Dental Calculus is an adherent, calcified or calcifying mass that forms on the surfaces of teeth and dental appliances.

1. DENTAL
CALCULUS
DR. VS, MDS
(PERIO)

2. DEFINITION
Dental Calculus is an adherent, calcified or calcifying mass that forms on
the surfaces of teeth and dental appliances.

3. HISTORICAL PERSPECTIVE
• Albucasis (936–1013 AD), an Arabian physician and surgeon, defined the
relationship between calculus and dental disease and explained the need for the
thorough removal of deposits.
• Albucasis described the way to remove calculus from teeth. Paracelsus (1493-1541)
developed an interesting theory called as doctrine of calculus.
• He understood that pathologic calcification occurred in a variety of organs, and he
considered these disease conditions to result from a metabolic disturbance whereby
the body takes nourishment from food and discards the refuse as “tartarus”, a
material that cannot be broken.

4. • Until the 1960s, the prevalent thinking in dentistry was that dental calculus was the
cause of periodontal diseases; that by its roughness it was irritating and that bacteria
then had a secondary influence.
• However, a series of classic studies on experimental gingivitis published from 1965 to
1968 clearly demonstrated the causative relation between dental plaque and gingivitis.
• Current thinking is that dental plaque is the precursor of calculus, which is mineralized
plaque.
• Calculus is invariably covered with plaque on its surface.

5. TYPE/CLASSIFICATION
• It is classified according to its relation to the gingival margin as
Supragingival calculus and
 subgingival calculus

6. The various forms of submarginal and subgingival
calculus are
• Spicules: Small isolated pieces of calculus. These
are frequently located at line angles and interdental
areas.
• Ledge: A larger deposit that forms on a section of
the tooth and is approximately parallel to the
cementoenamel junction (CEJ).
• Ring form: A ledge like deposit that encircles the
tooth, forming a ring of calculus. In addition to
calculus, roughness on the tooth surface may be
caused by rough restorations, carious lesion, or
necrotic cementum.

7. COMPOSITIONOF CALCULUS
composition
Inorganic content
a. Elements
Calcium
(39%),phosphorus
(19%), carbon
dioxide
(1.9%),magnesium
(0.8%), an traces of
sodium, zinc,
strontium, bromine,
copper, manganese,
tungsten, gold,
aluminium, silicon,
iron, fluorine.
b. Compounds:
Calcium
phosphate
(75.9%),
calcium
carbonate
(3.1%) and
traces of
magnesium
phosphate and
other metals.
c. Crystals:
Hydroxyapatite
(58%),
magnesium
whitlockite
(21%),
octacalcium
phosphate
(12%) and
brushite ( 9%)
are the four
main forms of
crystals
present.
Organic content
1.9 to 9.1% of carbohydrates
(galactose, glucose, rhamnose,
mannose, glucuronic acid,
galactosamine, arabinose,
galacturonic acid, glucosamine);
5.9 to 8.2% of proteins; 0.2% of
lipids (Neutral fats, fatty acids,
cholesterol, phospholipids,
cholesterol esters); Protein
polysaccharide complexes;
Desquamated epithelial cells;
Leukocytes and microorganisms.
Bacterial content
At periphery –
Gram-negative rods
and cocci
predominate.
Filamentous
organisms,
Diphtheroids,
Bacterionema and
Veillonella species
are also present.

9. CALCULUS FORMATION
• soft plaque is hardened by the precipitation of mineral salts, which usually starts between the
1st and 14th days of plaque formation
• calcification has been reporte to occur in as little as 4 to 8 hours
• calcifying plaque may become 50% mineralized in 2 days and 60 – 90% in 12 days
• Microorganisms are not always essential in calculus formation
• Calcification entails the binding of calcium ions to the carbohydrate – protein complexes of
the organic matrix and the precipitation of crystalline.
• Mineralization consists of crystal formation, namely hydroxyapatite, octacalcium phosphate,
magnesium whitlockite, and brushite each with a characteristic developmental pattern.

10. • The crystal forms in the intercellular matrix, on the surface of bacteria and finally within the
bacteria.
• Formation of calculus difference in person to persons, Itmay be classified as heavy, moderate, or
slight calculus formers or as noncalculus formers.
• Heavy calculus formers have higher salivary levels of calcium and phosphorus than do light
calculus formers.
• Light calculus formers have higher levels of parotid pyrophosphate.
• Pyrophosphate is an inhibitor of calcification.

11. Theories Related to Mineralization of Calculus
• 1. Booster/precipitation theory: Loss of carbon dioxide and formation of ammonia leads
to increase in the pH which leads to the precipitation of calcium phosphate salts.
• 2. Colloidal proteins in saliva bind calcium and phosphate ions and maintain a
supersaturated solution with respect to calcium phosphate salts
• 3. Phosphate liberated from dental plaque, desquamated epithelial cells, or bacteria
precipitates calcium phosphate by hydrolysing organic phosphates in saliva, thus
increasing the concentration of free phosphate ions.
• 4. Epitactic/Nucleation concept: The carbohydrate – protein complexes may initiate
calcification by removing calcium from the saliva and binding with it to form nuclei that
induce deposition of minerals. Seeding agents induce small foci of calcification that
enlarges and unites together to form calcified mass.

12. CLINICAL ASSESSMENT
• The clinical assessment can be done by:
• 1. Visual examination by use of compressed air
• 2. Probing

13. • 3. Radiographs: The deposits may also be visible on
radiographs although this is not always
reliable.Radiographs may be useful in diagnosis of
subgingival calculus . The location of calculus does
not indicate the bottom of the periodontal pocket
because the most apical plaque is not sufficiently
calcified to be visible on radiographs.
• 4. Clinical records: There are various indices for
recording and scoring calculus.

14. MODES OF ATTACHMENTOF CALCULUS TO THE TOOTHSURFACEAND IMPLANT
• Helmut A. Zander in 1952 described four types of calculus attachment
• 1. Attachment by means of an organic pellicle.
• 2. Mechanical locking into surface irregularities such as resorption lacunae and caries. This
type of attachment make the removal of calculus difficult as calculus embedded beneath the
cementum surface penetrates into the dentin.

15. • 3. Penetration of calculus bacteria into cementum.
• 4. Close adaptation of calculus undersurface depressions to the gently sloping mounds of
the unaltered cementum surface. Shroff later theorized that the type of calculus
attachment probably depends on the length of time the calculus has been on the tooth. The
attachment of calculus to pure titanium implant is less intimate than to root surface.

16. ROLE OF CALCULUS IN PERIODONTAL DISEASE
• Calculus may be harmful both physically and chemically to adjacent gingiva. Calculus is
permeable and thus, may absorb and adsorb toxic products. Calculus is rough and porous
which facilitates the retention of dental plaque. Calculus is always covered with
unmineralized plaque which provides further retention and promotes new plaque
accumulation and thus, 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.

17. LOCALCONTRIBUTING FACTORS
• 1. Anatomic factors
• a. Proximal contact relation:
• b. Cervical enamel projection (CEP) and enamel pearls:
• c. Intermediate bifurcation ridge:
• d. Palatogingival groove:
• e. Root proximity

18. 2. Iatrogenic factors
a. Restorative dentistry
b. Prosthesis
c. Orthodontic procedures
d. Extraction of impacted third molar:

19. • 3. Malocclusion
• 4. Habits as contributing factors
• a. Toothbrush and floss trauma: The
• b. Mouth breathing and tongue thrusting
• c. Tobacco use
• d. Factitious injuries: