definition of calculus,types,composition, theories of calculus formation ,anticalculus agents, use of chlorhexidine mouthwash

1. DENTAL CALCULUS
DEPARTMENT OF PERIODONTICS
PRESENTED BY:-
PAWAN KUMAR
BDS 3YR

2. CONTENTS:-
• DEFINITIONS
• CLASSIFICATION
• SUPRAGINGIVAL CALCULUS
• SUBGINGIVAL CALCULUS
• STRUCTURE
• COMPOSITION
• FORMATION OF CALCULUS
• THEORIES OF CALCULUS FORMATION
• ANTICALCULUS AGENT
• COMMERCIAL ANTICALCULUS PRODUCT
• REFFERENCE

3. DEFINITION :-
• CALCULUS IS A HARD DEPOSIT THAT IS FORMED BY
MINERALIZATION OF DENTAL PLAQUE ON THE SURFACE
OF NATURAL TEETH AND DENTAL PROSTHESIS,
GENERALLY COVERED BY UNMINERALIZED PLAQUE.
(CARRANZA’S CLINICAL PERIODONTOLOGY)
(11TH EDITION)

4. CLASSIFICATION :-
 DENTAL CALCULUS IS CLASSIFIED ON THE BASIS OF ITS LOCATION.
1. SUPRAGINGIVAL CALCULUS
2. SUBGINGIVAL CALCULUS

5. SUPRAGINGIVAL CALCULUS :-
• SUPRAGINGIVAL CALCULUS IS THE TIGHTLY ADHERENT CALCIFIED
DEPOSIT THAT FORMS ON THE CLINICAL CROWN OF THE TEETH
ABOVE THE FREE GINGIVAL MARGINS.
• IT IS CLINICALLY VISIBLE.
• IT IS ALSO CALLED “SALIVARY CALCULUS” BECAUSE IT FORMS
FROM THE SALIVA.

6. SUPRA GINGIVAL CALCULUS

7. SUBGINGIVAL CALCULUS:-
• SUBGINGIVAL CALCULUS IS CALCIFIED DEPOSIT THAT IS FORMED
ON THE ROOT SURFACE BELOW THE FREE MARGINAL GINGIVA.
• IT IS BELIEVED TO BE FORMED FROM THE GINGIVAL EXUDATE AND
HENCE CALLED “ SERUMAL CALCULUS” .

8. SUBGINGIVAL CALCULUS

9. STRUCTURE:-
• SUPRAGINGIVAL CALCULUS ARE USUALLY WHITISH YELLOW IN
COLOUR AND CAN STAINED BY TOBACCO OR FOOD PIGMENTS.
• ITS CONCISTENCY IS HARD AND CLAY LIKE.
• THEY DERIVE FROM MINERAL SALTS FROM SALIVARY
SECRETION,THESARE MORE ABDUNDENT ON THE LINGUAL SURFACE
OF ANTERIOR TEETH,OPPOSITE TO “WHARTON’S DUCT” AND
“BARTHOLOIN’S DUCT” AND BUCCAL ASPECT OF MAXILLARY MOLARS
OPPOSITE TO THE “STENSEN’S DUCT”.

10. SUPRAGINGIVAL CALCULUS

11. • SUBGINGIVAL CALCULUS IS DARK BROWN OR GREENISH BLACK IN
COLOR AND THE DEPOSIT ARE FIRMLY ATTACH TO THE TEETH
SURFACE.
• THESE ARE FIRM AND HARD AND CANNOT BE REMOVED EASILY.
• THERE ARE FOUND ON ANY ROOT SURFACE WITH A PERIODONTAL
POCKET.
• THEY ARE COMMONLY RING -LIKE OR LEDGE-LIKE
FORMATION,CRUSTY,SPINY OR NODULAR DEPOSITS.
• LESS COMMONLY SEEN AS FINGER -LIKE AND FERN- LIKE
FORMATIONS.

12. SUBGINGIVAL CALCULUS

13. COMPOSITION:-
INORGANIC COMPONENT (IN%)
• INORGANIC 70-90(%)
• CALCIUM 27-29
• PHOSPHOROUS 16-18
• CARBONATE 2-3
• SODIUM 1.5-2.5
• MAGNESIUM 0.6-0.8
• FLUORIDE 0.003-0.04
• CRYSTAL FORMS
• HYDROXYAPATITE 58
• MAGNESIUM WHITLOCKITE 21
• OCTACALCIUM PHOSPHATE 12
• BRUSHITE 9

14. ORGANIC COMPONENTS (IN%)
• MIXTURE OF PROTEIN POLYSACCHARIDE COMPLEX , 1.9-9.1
DESQUAMATED EPITHELIAL CELLS, LEUKOCYTES,
AND MICROORGANISM
• PROTEINS 5.9-8.2
• LIPIDS 0.2

15. FORMATION OF CALCULUS:-
• CALCULUS IS FORMED BY THE PRECIPITATION OF MINERAL SALTS
BETWEEN 1ST AND 14TH DAY OF PLAQUE FORMATION.
• IN 2 DAYS PLAQUE CAN BE 50% MINERALIZED AND 60%-90% GETS
MINERALIZED IN 12 DAYS.
• CALCIFICATION STARTS IN THE SEPARATE FOCI ON THE INNER SURFACE
OF THE PLAQUE.
• THE FOCI OF MINERALIZATION GRADUALLY INCREASES IN SIZE AND
COALESCE TO FORM A SOLID MASS OF CALCULUS .

