SEMINAR on the topic Dental calculus.pptx

Dental calculus, also known as tartar, is a hardened form of dental plaque that accumulates on the teeth and along the gumline. It forms when plaque, a sticky biofilm composed of bacteria, food particles, and saliva, mineralizes due to the presence of calcium and phosphate in saliva. This process can occur within a few days if plaque is not removed through proper oral hygiene.

1. dental CALCULUS GUIDED BY DR.NEEMA SHETTY DR. ADITI MATHUR DR. ASHISH BALI DR.TRISHI DR.BHAVIKA D. CHHAJED PG 2 nd YEAR

2. CONTENT INTRODUCTION HISTORY CLASSIFICATION COMPOSITION STRUCTURE OF CALCULUS FORMATION OF CALCULUS THEORIES OF CALCULUS FORMATION CACLCULUS ATTACHMENT ASSESSMENT AND EVALUATION OF CALCULUS ETIOLOGY SIGNIFICANCE OF CALCULUS IN PERIODONTAL DISEASES CONCLUSION REFERENCES

3. INTRODUCTION The primary cause of gingival inflammation is bacterial plaque. Other predisposing factors include calculus,faulty restorations, complications associated with orthodontic therapy , self inflicted injuries and use of tobacco. Calculus is derived from Greek words : Calcis : Limestone Tartar : White encrustations inside casks Once a tooth erupts, various material gets accumulated on the tooth surface, frequently called tooth accumulated deposits/materials. Soft Deposits : Acquired pellicle, Microbial plaque,Material Alba , Food debris Hard Deposits : Calculus

4. DEFINITION Calculus consists of mineralized bacterial plaque that forms on the surface of natural teeth & dental prosthesis. - CARRANZA 13 TH EDI Calculus can be defined as a hard concretion that forms on the teeth or dental prosthesis through the calcification of bacterial plaque. - PERIOBASICS SYNONYMS: Tartar Disambiguation Calcis Odontolithiasis Fossilized plaue

5. HISTORY

6. CLASSIFICATION

7. COMPOSITION INORGANIC CONTENT : Major inorganic proportions – 76% calcium phosphate - 3% calcium carbonate - traces of magnesium phosphate - other metals Principle inorganic components – - 39% calcium - 19% phosphorus - 2% carbon dioxide - 1% magnesium - trace amount of sodium , zinc , Strontium ,bromine, copper , tungsten , aluminum , silicon , iron , fluorine

8. Crystal forms : - hydroxyapatite 58% - magnesium whilockite 21% - octacalcium phosphate 12% - brushite 9% 97-100% of all supragingival calculus contains hydroxyapatite & octacalcium phosphate. - In the mandi. Anterior region – brushite - In the posterior areas – magnesium whitlockite

9. ORGANIC CONTENT: Mixture of protein-polysaccharide complexes , desquamated epi. Cells , leukocytes & various types of micro-orgs . 1.9% to 9.1% of organic content – carbohydrate consists of galactose , glucose , mannose , glucuronic acid , galactosamine. Salivary proteins ( 5.9% - 8.2% ) – most of amino acids 0.2% lipid – in the form of natural fats , free fatty acids , cholesterol , phospholipids.

10. Composition of supragingival calculus is similar to that of subgingival calculus with some difference : Same hydroxyapatite content , more magnesium whitlockite & less brushite , octacalcium phosphate . Ratio of calcium & phosphorus is higher in subgingivally & the sodium content es with the depth of the periodontal pockets.  

11. FEATURES SUPRAGINGIVAL CALCULUS DEFINITION Tightly adhering calculus deposit that forms on the crowns of the teeth coronal to the gingival margin. LOCATION Forms coronal to the Gingival Margin SOURCE • Derived from the Salivary Secretions: SALIVARY CALCULUS • DISTRIBUTION • Symmetrical arrangement, more on Facial surfaces of Maxillary Molars and Lingual surfaces of Mandibular Anterior teeth COLOR • It is white, yellow in color CONSISTENCY • Hard and clay like COMPOSITION • More brushite and octa calcium phosphate. Less Magnesium whitlockite VISIBILITY Clinically visible

12. FEATURES SUBGINGIVAL CALCULUS DEFINITION • Calcified deposits that forms on the tooth surface below tre free margin of gingiva LOCATION Deposits present apical to the crest of the Marginal Gingivaα SOURCE Derived from the Gingival Exudate: SERUMINAL CALCULUS DISTRIBUTION • Related to pocket depth, Heavier on Proximal Surfaces COLOR • Brown/Greenish Black in color CONSISTENSY • Hard and firm / flint or glass - like COMPOSITION • Less brushite and octa calcium phosphate. More magnesium whitlockite VISIBILTY • Not visible on routine clinical examination

13. Supragingival calculus – observed early in life , who do not have access to preventive dental care. First areas of exhibit calculus deposits – facial aspect of maxi. Molars & lingual surfaces of mandi. Incisors. Maximum calculus score – 25-30 years old. Calculus accumulation appeared to be symmetric – at 45 years. Subgingival calculus appeared 1 st independently or on the interproximal aspects of areas where supragingival calculus already existed. PREVALENCE

14. The following four modes of attachment have been described 1. Attachment by means of organic pellicle on enamel 2. Mechanical interlocking in cemental resorption lacunae 3.Penetration of calculus bacteria in cementum. 4. Close adaptation of calculus undersurface depressions to gently sloping mounds on the unaltered cementum surface CALCULUS ATTACHMENT

15. The soft plaque is hardened by the precipitation of mineral salts , starts between the 1 st & 14 th day of plaque formation . Calcification has been reported to occur – 4-8 hrs . Calcifying plaque may become 50% mineralized in 2 days & 60-90% mineralized in 12 days. Saliva – source of mineralization for supragingival calculus. GCF – source of mineralization for subgingival calculus. Calcification entails the binding of the organic matrix & the precipitation of crystalline calcium phosphate salt . Crystals form initially in intercellular matrix & on the bacterial surfaces – finally within the bacteria. FORMATION OF CALCULUS

16. As calcification progresses, the no. of filamentous bacteria & the foci of calcification change from basophilic to eosinophilic. Calculus – formed in layers – separated by a thin cuticle that becomes embedded in the calculus as calcification progresses.   Average daily increment in calculus formers – about 0.10%-0.15% by weight. The time required for calculus to reach its maximal level – 10 weeks to 6 moths. The decline from maximal accumulation is referred to as “reversal phenomenon”. RATE OF FORMATION

17. THEORIES OF CALCULUS FORMATION

18. BOOSTER MECHANISM

19. Bacteria may form phosphatases , which the local conc. Of phosphatases & thereby lead to calcification. It affect the pH of plaque & saliva & destroy protective colloidal action. It attach the calculus to the tooth. It provides chemicals that induce mineralization.   BACTERIAL THEORY

20. EPITACTIC THEORY According to this theory , seeding agents induce small foci of calcification that enlarge and coalesce to form a calcified mass referred to as the epitactic concept or heterogeneous nucleation.

21. Amorphous non-crystalline deposits & brushite – transformed to octacalcium phosphate - then to hydroxyapatite. In salivary calculus , brushite – result of the local elevation of Ph , calcium & phosphate conc. – then maturing process be modified to crystal of higher calcium to phosphate ratio. TRANSFORMATION THEORY

22. Occurring at specific sites because of the existence of an inhibiting mechanism at non-calcifying sites. During the calcification , inhibitor is parently altered or removed. Inhibiting substances – pyrophosphate & enzyme alkaline phosphatase. INIIBITION THEORY

23. According to this theory, calculus formation is the resultant of the action of phosphatases derived from either oral tissues or oral microorganism on some salivary phosphate containing complex, most probably phospheric esters of the hexophosphoric group ENZYMATIC THEORY

24. Oral hygiene index- simplified (John C. Green & Jack R. Vermillion 1994) Calculus surface index ( Ennever j et al. 1961) Calculus surface severity index ( Ennever j et al 1961) Volpe- manhold method of calculus ( A.R.Volpe et al. 1962) Calculus index used by national institue of dental research Calculus component of periodontal disease index ( Ramfjord 1959) INDICES

