Dental Calculus Overview

Dental Calculus

• Definition: Mineralized bacterial biofilm that forms on teeth.
• Formation: Occurs after plaque biofilm formation, typically within 48 hours to 2 weeks.

Composition

• Organic: 10-30%
  • Plaque bacteria
  • Dead epithelial cells and white blood cells
• Inorganic: 70-90%
  • Calcium
    • Calcium phosphate (hydroxyapatite, brushite)
    • Calcium carbonate
  • Magnesium
    • Magnesium phosphate (whitlockite)

Crystalline Structure

• Calcium brushite
• Octocalcium phosphate
• Calcium hydroxyapatite
• Magnesium whitlockite
• The crystalline content can vary based on location, age of calculus, and the individual.

Location

• Common attachment sites:
  • Gingival crevice
  • Root surface with periodontal pockets
  • Prosthesis
  • Restoration ledges
  • Imbricated teeth
  • Occlusal surfaces

Location in Relation to Gingivae

• Supra Calculus: Above the gum line.
• Sub Calculus: Below the gum line.

Differences between Supra and Sub Calculus

• Appearance:
  • SupraCalculus: Often has a yellowish-white color, rough texture.
  • Sub Calculus: Can be dark brown or black, smooth texture.
• Attachment:
  • Supra Calculus: Adheres to the tooth surface by acquired pellicle and penetration into enamel.
  • Sub Calculus: Attaches to the root surface in periodontal pockets.

Formation of Calculus

• Seeding Agents: Organic matrix in plaque acts as a seeding agent for calculus formation.
• Bacterial Enzymes: Phosphatases and proteases released by bacteria degrade calcification inhibitors in saliva, accelerating the process.
• Crystal Formation: Insoluble calcium phosphate crystals coalesce to form calcified mass of plaque known as calculus.

Calculus Accumulation Rate

• Variability: Rate of calcification and calculus accumulation varies widely based on:
  • Individual
  • Teeth
  • Time
• Classification of Calculus Formers:
  • Heavy
  • Moderate
  • Slight
  • Non-calculus formers

Detection

• Visual Inspection: Calculus can be visible, especially supra calculus.
• Radiographs: Reveals subgingival calculus.
• Tactile Exploration: Dental instruments help to detect calculus.

Clinical Relevance

• Dental Disease: Calculus can contribute to the progression of periodontal disease.
  • Plaque accumulation
  • Inflammation
  • Bone loss
• Patient Impact: Important for clinicians to educate patients on the importance of oral hygiene and calculus removal.

Saliva

• Saliva is a colorless, slightly sticky solution produced by the salivary glands.
• Salivary glands can produce either serous or mucous saliva.
• We produce 1-1.5 liters of saliva each day.
• The submandibular glands produce 60-65% of total saliva.
• The parotid glands produce 25% of total saliva.
• The sublingual glands produce 5-10% of total saliva.
• Minor salivary glands also contribute to saliva production.

Saliva: Definition and Composition

• Saliva is a colorless, slightly sticky solution produced by the salivary glands.
• Saliva consistency can be serous or mucous.

Saliva Production

• We produce 1-1.5 liters of saliva daily.

Sources of Saliva

• Submandibular glands produce the most saliva (60-65% of total production).
• Parotid glands contribute 25% of saliva production.
• Sublingual glands produce 5-10% of total saliva.
• Minor salivary glands also contribute to saliva production.