Thursday, November 10, 2011

A NOTE ON DENTAL CALCULUS


Dental calculus

For the periodontal diseases:
  •     The primary etiologic factor is: Is the dental plaque.
  •       The associated factor: is the dental calculus, it helps in new formation of the plaque.
  •       The modifying factor: is a systemic disease, it aggravates the disease when the plaque is presents.

 Calculus:
  •    Is a mineralized dental plaque that occurs in the tooth surfaces & dental prosthesis, it has many forms:
  •    Bridging over the gingival margin.
  •     Follow the festooning shape of the dentition.
  •     Lobular form.
  •     In case of malalignment :àprotected area for the plaque à calculus

 Classification:
             Supragingival                  &               subgingival calculus..
         Generally: both can occur together or one may appear alone.

Subgingival calculus: 
  •      Gingival fluid origin.
  •       Below the crest of the gingival margin.
  •       Hard, dark& flint like.
  •       Greenish black or dark brown in color.
  •       Firmly attached to the tooth, can’t be seen and detected by explorer No.621 probe.
  •       Extent nearly to the base of the pocket in chronic periodntitis, but doesn’t reach the Junctional epithelium.

 Supragingival calculus:    
  •     Saliva origin.
  •    Coronal to the gingival margin. Can be composed of supra &sub gingival calculus.
  •    Hard, clay like consistency, White, white yellowish in color& its color may be affected by the tobacco or food stain.
  •     Easy to be seen in the oral cavity, may be generalized or localized.
  •     Easy to be removed &usually recurrent especially in the: Lower incisors. 
  • Most common location :near to the orifices of the S. glands’ ducts

Parotid gland’s duct ”stenson”----->opposite to buccal surface of maxillary molars.

Submandibular “bartholine” & sublingual “wharton” ducts ----->Lingual surface of lower incisors.
it’s shape : either covers the occlusal surfaces or  bridge like structure over interdental papilla.

                                                Calculus contents:


Inorganic contents:70-90%
       
        Organic contents

2/3 of the calculus inorganic component is in crystalline form ;there are  4 types of crystals .

The crystals are:
hydroxyappatite ,58% à
magnesium white locate,21%  àmost in post
octacalcium phosphate,12% Brushite, 9% àmost in mandibular anteriors.
Detected more frequently in supragingival calculus.
Constitute the bulk.

Generally 2 or more crystals are detected in the calculus.

Incidence of 4 crystals à varies with age of calculus.


Mixture of  :
Protein-poly saccharide complex + desquamated host cells (leukocytes & host cells) + microorganisms.

Carbohydrates (1.9-9.1%):
Glucose , glactose   ,mannose ,arabinose ,rhamnose glucoric acid ,glactouric acid glucoseamine & glactose amine. à all are present in saliva except :
Rhaminose  &  arabinose .

Salivary proteins (5.9-8.2%):
Most are amino acids.

lipids 0.2%:nutral fat ,fatty acids ,cholesterol ester, phospholipids & cholesterol.

*Contents:
          The differences
    Supra gingival calculus
Between:
Sub gingival calculus

hydroxyappatite:
Ca Ph :
Mg white:
brushite:
ratio of Ca/Ph:
sodium contents:

salivary proteins:
             Equal.  
More.
Less.
More.
Low.  
Increase with the depth of PD pocket.
Yes                
            Equal
Less.
More
Less.
Higher.


No.



Calculocementum:
Is the calculus has morphological appearance similar to cementum. This is because the calculus is interdigitates the cementum & no differences between them.

Mode of attachment of the calculus to the tooth surface:
  • Close adaptation under surface depression.
  • In sub gingival calculus.
  • By organic pellicle (very weak)
  • Penetration of the bacteria to the cementum.
  • Mechanical interlocking to the surface irregularities: resorption lacuna or caries, in the cementum by sharpies fibers.                          

Calculus formation:
Calculus is the dental plaque that undergoes mineralization.
Calcification starts                      4-8 hrs   after plaque.
50 % become mineralized after   2 days.
60-90                                          12 days.
  • Plaque can be daily removed at home by brushing but the calculus is
  • not ,it is only removed clinically by the dentist .
  • Calculus formation à the bacterial action will stopped (adv) but it will act as stagnation area for new plaque accumulationà (protection for plaque). 
  • Early plaque contains small amount of inorganic material but it will increase as the plaque develops into calculus. 
  • All plaque doesn’t necessarily undergo calcification.
  • It reaches a plateau of maximal mineral by 2 days.
  • Microorganisms are not always essential in calculus formation. 
  • Plaque has ability to conc. The Ca at  2-20 times it’s level in saliva. 
  • There is a suggestion that Ph is more critical than Ca in plaque mineralization.
  • Early plaque of heavy former àmore Ca ,3 times Ph &less K than non calculus former.




5 comments:

  1. Well written article.

    please amend

    Submandibular - Wharton's
    Sub lingual - Duct of Rivineus / Bartholin's

    ReplyDelete
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