25. CAUSES PERIODONTAL DESTRUCTION IN THE FOLLOWING MANNER: Calculus brings bacterial overlay closer to the supporting tissues. Interfere with local self-cleansing mechanism Provide nidus for continuous plaque accumulation. Make plaque removal more difficult. ROLE OF CALCULUS IN PERIODONTAL DISEASE

26. Conventional calculus detection technique: Direct vision – limited for supragingival calculus only. Compressed air can facilitated the viewing of subgingival calculus. Tactile sense of the operator – by using probe , explorer or a curette Radiographic technique DIAGNOSIS

27. Advancements in calculus detection technique: Calculus detection systems Perioscopy (fiberoptic endoscopy based technology) detecTar ( spectro -optical technology) Diagnodent (autofluorescence based technology)

28. Calculus detection & removal system: Perioscan (ultrasound technology) Keylaser (laser based technology)

29. Agents for softening the mature calculus deposit: ACIDS Earliest techniques - wooden stick which was moistened with aromatic sulphuric acid before being introduced into a periodontal pocket to dissolve calculus and to act on the soft tissues as an astringent (Barker 1872). Niles (1881) - nitro muriatic acid Other acids - 20% trichloroacetic acid, bifluoride of mercury and 10% sulphuric acid DISADVANTAGES - caustic to soft tissues and decalcify tooth structure. ANTICALCULUS AGENTS:

30. 2. ALKALIS: Badanes (1929) - argued that it was the action of the mild alkalis contained in the waters that dissolved the three principal organic constituents of salivary calculus; globulin, mucin and calcium oxalate.

31. 3. CHELATING AGENTS: Chelating agents are used to dissolve crystallized calcium salts and are capable of combining with calcium to form stable compounds. Sodium hexametaphosphate was found to remove supragingival calculus from extracted teeth in 10 to 15 days (Kerr & Field 1944). EDTA – ( jabro et al. 1992) – application of EDTA gel resulted in ease of calculus removal.

32. ANTIMICROBIALS: 1 . CHLORHEXIDINE Cationic bis-biguanide which acts by being absorbed onto the bacterial cell wall – leading to damage of permeability barriors At high conc. – precipitation & coagulation of the cytoplasmic contents occurs (Hennessey 1977).

33. 2 . ZINC IONS: Reduce plaque acidogenicity ( oppermann 1980) & plaque growth (sexton 1986). Inhibits crystal growth by binding to the surface of solid calcium & phosphate (gilbert 1988). 3. BISPHOSPHONATES: Synthetic pyrophosphate analogues – to prevent calcium deposition by inhibiting crystal growth.

34. 4. TRICLOSAN: Non-ionic antibacterial agent with a wide spectrum of activity against bacteria , fungi , & yeasts. When delivered from a dentifrices – bind to oral mucous membrane & tooth surfaces. Used in combination with other anti-calculus agents.

35. Anti-calculus agents used in commercial dentifrices: Triclosan with PVM/MA copolymer Pyrophosphate with PVM/MA copolymer Zinc ions

36. Calculus plays an important role in maintaining & accentuating periodontal disease by keeping plaque in close contact with the gingival tissue & creating areas where plaque removal is impossible. Therefore, the clinical skill to remove the calculus & other irritants as a basis for adequate periodontal & prophylactic therapy. CONCLUSION:

37. Newman and Carranza’s , clinical periodontology , 13 th edition. Dr. Nitin Saroch , periobasics , A Textbook of Periodontics & Implantology , 2 nd edition. Fairbrother KJ, Heasman PA. Anticalculus agents. J Clin Periodontol . 2000 May;27(5):285-301. Shalu bathla , textbook of periodontics , 1 st edition. Akcalı A, Lang NP. Dental calculus: the calcified biofilm and its role in disease development. Periodontol 2000. 2018 Feb;76(1):109-115.  REFERENCES