, ( sodium etidronate )
Zinc salts + pyrophosphates + NaF
Citroxain ( Papain, alumina + sod.
Citrate )
 So we can say that……

Calculus plays an important role in aiding periodontal disease by :

1.Keeping plaque in close contact with the gingival tissue.
2.Interfering with local self cleansing mechanism.
3.Creating areas where plaque removal is impossible.
4.Provide nidus for continuous plaque accumulation.

Therefore, the clinician must not only possess the clinical

skill to remove the calculus and other irritants that attach to the teeth
but also be very precise about performing this task.
LOCAL CONTRIBUTING
FACTORS/
OTHER PREDISPOSING
FACTORS/
IATROGENIC FACTORS
LOCAL CONTRIBUTING FACTORS
1. Anatomic factors
a. Proximal contact relation
b. Cervical enamel projection
c. Intermediate bifurcation ridge
d. Palatogingival groove
e. Root proximity
2. Iatrogenic factors
a. Restorative dentistry
b. Faulty Prosthesis
c. Orthodontic procedures
d. Extraction of impacted teeth
 Malocclusion
 Habits
HAVE A GOOD
DAY…..