16. • CALCULUS FORMATION CONTINUES UNTILL IT REACHES MAXIMUM
LEVELS IN ABOUT 10 WEEKS AND 6 MONTHS, AFTER WHICH THERE IS
DECLINE IN ITS FORMATION DUE TO MECHANICAL WEAR FROM FOOD
AND FROM LIPS, CHEEKS AND TONGUE.
• THIS DECLINE IS REFFERED TO AS “REVERSAL PHENOMENON”.

17. THEORIES OF CALCULUS FORMATION:-
CALCULUS FORMATION THEORIES ARE AS FOLLOWS:-
• BOOSTER MECHANISM
• EPITACTIC CONCEPT
• INHIBITION THEORY

18. BOOSTER MECHANISM:-
• ACCORDING TO THIS THEORY, PRECIPITATION OF
CALCIUM AND PHOSPHATE SALTS RESULT IN LOCAL RISE
IN THE pH OF SALIVA .
• FACTORS SUCH AS LOSS OF CARBON DIOXIDE AND
AMMONIA COULD LEAD TO RISE IN pH .

19. OTHER WAYS BY WHICH THE PRECIPITATION OF CALCIUM
PHOSPHATE SALTS CAN OCCUR ARE:-
1) COLLOIDAL PROTEINS IN SALIVA BIND TO CALCIUM
AND PHOSPHATE IONS, THUS PRODUCING A
SUPERSATURATED SOLUTION.
• WHEN SALIVA STAGNATES IN THE ORAL CAVITY,
COLLOIDS SETTLES AND RESULT IN THE PRECIPITATION
OF CLCIUM AND PHOSPHOROUS SALTS.

20. 2) PHOSPHATASE LIBERATED FROM DENTAL PLAQUE,
DESQUAMATED EPITHELIAL CELLS OR BACTERIA PRECIPITATED
CALCIUM PHOSPHATE BY HYDROLIZING ORGANIC PHOSPHATES
IN SALIVA,
THUS INCREASING THE CONCENTRATION OF FREE PHOSPHATE
ION.

21. EPITACTIC CONCEPT:-
• ACCORDING TO THIS CONCEPT ,SEEDING AGENTS INDUCE
SMALL FOCI OF CALCIFICATION. THESE FOCI ENLARGE AND
COALESCE TO FORM CALCULUS.
• THE SEEDING AGENTS IN CALCULUS ARE NOT CLEARLY
KNOWN, BUT SUSPECTED AGENTS COULD BE INTERCELLULAR
MATRIX OF PLAQUE, CARBOHYDRATE-PROTEIN COMPLEX AND
PLAQUE BACTERIA.

22. INHIBITION THEORY :-
• THIS THEORY CONSIDER THE POSSIBILITY OF CALCIFICATION
OCCURING ONLY AT SPECIAL SITE BECAUSE THERE EXIST AN
INHIBITING MECHANISM AT NON-CALCIFYINGSITES.
• WHEREVER CALCIFICATION OCCUR THE INHIBITOR IS EITHER
ALTERED OR REMOVED.
• ONE SUCH INHIBITING AGENT COULD BE POLYSULHATE,
WHICH PREVENT THE INITIAL NUCLEUS FROM GROWING BY
POSSIBILY ‘POISONING’ THE GROWTH CENTER OF CRYSTAL.

23. ANTICALCULUS AGENT:-
FIRST GENERATION AGENTS:
• DISSOLUTION AGENTS:
• ACIDS
• SPRING SALTS
• SODIUM RICINOLEATE
• PLAQUE ATTACHMENT INHIBITORS:
• SILICONS
• ION EXCHANGE RESINS

24. • PLAQUE INHIBITON AGENTS:
• ANTIBIOTICS (NIDDAMYCIN)
• ANTISEPTICS (CHLORAMINE-T)
• MATRIX DISRUPTION AGENTS:
• ENZYMES (MUCINASE)
• ASCORBIC ACID
• SODIUM PERCARBONATE
• COPPER SULPHITE
• 30% UREA

25. SECOND GENERATION AGENTS:-
• INHIBITORS OF CRYSTAL GROWTH:
• VITAMIN C
• PYROPHOSPHATE
• DIPHOSPHONATE
• ZINC SALT
• CALCIUM LACTATE
• SODIUM FLOURIDE
• COPOLYMER
• CITROXAIN
• SODIUM CITERATE

26. COMMERCIAL ANTICALCULUS PRODUCT
 MOUTHWASH
• CHLORHEXIDINE GLUCONATE (0.2%) IS THE RECOMMENDED
BY THE WORLD HEALTH ORGANISATION.
• IT IS A CATIONIC BISBIGUANIDE.
• EXHIBIT ANTIPLAQUE AND ANTI BACTERIAL PROPERTY.
• EFFECTIVE AGAINST GRAM +VE AND GRAM –VE
ORGANISMS.

27. CHLORHEXIDINE MOUTHWASH

28. MOUTHWASH

29. REFFERENCE:-
• CARRANZA’S CLINICL PERIODONTOLOGY
(11TH EDITION)
• ESSENTIALS OF CLINICAL PERIODONTOLOGY AND
PERIODONTICS
(SHANTIPRIYA REDDY)
(4TH EDITION)
• PICTURE COURTESY – GOGGLE